Archived: Portswood Solent GP Practice

Updated 5 October 2016

Solent NHS Trust manages three GP practices called Nicholstown Surgery, Adelaide Health Centre and Portswood GP practice.

The Portswood Solent GP Practice, 7 Belmont Rd, Southampton SO17 2GD is situated in Southampton City, in the Portswood area.

The practice is located in a converted Georgian house in a residential area. There is one large reception area on the ground floor. At the back of the practice, with access from another road there is an alternative flat entrance for patients with limited mobility.

There are four clinical rooms on the ground floor, with two large treatment rooms, all of which are wide enough for wheelchair access. The second floor has offices and a conference room for meetings.

The practice provides general medical services to 4,900 patients with an ethnic population estimated as 2.9% mixed, 12.0% Asian, 2.4% black, 1.6% other non-white ethnic groups and 16% of patients are aged over 65 years.

All GPs who work in the practice are salaried. There is currently one male and three female GPs, who provide the equivalent of 2.7 whole time equivalent GPs. The practice is using regular locums currently due to covering long term absence.

There is a nursing team with two advanced nurse practitioners, two part-time practice nurses, one nurse practitioner for older patients and a health care assistant. The practice supports student nurses in training.

The practice is supported by a practice manager and a deputy manager. There are six reception and secretarial staff, which is the equivalent to 3.83 whole time equivalent staff.

The practice offers 15 minute appointments and is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.30am to 5pm daily. Extended hours appointments are offered on Monday evenings until 8pm.

Patients are directed to use the NHS 111 system when the practice is closed. This is the first inspection for this location.

Updated 5 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Portswood Solent GP Practice on 28 June 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice provided an anti-coagulation service, managed by the practice nurses, including those who were housebound.
• The practice followed the Identification and Referral to Improve Safety (IRIS) system which trained staff to focus on identification of Domestic Violence and Abuse through clinical enquiry and guides response, referral and recording.

We saw areas of outstanding practice:

• The practice employed and introduced the role of a nurse practitioner for older people (NPOP). This consisted of an experienced nurse practitioner allocated for home visits for patients over 75 years of age. The NPOP co-ordinated meetings with the multi-disciplinary team and responded quickly to home visit requests, for example, on the same day to urgent requests from care homes or after hospital discharge. They completed a mortality review for the whole practice to learn from. Following the introduction of the NPOP, there was a reduction of GP visits from 50 to 26 over a four month period.

The area where the provider must make improvements are:

• Ensure the practice specific policies and Solent NHS trust policies are up to date to ensure all staff are aware which policy is current and where they are accessed.

The areas where the provider should make improvement are:

• Review the processes and systems in place to promote patient uptake in cervical screening, bowel and breast screening.
• Ensure that the medicines policies and procedures are followed at all times, particularly in relation to vaccine storage. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 October 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• 72% of patients with diabetes had cholesterol reading that was within safe limits. This was comparable to the clinical commissioning group average of 70% and national average of 71%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met.
• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. For example, there was an allocated a Solent NHS trust community matron who manages weekly virtual ward meetings for those patients at high risk of hospital admission.

Updated 5 October 2016

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 living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 68%. This compared to a clinical commissioning group average of 73% and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice ensured they contacted these professionals every 6-8 weeks to ensure the health needs of this group were met.
• The practice sent reminder letters to families when children had attended accident department and did not attend planned appointments for immunisations or booked practice appointments. This was then highlighted to the practice safeguarding lead and relayed to health visitors.

Updated 5 October 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice introduced a nurse practitioner for older people. This consisted of an experienced nurse practitioner allocated for home visits for patients over 75 years of age. This nurse co-ordinated meetings with multi-disciplinary team. They responded quickly to home visits requests, for example, after hospital discharge and into care homes. This was a proactive approach to meeting the needs of housebound population. They completed a mortality review for the whole practice to learn from.
• Following the introduction of the NPOP there was a reduction of GP visits from 50 to 26 visits over four months.

Updated 5 October 2016

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.
• 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.

Updated 5 October 2016

The practice is rated as good for the care of people experiencing poor mental health (including people living with dementia).

84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was higher than the clinical commissioning group average of 78% and the national average of 77%.

The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• The practice carried out advance care planning for patients living with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and those living with dementia.

Updated 5 October 2016

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 homeless patients, those at risk of domestic violence, travellers and those with a learning disability.
• The practice referred patients for advocacy using the Identification and Referral to Improve Safety (IRIS system); this showed awareness of domestic violence within their patient population.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed 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.