Dr Castle & Partners, Sole Bay Health Centre

Updated 11 February 2016

Dr Castle and Partners also known as The Sole Bay Health Centre, provides general medical services to approximately 5,059 patients in the coastal, rural area of Southwold. Treatment and consultation rooms are situated on the ground floor. There is a lift and available for patients to access the first floor area and treatment rooms. Parking is available with level access and automatic doors. The practice population for patients over 85 years was four times the national average and three times the local CCG average.

The practice has a team of four GPs. All four GPs and a nurse practitioner are partners, meaning they hold managerial and financial responsibility for the practice. There is a team of four practice nurses, and one health care assistant who run a variety of appointments for long term conditions, minor illness and family health. A community matron is also attached to the practice as part of a pilot project to improve access to health and social care needs.

There is a practice manager and a team of non-clinical administrative, secretarial and reception staff who share a range of roles, some of whom are employed on flexible working arrangements. Community midwives run sessions weekly at the practice and an exercise instructor provides two sessions per week. The community matron, a specialised diabetic nurse and the district nursing team also attend the practice. In addition there is a team of cleaners employed to oversee the practice cleaning. The practice is teaching and training practice.

The practice provides a range of clinics and services, which are detailed in this report, and operates generally between the hours of 8.00am and 6.30pm, Monday to Friday. Appointments are from 8.50am every morning to 12 noon and from 3.30pm to 5.20pm daily. In addition to appointments that can be booked from three to six months in advance, urgent appointments are available for people who need them.

Branch Surgeries were held on a Thursday afternoon at Wenhaston Village Hall and a Wednesday afternoon at Walberswick Village Hall. Patients were able to contact the main surgery reception to book an appointment.

When the practice is closed patients are directed to the NHS 111 service.

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Castle and Partners also known as Sole Bay Health Centre on 24 November 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for providing caring and well-led services. We found the practice to be good for offering safe, effective and responsive services.

In addition we found the practice to be outstanding for providing services for older people and people with long term conditions, and good for providing services to families, children and young people, working age people, people whose circumstances might make them vulnerable, and people experiencing poor mental health.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.

We saw several areas of outstanding practice including:

• The Southwold Care Services Improvement Partnership (CSIP) project reflected the complex needs of the older population, with the majority of individuals supported being over 85yrs. The practice was in the process of discussions with the clinical commission group for an adjoining plot of land to be developed into the Sole Bay Health and Care Home as an extension to the work already undertaken by CSIP.

• The practice had instigated the Sole Bay Care Fund, this was an independent registered charity run by local trustees to provide short term emergency care, resources and equipment not normally funded by the NHS or Social Services. The fund provided immediate care and support to those patients with an acute medical or social care need and in many cases was effective in reducing unnecessary hospital admissions by providing short term care in the home or as near to home as possible.

However there were areas of practice where the provider should make improvements:

• Record verbal complaints in order to widen shared learning.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 2016

The practice was rated as outstanding in the domains of caring and well-led. These ratings apply to everyone using the practice, including this population group. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when required. All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met. For those patients with the most complex needs, the named GP worked with the community matron and relevant health and care professionals to deliver and ensure a multidisciplinary package of care was available when needed. For example we saw the Sole Bay fund had enabled people with long term conditions to stay in their homes when their health deteriorated.

The practice achieved high QOF scores and had a principle of rarely excepting patients from QOF. In addition, the practice had developed a suite of searches that were run to target conditions and patients not identified by QOF indicators and registers. Clinical audits were used to improve the outcomes for patients with long term conditions.

The practice nurses worked with patients to manage long term conditions and recalled patients with conditions such as asthma and diabetes. The nurses maintained their training in this area to ensure they complied with best practice and the most recent guidelines. One GP utilised a risk profiling computer search software to identify patients who had a high risk of hospital admission, overdue screening or were put at risk because of their medications. The evidence from these searches was used to inform clinical management of these patients and ensure their safety

Updated 11 February 2016

The practice was rated as outstanding in the domains of caring and well-led. These ratings apply to everyone using the practice, including this population group. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 11 February 2016

The practice was rated as outstanding in the domains of caring and well-led. These ratings apply to everyone using the practice, including this population group. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice worked closely with the community matron and palliative care team and actively encouraged and helped patients to remain at home should they wish to in their last weeks and days.

The practice contacted those patients who did not attend for their vaccination and the practice nurses visited care homes and house bound patients to administer vaccinations. This also gave an opportunity for chronic disease monitoring for those patients.

Clinicians administered flu vaccinations at flu clinics and opportunistically and flu vaccination rates were in line with national averages. A local carers’ support service had attended the practice to promote support services and signpost patients and their relatives to other services.

The practice had instigated the Sole Bay Care Fund, which was an independent registered charity run by local trustees to provide short term emergency care, resources and equipment not normally funded by the NHS or Social Services. The fund provided immediate care and support to those patients with an acute medical or social care need and in many cases was effective in reducing unnecessary hospital admissions by providing short term care in the home or as near to home as possible. The fund raised money by donations and legacies and by organising events such as sponsorship for marathons, which we saw staff and members of the patient participation group were very active in participating.

Updated 11 February 2016

The practice was rated as outstanding in the domains of caring and well-led. These ratings apply to everyone using the practice, including this population group. 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 11 February 2016

The practice was rated as outstanding in the domains of caring and well-led. These ratings apply to everyone using the practice, including this population group. The practice was aware of the number of patients they had registered with dementia and additional support was offered. This included those with caring responsibilities. A register of patients living with dementia was maintained and their condition regularly reviewed through the use of care plans. All 73 patients on the dementia register had been reviewed in the last 12 months. Patients were referred to specialists and then on-going monitoring of their condition took place when they were discharged back to their GP. Annual health checks took place with extended appointment times if required.

Patients were signposted to support organisations such as the mental health charity (MIND) and the community psychiatric team for provision of counselling and support. All the staff we spoke with had an understanding of the Mental Capacity Act and their role in implementing the Act. There was a system in place to follow up patients who had attended accident and emergency (A&E) where they might have been experiencing poor mental health. There were 57 patients on the mental health register, of these 55 had been seen and reviewed in the last year. 36 patients on the register were eligible under QOF for a care plan and of these patients, 30 had a plan in place with the remaining six patients scheduled for a care plan to be completed. For the 21 patients who were not eligible for a care plan, we were told 11 were in remission, two patients were classed as excluded, two patients had a dementia care plan and six were due further reviews as they also may also be classed as in remission. Patients were sent regular reminders, we were told the practice did not just invite them for a review for a set number of times.

Updated 11 February 2016

The practice was rated as outstanding in the domains of caring and well-led. These ratings apply to everyone using the practice, including this population group. Double appointment times were offered to patients who were vulnerable or with learning disabilities. Carers of those living in vulnerable circumstances were identified and offered support which included signposting them to external agencies. Staff knew how to recognise signs of abuse in vulnerable adults and children. All staff had been trained in safeguarding and were very aware of the different types of abuse that could occur and their responsibilities in reporting it. 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 held monthly multi-disciplinary team (MDT) meetings attended by GPs, district nurses, practice nurses and when possible community psychiatric nurses to discuss vulnerable patients.