Archived: Arun Medical Group

Updated 28 May 2015

Arun Medical Group offers general medical services to people living in Littlehampton, East Preston, Climping, Lyminster, Wick, Rustington, Kindston Gorse, and Poling, West Sussex. The practice is involved in the education and training of doctors, practice staff and other healthcare professionals. There are approximately 7061 registered patients.

The practice is run by two partner GPs and a nurse partner. The practice was also supported by three salaried GPs, nurses, healthcare assistants a team of receptionists and administrative staff. At the time of our inspection there was no business manager in post, the previous business manager having left their post earlier in the month prior to the inspection.

The practice runs a number of services for its patients including asthma clinics, child immunisation clinics, diabetes clinics, a weight management group, new patient checks and holiday vaccinations and advice.

Services are provided from:

Littlehampton Surgery,18 – 20 East Street, Littlehampton, West Sussex, BN17 6AW

The practice has opted out of providing Out of Hours services to their patients. There are arrangements for patients to access care from an Out of Hours provider.

The practice population has a higher number of patients between 60 and 85 years of age than the national average although on a par with the CCG average. There are a marginally higher number of patients with long term health conditions although this is significantly lower than the previous year. The number of patients with health related problems in daily life is significantly higher than both the national and CCG average.

Updated 28 May 2015

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Arun Medical Group on the 21st January 2015.

The practice has an overall rating of good.

Arun Medical Group provides primary medical services to people living in Littlehampton. The practice boundary encompasses the River Ward and Ham Ward districts. At the time of our inspection there were approximately 7060 patients registered at the practice with a team of two GP partners and a nurse partner. The practice was also supported by three salaried GPs, nurses, an associate practitioner, a healthcare assistant and a team of reception and administrative staff. Arun Medical Group is a training practice.

The inspection team spoke with staff and patients and reviewed policies and procedures. The practice understood the needs of the local population and engaged effectively with other services. There was a culture of openness and transparency within the practice and staff told us they felt supported. The practice was committed to providing high quality patient care and patients told us they felt the practice was caring and responsive to their needs.

Our key findings were as follows:

• GPs had their own patient lists and where possible encouraged continuity of care by patients seeing their named GP.
• Patient feedback about the practice and the care and treatment they received was very positive.
• The involvement of patients in the development of the practice was positive and inclusive.
• There was evidence the practice was listening to its patients and responding to any concerns or suggestions in a timely and effective manner.
• Infection control audits and cleaning schedules were in place and the practice was seen to be clean and tidy.
• The practice had systems to keep patients safe including safeguarding procedures and means of sharing information in relation to patients who were vulnerable.
• Learning from incidents was apparent and we saw good examples of changes made as a result of learning.
• There were a range of appointments to suit most patients’ needs.
• Patients with palliative care needs were supported using the Gold Standards Framework.

• The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 May 2015

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles and were trained in chronic disease management, including asthma, chronic obstructive pulmonary disease (COPD), and diabetes. The practice worked closely with the community diabetic specialist nurse who ran a joint clinic with the practice nurses. Patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Patients with palliative care needs were supported and monthly multidisciplinary meetings with the palliative care nurse were held to discuss patients at the end of life. Flu vaccinations were routinely offered to patients with long term conditions to help protect them against the virus and associated illness.

Updated 28 May 2015

The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up children who were at risk. Immunisation rates were relatively high for all standard childhood immunisations. Specific services for this group of patients included family planning clinics, antenatal clinics, post natal checks, teenage sexual health clinics and childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with health visitors at clinical meetings to discuss concerns and child protection issues. Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse. Safeguarding policies and procedures were readily available to staff and processes to follow were clearly visible on notice boards in staff areas. The practice ensured that children needing emergency appointments would be seen on the day.

Updated 28 May 2015

The practice is rated as good for the care of older people. Patients had a named GP which allowed for continuity of care. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. Patients were able to speak with or see a GP when needed and although the practice was not always accessible for patients with mobility issues, home visits were available. The practice had a housebound register and those patients had annual reviews. The practice identified patients at risk including those at risk of hospital admissions. Patients living in nursing or care homes were included on the practice admission avoidance register and had an admission avoidance care plan in place. Multidisciplinary meetings were held to discuss patients and the practice worked closely with the proactive care team to plan care accordingly. Clinics were held twice a month where advanced nurse practitioners would visit patients at home and review their condition. Patients over the age of 75 were visited and reviewed following discharge from hospital. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in diabetic and end of life care. It was responsive to the needs of older people, and offered home visits and telephone appointments for patients who found it difficult to get into the surgery. The practice also provided a service to the local nursing homes and provided individual patient reviews according to need. There were arrangements in place to provide flu and pneumococcal immunisation to this group of patients. Clinics included diabetic reviews and blood tests. Blood pressure monitoring was also available.

Updated 28 May 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. Extended access appointments were available each morning, as were telephone consultations. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. The practice offered a travel clinic for advice and vaccinations and NHS health checks were offered to patients aged 50-55, having previously offered health checks to the 45-50 age group. Patients could be referred to smoking cessation services and could be supported within the practice by a healthcare assistant. A weight management service was also available.

Updated 28 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients with dementia were flagged on the practice’s computer system and had an annual review. Patients with severe mental health needs had care plans where both physical and mental health were assessed as well as annual reviews. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice worked closely with local counsellors, the mental health team and consultants. There were referral processes in place for counselling services and child and adolescent mental health services.

Updated 28 May 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including those with a learning disability. GPs carried out annual health checks for people with a learning disability and where necessary the practice offered longer appointments for vulnerable patients. Clinical staff had attended training from the locality learning disability health facilitator to better support patients with a learning disability. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. Translation services were available for patients who did not use English as a first language. The practice could not always accommodate patients with a physical disability due to issues with the premises although alternative arrangements could be made, including home visits and plans were in place to move the practice to more suitable premises in 2016. Carers and those patients who had carers were flagged on the practice computer system and when registering with the practice were signposted to the local carers support team. Patients who might have hearing or visual disability were identified when accessing services and signing interpreters were available.