Archived: Warrior Square Surgery

Updated 22 July 2016

Warrior Square Surgery is run by a partnership of three GPs (two male and one female) who are supported by a female salaried GP. The practice is looking to recruit two further GPs and possibly a further nurse practitioner in the future as two of the current partners eventually wish to reduce their workload. They are also supported by three practice nurses, two health care assistants, a phlebotomist, a team of receptionists and administrative staff, a finance manager and two practice managers.

The GPs run shared lists, so patients can see whichever GP they wish, although patients on the practice list do have a named GP.

The practice moved out of its previous premises in St Leonards in July 2013 following a significant fire and into their current temporary premises. The current premises are on the seventh floor of an office building on the Hastings seafront. The premises have good lift access. They have recently made a decision not to try to move back in to their old premises as they remain uninhabitable and are currently looking for suitable new premises in the St Leonards area.

The practice has a list size of approximately 7,300 patients and operates from a single site at:

7th Floor, Cavendish House, Hastings, East Sussex TN34 3AA

The practice runs a number of services for its patients including chronic obstructive pulmonary disease and asthma management, child immunisations, diabetes management, Ear syringing, family planning, new patient checks and travel health advice amongst others.

Joint injections and minor surgery are carried out at the practice.

Warrior Square Surgery is open from 8.30 am to 6pm Monday to Friday.  It is closed between 1pm and 2pm on Fridays for staff training.

A duty doctor can be contacted via 111 when the practice is closed between 8am to 6.30pm Monday to Friday. This ‘marginal rota’ is shared with GPs from another local practice.

Appointments are available from 8.30am to 12pm every morning and from 4pm to 6pm on Monday to Thursday and 3.50pm to 6pm on Friday.

Extended hours appointments are offered on one evening a week rotating around Tuesday, Wednesday or Thursday evenings from 6.30pm to 8.15pm.

When the practice is closed patients are asked to phone the NHS 111 service that will help them access the appropriate out of hours care.

The practice population has a slightly lower number of patients under 18 than the national average. There are also an average number of patients of 65+ years. There are above the national average number of patients with a long standing health condition and just above the national average number of patients with a caring responsibility. There are a lower than average number of patients in paid work or full time education. The percentage of registered patients suffering deprivation (affecting both adults and children) is significantly higher than average for England and the local clinical commissioning group area.

The practice is a training practice for year four and year five medical students.

Updated 22 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Warrior Square Surgery on 15 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 and there was continuity of care, with urgent appointments available the same day. However some patients did find it difficult to get through on the telephone in the mornings.
• 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 practice employed a nurse practitioner who worked closely with the GPs to help manage some patients with more complex illnesses at their homes and in the surgery.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

Ensure that all non-clinical staff complete infection control training and record all training formally.

To continue to monitor any changes made to try to improve patient access to appointments particularly via the telephone and to canvass patient views on access.

To look at ways of reducing the level of exception reporting in particular in relation to asthma reviews and some mental health reviews.

Continue to look at ways of increasing uptake for national screening programs in particular cervical screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 July 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.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading was 140/80 mmHg or less was 84% (clinical commissioning group (CCG) average 82%, national average 78%).

• The practice nurse and GP diabetic leads met weekly to discuss any outstanding issues involving any patients with diabetes.

• The practice were involved in two clinical commissioning group initiatives to ensure the effective use of inhaled corticosteroids in patients with asthma and chronic obstructive pulmonary disease.

• 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.

Updated 22 July 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 just below average for some standard childhood immunisations.

• All children and their siblings who were under child protection procedures were coded appropriately on their clinical system and highlighted as an alert when their notes were accessed.

• The GP safeguarding lead had bi-monthly meetings with the health visitor about any families of concern.

• A social prescribing service advisor was based in the practice two and a half days a week. This was a service where patients were helped with issues such as debt management, housing and benefits.

• 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 recorded that a cervical screening test has been performed in the preceding five years was 72% (CCG 84%, national average 82%).

• The practice identified patients that had failed their screening appointments and sent further reminders, texts and phone calls in addition to those sent out by the national screening centre.

• 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 and health visitors.

Updated 22 July 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 people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice had employed a nurse practitioner to work as part of her role with the practice’s housebound patients. They liaised with other health care agencies via a mobile phone that by-passed the surgery’s system. With the patient’s consent, they also worked with family members.

• The nurse practitioner reviewed the local admissions dashboard daily to identify admissions and discharges from hospital.

• The nurse practitioner managed the admissions avoidance register.

Updated 22 July 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.

• A surgery was held one evening a week with bookable appointments with GPs and a health care assistant was available.

• 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 including smoking cessation support.

• The nurse practitioner and practice manager reviewed the out of hours and walk in centre attendances regularly. This was to identify frequent attenders and establish whether there were any other measures that the surgery could put in place to support patients to attend the practice where appropriate.

• Patients could email the surgery through a practice email address. All reception staff had access to it and messages were closely monitored and passed to the appropriate department throughout the day.

Updated 22 July 2016

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

• 81% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 82% and national average of 84%.

• The practice held a dementia register and a mental health register.

• The practice was third in the list of top ten practices in the locality for diagnosis of dementia.

• A nurse practitioner had been employed to work with patients with dementia in care homes and nursing homes as part of their role.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record was 96% (CCG average 93%, national average 88%).

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

• The practice had close links with the community mental health team who were housed in the same building.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and counselling services were available on the surgery premises.

• 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 dementia.

Updated 22 July 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 those with a learning disability.

• The GP lead for people with learning disabilities worked closely with carers and residential home managers to complete reviews in the patient’s familiar surroundings.

• 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.

• The practice were developing their Vulnerable Patients Scheme, which was a local clinical commissioning group initiative.