Southbourne Surgery

Updated 28 April 2017

Southbourne Surgery is based in the Southbourne area of Bournemouth. The practice is located in a purpose built building with a community service in a separate area of the same building and a pharmacy in a building opposite. At the time of our inspection there were approximately 8,900 patients on the practice list. The district nursing team and health visitors are based in the building and the practice had access to community midwives based at the local hospital. A community physiotherapist works at the practice two days a week providing services to patients from the practice and other local practices. The practice has a General Medical Services (GMS) contract.

The practice has five GP partners and a salaried GP (three male and three female). The practice is a training practice and at the time of our inspection had one foundation doctor (A foundation doctor is undertaking a two-year general postgraduate medical training programme which forms the bridge between medical school and further specialist training). The doctors are supported by four nurses, a healthcare assistant, a practice manager, assistant practice manager, reception and administration staff.

The practice is open between 7.30am – 6.30pm Monday to Friday. Extended hours appointments are offered daily between 7.30am and 8am. The practice has opted out of providing Out Of Hours services to its own patients. Outside of normal practice hours, patients can access NHS 111, and an Out Of Hours GP service is available.

The service is provided at the following location:

Southbourne Surgery

17 Beaufort Road

Southbourne

Bournemouth

Dorset

BH6 5BF

The practice has a higher than average number of patients aged 40 to 50 years and female patients over 80 years old. It has lower than average number of patients aged 15 to 34 years.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Southbourne Surgery on 22 March 2016. Overall the practice was rated as good for providing effective, caring and responsive services; and was rated as requires improvement for providing safe and well-led services. As a result, the practice was given an overall rating of requires improvement. Following the inspection we issued two requirement notices. A notice was issued due to a breach of Regulation 12 of The Health and Social Care Act (Regulated Activity) Regulations 2014, relating to safe care and treatment; and a notice was issued due to a breach of Regulation 17 of The Health and Social Care Act (Regulated Activity) Regulations 2014, relating to good governance.

There were several areas of risk identified at Southbourne Surgery. Within our last inspection report we said the provider must ensure that:

• Policies and procedures for infection control were fully implemented including a robust system for stock checks and appropriate use of sharps safes.
• A risk assessment was undertaken for all staff, such as administrators who did not have a Disclosure and Barring Service (DBS) check in place.
• All staff were trained to the appropriate level in adult and child safeguarding, and that there was evidence to confirm this.
• A system of annual staff appraisals was implemented.
• All equipment, including the stair lifts, had appropriate maintenance checks and was suitable for use.
• Staff were trained and were confident to support patients in the use of equipment such as the stair lift.
• A system was put in place so that policies and procedures were updated and implemented, and staff were aware of how to access them.

The full comprehensive report on the 22 March 2016 inspection can be found by selecting the ‘all reports’ link for Southbourne Surgery on our website at www.cqc.org.uk.

We undertook a focused inspection of the practice on 28 March 2017. The inspection was to confirm that the practice had implemented its action plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 22 March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings across all the areas we inspected during this inspection, were as follows:

• We saw documentary evidence of a system, which was now in place to check medical consumables expiry dates in all clinical rooms. All sharps safe expiry dates were checked and sharps safe pouches that were full or not used were disposed of after three months.
• We saw documentary evidence that Disclosure and Barring Service (DBS) checks were applied for or recorded in personnel files for existing staff employed prior to CQC registration, as well as new staff. We also saw documentary evidence that a risk assessment tool was in place to determine whether administrative staff required a DBS check.
• We saw documentary evidence that all staff were trained to the appropriate level in adult and child safeguarding.
• We saw documentary evidence that the practice had implemented a system of annual staff appraisals.
• We saw documentary evidence that the practice stair lifts had appropriate maintenance checks and were suitable for use.
• Staff demonstrated that they were fully trained and confident to support patients in the use of stair lift equipment.
• We saw documentary evidence that a system had been put in place to update and implement policies and procedures, and we spoke to staff who demonstrated awareness of how to access them.

Following this inspection the practice was rated as good overall across all domains.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 August 2016

The practice was rated as requires improvement for providing safe and well-led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• 76% of patients with diabetes, on the register, in whom the last IFCCHbA1c was 64 mmol/mol or less in the preceding 12 months, was comparable with the national average of 78%.
• 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 a robust recall system for these patients run by named members of administration staff.

Updated 11 August 2016

The practice was rated as requires improvement for providing safe and well-led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 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 high for all standard childhood immunisations.
• 74% of patients with asthma, on the register, who had had an asthma review in the preceding 12 months that included an assessment of asthma control was comparable with the national average 75%.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• 84% of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was slightly higher than the national average 82%.
• 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 11 August 2016

The practice was rated as requires improvement for providing safe and well-led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 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 patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice has implemented an over seventy fives project with one GP spending three clinical session a week on this.

Updated 11 August 2016

The practice was rated as requires improvement for providing safe and well-led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 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.
• The practice offered electronic prescribing which allowed the prescription to be sent electronically to the pharmacist of the patient’s choice which could be near their place of work.
• The practice offered extended hours appointments from 7.30am every weekday morning.

Updated 11 August 2016

The practice was rated as requires improvement for providing safe and well-led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 92% 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%.
• 92% of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was better than the 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.
• 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.
• The practice provided care to a number of patients who were living in a supported living environment.

Updated 11 August 2016

The practice was rated as requires improvement for providing safe and well-led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams 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.