Archived: Hastings Old Town Surgery

Updated 10 March 2017

Hastings Old Town Surgery offers general medical services to the people of the Old Town area of Hastings. There are approximately 8350 registered patients.

Hastings Old town Surgery is run by two partner GPs (one male and one female). The practice is also supported by one part time salaried GP (female) and two regular part time locum GPs (both male). Additionally there are three practice nurses, a health care assistant and a phlebotomist. The team also includes a practice manager, a back office manager and a self-employed business manager. There are four medical secretaries each with additional responsibilities and six reception staff most of whom also have some additional responsibilities.

The practice currently teaches FY2 doctors (doctors in their second year after qualifying) and medical students. One of the partners is training to be a GP trainer so that the practice can train doctors who wish to specialise in general practice.

The practice shares a building with one other GP practice and was formed from the merger of three surgeries in August 2015.

The practice runs a number of services for its patients including asthma and COPD (chronic lung disease) clinics, child immunisation, diabetes clinics, contraception services, well person checks, weight management, smoking cessation, post-natal and eight week baby checks, new patient checks and travel health clinics. The practice runs an ear micro suction service and accepts referrals from other local GPs for this. There is a counselling service available in the building.

Services are provided from:

Roebuck House, Hastings, TN34 3EY.

The practice is run from three floors and has lift access.

The practice is open from 8.30am on Monday, Wednesday and Friday and 7.30am on Tuesday and Thursday. The surgery is shut between and 1pm and 2pm. The practice closes at 6.30pm on Monday, Tuesday, Wednesday and Thursday and at 5.00pm on Friday. There is access for emergencies between 8am and 8.30pm Monday to Friday and 5.00pm to 6.30pm on Friday. Routine surgery hours are 8.30 am to 12am Monday to Friday, 2.30pm to 5.20 pm on Monday, 2.00pm to 5.20pm on Tuesday, 2.30pm to 4.30pm on Wednesday, 2.00pm to 4.20pm on Thursday and 2pm to 4pm on Friday. Extended hours appointments are offered from 7.30am to 8am on Tuesday and Thursday, from 6.30pm to 7.15pm on Monday and 6.30pm to 8pm on Tuesday and Wednesday. In addition to pre-bookable appointments that could be booked up to six months in advance, urgent appointments are also available for people that need them.

When the surgery is closed patients can access out of hours care via the 111 telephone number. Urgent calls between 8am and 8.30am are put through to the duty GP.

The practice population has a higher than the national average number of patients aged over 65 although this is lower than the local average. There is slightly lower than the local and national average number aged 18 years or less. There is a slightly lower than average number of patients with a long standing health condition and slightly higher than average number of patients with a caring responsibility for both local and national averages. The percentage of registered patients suffering deprivation (affecting both adults and children) is higher than both the local average and national average.

Updated 10 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hastings Old Town Surgery on 08 December 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 evidence showed the practice responded quickly to issues raised.
• Patients said they found that they could make an appointment with a named GP, although not always at the time they preferred, 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 areas where the provider should make improvement are:

• To review and where necessary update the practice’s fire risk assessment on an annual basis.

• Implement actions to mitigate any risk from legionella identified within the practice.

• Ensure that plans for all staff to have an up to date appraisal are implemented.

• Where clinically appropriate to continue to improve the systems for the identification and review of patients with a diagnosis of dementia.

• Continue to regularly monitor the maximum and minimum temperatures of all fridges containing medicines to ensure that they remain within the recommended range.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2017

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 82% (clinical commissioning group (CCG) average 80%, national average 78%).

• Patients with diabetes who required insulin could have their treatment commenced and monitored at the practice.

• 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.

• The practice had introduced initiation and monitoring of blood thinning medicines at the practice.

Updated 10 March 2017

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.

• As the practice had recently formed from a merger of several practices, we were unable to obtain verifiable current child immunisation rates for the new practice at the time of the inspection.

• 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 practice’s uptake for the cervical screening programme was 77%, which was above the CCG average of 75% and the national average of 74%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• All unwell children would be seen on the day and the practice preferentially booked school age children in to appointments after school hours.

• The practice sign posted teenagers to age appropriate counselling and sexual health services, including test yourself chlamydia packs (chlamydia is a sexually transmitted infection). 

Updated 10 March 2017

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 targeted patients over 75, in particular, the housebound for a comprehensive review of their health and social care needs and the development of a care plan to help avoid unnecessary admission to hospital.

• Reviews included a medicines review, installation of safety equipment, key safes and alarm buttons. Medical reviews included screening for several heart problems.

• The GPs undertook regular ward rounds at a local nursing home.

Updated 10 March 2017

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 full range of online facilities were available including booking appointments and ordering repeat prescriptions. The practice had a website and social media page.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• Extended hours services were offered that included early morning appointments from 7.30am with both the nurse and healthcare assistant two days a week, evening appointments and also late evening phone calls.

• The practice was aware of the problems of accessing health care for the working population. It therefore encouraged self- monitoring and management of chronic diseases and provided telephone consultations to support these patients.

• The practice was about to embark on a nine month diabetes prevention pilot scheme targeting those patients at risk of developing diabetes.

Updated 10 March 2017

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

• 70% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is lower than the CCG average (82%) and the national average (84%). The practice said that this had been due to difficulties in identifying and contacting all of the eligible patients following the merging of three practices.

• The percentage of patients with severe and enduring mental health problems who had a comprehensive care plan documented in the record, in the preceding 12 months was 83% (CCG average 87%, national average 89%). However the exception reporting rate was considerably lower than the local and national averages so that the number of patients receiving the intervention (81%) was higher than the CCG average (79%) and national average (78%). (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

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

• 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.

• The practice hosted an in-house counselling service provided by the local mental health trust.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• For some patients the practice could offer referral for carers’ breaks.

Updated 10 March 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held registers of patients living in vulnerable circumstances including those with a learning disability.

• Patients with a learning disability were offered annual health checks.

• 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 worked closely with other agencies including social services, community nursing, mental health teams and the local hospice to review all of their vulnerable patients at regular multi-disciplinary team meetings.