Archived: Sedlescombe House

Updated 10 June 2016

The Sedlescombe House Surgery is run by a single full time GP (female). The practice also has one salaried part time GP (female). They were also supported by a practice nurse, two health care assistants, a team of receptionists, administrative staff, and a practice manager.

At the time of the inspection the practice had 3644 patients on their list.

The GPs ran shared lists, so patients could see whichever GP they wished, although all patients on the practice list did have a named GP.

The previous senior partner for the practice had retired 12 days prior to the inspection and the practice is in the process of trying to recruit a further GP either as a partner or salaried GP.

We were told that the practice had been run on fairly traditional lines in the past, but that they were in the process of upgrading their systems and processes without deviating from their core patient centred values. We saw evidence that significant improvements were being made to the practice systems and processes.

The practice runs a number of services for its patients including COPD and asthma clinics, child immunisations, diabetes clinics, new patient checks, travel health clinics and smoking cessation clinics amongst others. Intrauterine Contraceptive Devices (IUCDs) can be fitted at the practice.

Joint injections are carried out at the practice.

Services are provided at:

Sedlescombe House, St Leonards On Sea, East Sussex TN38 0TA

The building had been purpose built in 1987.

The practice is open between 8am to 6pm Monday to Friday and is closed between 1pm and 2pm. Appointments are available from 8.30am to 11am every morning and 3.30pm to 5.40pm every afternoon. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments are also available for people that need them. At lunchtime and between 6pm and 6.30pm any urgent calls are put through to the duty doctor.

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

The practice population has a slightly lower number of patients aged 65 or over than the national average. There is also a slightly higher than average number of patients of 18 years or less. There is a slightly higher than average number of patients with a long standing health condition and an average number of patients with a caring responsibility. There is a higher 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 slightly higher than average for England.

The practice is currently registered with the CQC as a partnership. They have commenced the process of converting the practice from a partnership to single provider status.

Updated 10 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sedlescombe House on 19 April 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. However there was no robust system for formal dissemination, and recording of the dissemination of, learning points.
• Risks to patients were assessed and well managed with the exception that the action points contained in the Legionella risk assessment had not yet been addressed and not all staff had completed formal fire safety training.
• 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.
• All staff had been trained in child safeguarding to the appropriate level for their role. All staff with the exception of one member of the clinical staff could provide evidence of having received training in the safeguarding of vulnerable adults.
• 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.
• Most patients said that they found it easy to make an appointment, 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 must make improvement are:

To introduce more robust systems for formal dissemination, and recording of the dissemination of, learning points from significant events.

To ensure that the recommendations of the Legionella risk assessment are reviewed and actioned.

To ensure that all staff have received vulnerable adult safeguarding training to the appropriate level and ensure all staff have undergone fire safety training.

The areas where the provider should make improvements are:

To designate and train some members of staff as fire wardens.

To ensure all new staff are risk assessed as to whether they require a DBS check.

To increase the number of patients diagnosed with dementia that are reviewed in a face to face meeting annually.

Assess the reasons for high levels of exception reporting for dementia, mental health, heart failure and cancer patients.

To ensure that all carers are identified and flagged on the records.

To look at ways to improve patient access to telephone and face to face consultations.

To make and retain full records of practice meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 June 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.

• Staff were trained in the recall of patients with long term chronic conditions to ensure all patients were invited for regular appropriate reviews.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading was 140/80 mmHg or less was 83% (clinical commissioning group (CCG) average 82%, national average 78%).

• Patients were educated as appropriate about their health conditions and involved in decisions about its management.

• 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.

• Medicine reviews were carried out regularly to ensure that patients understood and were complying with their treatment.

Updated 10 June 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 comparable to CCG averages for all standard childhood immunisations.

• All children and young people asking for an appointment on the day were either seen by the GP or received a telephone consultation depending on the problem.

• 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 test had been performed in the preceding five years screening was 80% (CCG 84%, national average 82%).

• Post-natal checks were available on site as well as checks on babies who were eight weeks old.

• 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.

• The practice had access to the social prescribing service at a local health centre which provided patients with advice and help with issues such as accessing benefits, debt counselling and housing advice.

• All clinical staff were aware of the law on consent in relation to young people.

Updated 10 June 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 looked after patients in several nursing homes.

• Proactive multidisciplinary team meetings were held monthly which included discussion about patients over 75 years.

• Medication was regularly reviewed.

• Referrals were made where appropriate to agencies to help access community based help and support.

• The practice provided influenza, shingles and pneumonia vaccines to their older patients and those other patients who were eligible.

Updated 10 June 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.

• Nurse appointments were available from 8am.

• The practice did not offer formal extended surgery hours, but GPs would be flexible and see patients outside normal hours in exceptional circumstances.

• The practice had introduced an on-line booking service for appointments and an on-line repeat prescription service.

• There was a range of health promotion and screening that reflected the needs for this age group.

Updated 10 June 2016

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

• 77% 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 clinical commissioning group average (82%) and the national average (84%).
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record is 88% which is comparable to the CCG average (93%) and 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.

• A representative from the local dementia care service attended multidisciplinary team meetings.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

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

• Patients in this population group were offered the opportunity to book longer appointments if required.

Updated 10 June 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, travellers and those with a learning disability.

• The practice was flexible in offering appointments to patients with learning difficulties including offering longer appointments where necessary.

• 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 looked after patients with learning difficulties in several care homes.

• The practice was involved in a new Locally Commissioned Service for Vulnerable Patients. This was a scheme that encouraged the practice to identify and increase the support for a wider range and number of patients with additional needs.