South Saxon House Surgery

Updated 23 March 2018

South Saxon House Surgery is a GP practice that provides medical services to the people of St Leonards on Sea and the surrounding area under a General Medical Services contract. The practice had approximately 3375 patients at the time of the inspection. Patient numbers had risen from around 2,700 since the move to the current location in April 2016.

The practice is run by a single (female) GP who is covered by regular locums when not available. The clinical team also consists of a practice nurse and an advanced nurse practitioner (a second is due to start later in February 2018), a healthcare assistant (HCA) and a phlebotomist (all female). The clinical team are supported by a practice manager, an office manager and a team of reception and administrative staff.

The practice address is:

4 Whatlington Way

St Leonards on Sea

East Sussex

TN38 9TE

The practice is open Monday to Friday from 8am to 6pm. Appointments are available with the GP from 8.30am to 11.30 am Monday to Friday and from 3.30pm to 5.30pm on Monday, Tuesday, Thursday and Friday afternoons and on Wednesday afternoon from 1pm to 2.30pm. On Wednesday afternoons and between 6pm and 6.30pm the GP can be contacted in an emergency via the practice. Appointments with the nurse are available on Tuesdays, Thursday afternoon and Fridays. The HCA is available on Monday and Thursday. Appointments with the nurse are also available on Thursday evening from 5pm to 8pm.

When the surgery is closed the Out of Hours provider IC24 can be contacted via the 111 provider.

Five morning GP appointments and two afternoon appointments each day are pre-bookable, the rest are book on the day. Appointments with the nurse can be booked up to three months in advance.

The practice population has a higher number of patients between the ages of 10 and 24 and 35 to 64 than the national average. There is also a lower than average number of patients aged 65 or more. There is a lower than average number of patients with a long standing health condition and slightly higher than average number of patients with caring responsibility or who have health related problems in daily life. The percentage of registered patients suffering deprivation (affecting both adults and children) is higher than average for the Clinical Commissioning Group (CCG) or the average for England.

Updated 23 March 2018

We carried out an announced comprehensive inspection at South Saxon House Surgery on 27 September 2017. The overall rating for the practice was good. The practice was also rated good for the effective, caring, responsive and well-led domains and all of the population groups. It was however rated as requires improvement for the safe domain. The full comprehensive report on the September 2017 inspection can be found by selecting the ‘all reports’ link for South Saxon House Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 February 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 27 September 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

At our inspection of 27 September 2017, we found that:

• The system for recording and monitoring Medicines & Healthcare products Regulatory Agency  (MHRA) alerts did not ensure that clinical action was always taken.

• Not all external storage bins containing clinical waste were kept locked at all times.

• Batch numbers, expiry dates and amounts used were not always recorded when local anaesthetic was used during minor surgical procedures.

At this inspection our key findings were as follows:

• The systems for recording MHRA and other alerts ensured that the alerts and actions were recorded and acted upon.

• All external clinical waste storage bins were locked at all times.

• Batch numbers, expiry dates and amounts used were always recorded when local anaesthetic was used during minor surgical procedures.

Additionally we saw that:

• The system for tracking and auditing histology specimens ensured that results were received and acted upon appropriately.

• Alerts denoting a child at risk were also placed on family and other household members’ computer records as appropriate.

• The practice had discussed areas in the GP national survey where results were below the local and national averages and were considering ways of addressing them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 November 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The practice provided one stop clinics and screening clinics for patients with long term conditions. At these clinics all tests and consultations with the nurse and if necessary GP were carried out at the same appointment.

• Unverified figures from the practice showed that 84% of patients with diabetes were reviewed in a face to face interview in 2016/2017. There were no published local or national comparators available at the time of the inspection.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, if appropriate the named GP arranged joint home visits with other professionals such as the occupational therapist, specialist cancer care nurse or physiotherapist when required.

Updated 21 November 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances. However although all children at risk had their computer records tagged with an alert although not all household members did.

• Unverified and unpublished data shown to us by the practice showed Immunisation uptake rates for children of one year and under to be just over 80%. Immunisation uptake rates for children of two years were 96% up to 100% and for five years in a range from 87% to 97% for all standard childhood immunisations. There were no local or national comparators.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

• Unverified data from the practice for 2016/2017 showed that the percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 82%. There were no published local or national comparators available.

• Safeguarding policies were in place with safeguarding being an agenda item on the monthly multi-disciplinary team meetings. Health visitor contact details were available to all GPs and staff to discuss child safeguarding concerns.
• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

Updated 21 November 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. The practice involved patients and where appropriate carers in the review.

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

• All local care homes on the practice list were visited weekly with additional visits as required.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services such as community nurses.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 21 November 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours for nurse appointments.

• 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. There was a link on the website home page to a practice survey and patients were encouraged to leave comments and suggestions as to how the service and care could be improved

• Evening appointments were available with the practice nurse.

• Appointments could be booked or cancelled and repeat prescriptions ordered online.

• 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.

• Telephone appointments were available with each clinician during each surgery.

• Patients were offered new patient health checks and health checks for 40 to 74 year olds.

• The practice proactively offered exercise advice and referral to a local gym for those with a BMI >30.

Updated 21 November 2017

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

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

• We saw unverified data from the practice that 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• We saw unverified data from the practice that 93% of patients diagnosed with mental health disorders had their care reviewed in a face to face meeting in the last 12 months.

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

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• A Mental Health Worker was available for counselling sessions in the practice every week.

Updated 21 November 2017

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. All patients that staff members perceived to be vulnerable were flagged up on the computer system.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable. Palliative/End of Life Care provided by the GP provider with a register of patients to ensure effective care and support is provided to such patients/relatives in their own homes

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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. We saw examples where staff had raised safeguarding concerns.