Adelaide Health Centre/Western Community Hospital

Updated 24 December 2018

This report relates to the regulatory activities being carried out at Adelaide Health Centre which is situated in William Macleod Way, Millbrook, Hampshire SO16 4XE. The practice is operated by Solent NHS Trust and has three sites in the Southampton area known locally as the Solent GP Surgery. We visited all three sites during our inspection. The practice has a website which is located at www.solent.nhs.uk

The other sites are located at:

Nicholstown Surgery, Fanshawe Wing, Level B, Royal South Hants Hospital, Brinton Terrace Southampton, Hampshire, SO14 0YG.

Portswood Solent Surgery, 7 Belmont Road, Portswood, Southampton, Hampshire, SO17 2GD

Solent NHS Trust provides a Homeless Health Care Team at the Two Saints Day Centre, 30 Cranbury Avenue, Southampton SO14 0LT. Patients can self-refer between Monday to Friday 9am-4pm and can also be seen at Patrick House Hostel on Monday and Wednesday mornings. We visited the Two Saints Day centre as part of this inspection.

Adelaide Health Centre is registered for the following Regulated Activities: Diagnostic and screening procedures; Family planning; Maternity and midwifery services; Surgical procedures and Treatment of disease, disorder or injury.

Local authorities, NHS trusts, voluntary organisations, charities, limited companies and limited liability partnerships require a nominated individual. This practice has a nominated individual who has been nominated by the Solent NHS Trust. A nominated individual must be employed as a director, manager or secretary of the organisation with responsibility for supervising the management of the regulated activity. The provider must be sure of that individual’s ability to fulfil the responsibility of their role.

The deprivation decile rating for the practice area is six (with one being the most deprived and 10 being the least deprived). The practice provides a primary medical service to approximately 17,586 patients of a diverse age group across the three sites. The 2011 census data showed that the majority of the local population identified themselves as being White British.

Adelaide Health Centre, is led by a senior management team consisting of a Primary Care Manager, Clinical Lead GP and a Matron. At each of the sites there are Site Managers and Lead GPs. The Adelaide Health Centre team consists of 12 salaried GPs including two long term locums, six Advanced Nurse Practitioners, two trainee Advanced Nurse Practitioners, four practice nurses and five Health Care assistants. Clinical staff are also supported by 15 receptionists (three supervisors) seven back office administrators, a clinical pharmacist, a medicines manager and a lead practitioner.

Patients using the practice also have access to health visitors, counsellors, carer support workers, district nurses, and midwives. Other health care professionals visited the practice on a regular basis.

The Adelaide Health Centre practice premises, phone lines and reception desk are open seven days a week between 8am to 8pm, including bank holidays. Appointments are offered between those times. Outside of these times patients are directed to contact the out of hour’s service and the NHS 111 number. This is in line with local contract arrangements.

The practice offers a range of appointment types including face to face same day appointments, telephone consultations and advance appointments (two to three weeks in advance) as well as online services such as repeat prescriptions.

Updated 24 December 2018

This practice is rated as Good overall. (Previous rating June 2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Adelaide Health Centre on 16 and 17 October 2018 as part of our inspection programme.

At this inspection we found:

•The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

•The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

•Staff involved and treated patients with compassion, kindness, dignity and respect.

•Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

•There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

•Continue to review all health and safety risk assessments across all sites so that outstanding actions are completed.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Updated 6 January 2014

Overall we found that because community teams provided a coordinated and comprehensive service, people with long term conditions received safe care.

There was good communication between inpatient locations and community services which meant that people were supported effectively to improve or maintain their health and welfare and reduce the need to return to hospital. There were clear examples of effective multidisciplinary working across teams and with other organisations. There were excellent services that improved health and wellbeing for vulnerable people such as the homeless. We saw examples of how the services promote safe care by monitoring and learning from incidents, and using a range of benchmarking activity comparing against national and regional performance. Teams and specialist practitioners worked within accepted research based guidelines.

We were concerned about safety of patients being supported by some of the community based teams. This was due to staff deployment, especially out of hours, not matching demand in some localities. This had been identified by the Trust as a risk but had not been fully resolved although staff had been recruited for some teams. To monitor the risk the trust had a system whereby staff levels were reported to the senior nurse each day.

Services were effective as staff worked in a robust multidisciplinary way that meant patients were supported through the phases of their illness and to remain at home. There were many examples of good liaison with hospitals or inpatient units to promote early discharge or to prevent hospital admission. There was effective monitoring of the performance of teams to support people with long term conditions through reporting within teams and to the trust managers. There were specialist nurses, and therapists who provided expert advice across teams. Consultant medical staff or general practitioners led some areas of the service such as clinics and community virtual wards which meant that medical decisions could be made along with the multidisciplinary clinical team

Services for people with long term conditions were caring. In our discussions with patients and relatives or carers we found people were mostly very satisfied with the care and support they received. Patients receiving rehabilitation and ongoing care described being well supported by a team of staff who recognised their needs and agreed plans of support with them. We observed staff providing compassionate care and consulting with patients in clinics and in their homes. In several teams we saw that patients were allocated a key worker with whom they could build a trusting relationship and who ensured wider needs were met to promote health and welfare.

The staff in community and inpatient services of the Trust worked in multidisciplinary teams and collaboratively with patients to provide care and treatment that met patient's needs. This enabled people to stay at home as they managed living with long term conditions or to recover from acute phases of their condition.

Specialist clinics in community locations had been established by the Trust where staff provided expert advice at appointments or rehabilitation sessions. The Homeless Healthcare Team provided an excellent service for homeless people who could receive support for long term health issues such as diabetes and including screening for liver disease. People with rheumatoid arthritis were supported to sample exercise or relaxation sessions that may be of help to their condition and also encourage social interaction.

Services were well-led because the Trust had developed a clear strategy to support people long term conditions. Managers and staff had been restructured in a way that promoted integration of services for those patients living with long term conditions or receiving rehabilitation to improve their health and welfare after injury or acute episodes. Needs assessment in the area covered by the Trust had shown that increasingly people will have multiple health needs. To manage this the Trust had developed teams that included a range of specialists to work in a multidisciplinary way and to enable complex case management. The Trust had established central points of access and clinics for people needing care, treatment and advice about their conditions. Staff said they were able to openly discuss any issues about patient care and safety with their managers. Staff told us they were supported to develop skills and knowledge and continue to develop their professional competencies to support the complex needs of patients they cared for.

Updated 6 January 2014

We found that the children’s and families’ service was safe, effective, caring and in the main responsive to the needs of the local population.

Services are generally safe. There were arrangements in place to minimise risks to children and young people receiving care and staff working alone in the community. Staffing levels were generally safe in the services and there was consistency in incident reporting practice. There were effective systems in place to learn from incidents and sharing of that learning both within individual teams and across the organisation. We were told by staff that there were some inconsistencies in the recording of training.

Services were generally effective, evidence based and focussed on the needs of children and young people. We saw some examples of very good collaborative work and innovative practice. The Trust was making changes to ensure the different parts of the service worked together to provide an effective service across the region. The majority of services’ governance arrangements ensured a robust process of information sharing between operational services and the Trust Board. Most teams had a clear overview of their own performance and outcome measures which were based on the needs of the population.

The vast majority of people told us they had positive experiences of care. Parents and carers felt well supported and involved with their children’s treatment and told us that staff displayed compassion, kindness and respect at all times. Many staff spoke with passion about their work and were proud of what they did. Staff knew about the organisation’s commitment to people and their representatives and the values of the organisation they worked for.

We found the children and families service was responsive to people’s needs and people from all communities could access services. Overall we found that effective systems were in place to ensure that children, their relatives and those close to them received the support they needed in the community, despite some differences in local commissioning arrangements.

The service was in general well–led with effective decision making and strategic planning. There were risk management systems in place across the service and generally staff had a clear oversight of risks to quality in the organisation. Innovation was encouraged by the leadership of the service and this led to improvements in the delivery of services.

Updated 24 December 2018

Updated 6 January 2014

We found that the end of life care service was safe, mainly effective, caring and responsive to the needs of the populations it served. The end of life care service was outstandingly well-led in Portsmouth.

Services were safe. There were arrangements in place to minimise risks to patients and to staff working alone in the communities. Staffing levels were appropriate to the needs of the service. There was a consistent approach to reporting incidents and these were generally well followed up and the results fed back to staff. There were effective systems in place to learn from any reported incidents. However, sharing of information across both teams was not common practice.

Services were generally effective, evidence based and focused on the needs of the patients requiring end of life care, and their families. We saw and heard of some examples of excellent collaborative practice and this added value to the experience of the patient being cared for.

Services were exceptionally caring. Patients and their families told us how well cared for and well supported they felt by the end of life care services. All care was delivered with respect, specific knowledge and great compassion. Staff were clearly proud of their service and actively made plans to further improve it.

Services were responsive to the diverse needs of the populations it served. We found that they took note of individual requirements and ensured that anyone who wished to access the service was enabled to do so.

Services were exceptionally well-led in Portsmouth, with effective direction, planning and clear decision making and communication. Risk management systems were in place, and staff were fully aware of their responsibilities in reporting and in implementing new practice.

Updated 24 December 2018

Updated 24 December 2018

Updated 24 December 2018

Updated 24 December 2018

Updated 24 December 2018