Hastings Primary Care Hub

Updated 21 October 2016

The Hastings Medical Practice and Walk-In Centre holds an Alternative Personal Medical Services (APMS) contract with the Hastings and Rother Clinical Commissioning Group (CCG) and offers general practice services to the people of Hastings. There are approximately 3,400 registered patients. Additionally the practice offers a GP led walk-in centre and will accept all patients, whether registered at the practice or not, for one off consultations between the hours of 8am and 8pm Monday to Sunday. The population of the Hastings area which the walk in centre covers is 183,000 although this figure increases during the summer period.

The Hastings Medical Practice and Walk-In Centre is run by Integrated Care 24 (IC24) a non-profit making social enterprise organisation that provides Out of Hours services, 111 services and GP services across central and southern England.

The practice has five regular salaried GPs (three male and two female) one of whom is designated Medical Services Director. They are supported by three practice nurses one of whom was an Independent Prescriber and could therefore prescribe medicines for specific clinical conditions, an assistant practitioner, one health care assistant, a team of receptionists and administrative staff, the Head of Primary Care, Walk In Centres and Pharmacies and the Patient Services Manager. The practice have just appointed a clinical pharmacist. The provider IC24 also provides services at a walk in centre at Eastbourne and the Medical Services Director and Head of Primary Care also manage that centre. There were plans in progress to use nursing staff with specialist skills across both sites.

All patients on the practice list have a named GP although the GPs operated a shared list system so patients could choose which GP they saw.

The practice runs a number of services for its patients including chronic obstructive pulmonary disease (COPD) and asthma clinics, child immunisations, contraception advice, diabetes clinics, new patient checks, travel health checks and vaccines, smoking cessation advice and weight advice.

Services are provided at

The Ground Floor

Hastings Station Plaza Health Centre,

Station Approach

Hastings

East Sussex

TN34 1BA

The building is owned and maintained by NHS Property Services and contains other GP surgeries as well as a variety of other health and social services.

The practice is open between 8am and 8pm Monday to Sunday and access to the walk in service is available during those hours. Booked appointments for registered patients are available from 8am to 6.30pm daily including weekends. In addition to pre-bookable appointments that can be booked up to four weeks in advance, booked urgent appointments are also available for registered patients that need them. Registered patients also have access to walk in appointments from 8am to 7.50pm Monday to Sunday.

The practice are contracted to see 18,000 patients via the walk in centre per year. In the year July 2014 to June 2015, they saw 18,811 walk in patients.

There is a very diverse mix of ethnicities amongst the patients of the practice with 34% not having English as their first language.

The practice exhibits a very high turnover of patients.

The percentage of registered patients suffering deprivation (affecting both adults and children) is significantly higher than average for England. The practice states that many of their patients are homeless with complex health and social care issues and have difficulty engaging with other practices or local providers. The practice population has a much lower number of patients 65 plus than the national average (93% are under 65 years and 70% are under 45 years) and a higher than average group of patients in the 20 to 35 age group. There is also a higher than average number of patients of nine years of age or less, with a much higher than average number of patients below four years of age. There are an average number of patients with a long standing health condition compared with the national average and an average number of patients with a caring responsibility. There have a higher than average number of patients who are unemployed.

Updated 21 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hastings Medical Practice and Walk-In Centre on 27 July 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.
• The practice provided both general practice services with a list of patients registered to the practice and also a GP led walk in service open to unregistered as well as registered patients.
• Patients registered with the practice 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 was open from 8am to 8pm and saw all patients that presented during that time.

• The practice saw 98% to 99% of patients using the walk in service within two hours.

• 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 ensure that maximum and minimum fridge temperatures are recorded and reviewed on a daily basis.

To review systems for recording of carers to ensure that all patients who wish to identify themselves as carers have this documented.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 21 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. Chronic disease teams consisted of a GP, a lead nurse and an administrator.

• Each recognised long term condition was managed by a team consisting of a lead GP, lead nurse and an administrator who would regularly review the registers and ensure that patients were reviewed and managed in line with current guidelines. Teams would ensure that they remained up to date with current teaching and changes in guidelines would be discussed at monthly clinical meetings.

• 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 just employed a clinical pharmacist, whose role was to assist with the medicines management of patients with complex conditions.

Updated 21 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 low for some standard childhood immunisations.

• The local safeguarding lead nurse was informed of the

• Children using the walk in centre were seen by a nurse for assessment as a priority

• We saw that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The percentage of women aged 25 or over and who had not attained the age of 65 whose notes recorded that a cervical screening test had been performed in the preceding five years was 82.2% (CCG average 83.9%, national average 82.6%).

• 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 21 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 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 where appropriate.

Updated 21 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 reflected the needs for this age group.

• The practice was open from 8am to 8pm every day of the year.

• The practice had recently introduced a text messaging appointment reminder service.

Updated 21 October 2016

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

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average (84%). However the practice had a very low percentage of patients over 65 and this equated to three patients.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate was 93% (CCG average 93%, national average 88%).

• The percentage of women aged 25 or over and who have not attained the age of 65 with schizophrenia, bipolar affective disorder and other psychoses whose notes record that a cervical screening test has been performed in the preceding five years was 100% (CCG average 92%, national average 89%).

• The practice additionally had a significant number of registered patients who had been diagnosed with personality disorders.

• 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 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 21 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 people and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• Because of the location of the practice and the fact that it was also a walk in centre, the practice saw a significant number of patients with complex health and social care issues.

• The practice would take vulnerable patients, including the homeless, who accessed them through the walk in service on to their registered patient list. The practice used the surgery address to register them and tried to retain updated phone and contact records for them. We saw an instance where this occurred on the day of the inspection when extensive efforts were made to help a patient with medical and social care problems.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice were taking part in a new locally commissioned service to improve the system of recording and sharing of care plans with other agencies where appropriate for vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• The practice had been part of a pilot scheme in to a new social prescribing service to give help and advice to vulnerable patients on a wide variety of social issues such as housing, debt, benefits, relationships, parenting and general wellbeing. The service was now available in the same building and the practice regularly referred patients to the service. A session was also held within the practice one evening a week.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documenting safeguarding concerns and how to contact relevant agencies in normal working hours and Out of Hours. We saw examples of where the practice had made appropriate safeguarding referrals.