Victoria Road Surgery

Updated 25 July 2016

Victoria Road Surgery is run by a partnership of six GPs (three male and three female). They are supported by one salaried GP and three regular locum GPs, one of whom covers annual and sickness leave. The practice team also consists of a nurse practitioner, six practice nurses, three health care assistants, a practice manager, five other management staff and a team of receptionists and administrative staff.

One of the partners has decided to change their role and become a salaried GP. They will be reducing their work load by two sessions per week. The practice is taking steps to recruit a new partner or salaried GP and a second nurse practitioner.

The GPs run shared lists, so patients can see whichever GP they wish, although all patients on the practice list do have a named GP.

The practice has a list size of approximately 13,000 patients and operates from two sites. The practice had recently seen its list size rise by 1,500 patients following the closure of another practice locally. The main Victoria Road site is a converted and extended Victorian house which is owned by the partners. The second surgery is based within a 1970s health centre in Durrington. This is shared with another practice and ancillary services and is rented from the local NHS Trust.

Services are provided at:

Victoria Road Surgery, 50 Victoria Road, Worthing, West Sussex, BN11 1XE.

and at

Durrington Health Centre, Durrington Lane, Worthing, West Sussex, BN13 2RX.

Only the Victoria Road site was visited on the day of the inspection.

The practice runs a number of services for its patients including COPD and asthma management, child immunisations, diabetes management, cervical smears, new patient checks and travel health advice amongst others. Intrauterine Contraceptive Devices (IUCDs) can be fitted at the practice. The practice also offers an open access clinic for children under five every day, when no appointment is necessary.

Joint injections and minor surgery are carried out at the practice.

The practice at Victoria Road is open between 8am to 6.30pm Monday to Friday. The surgery at Durrington is open between 8am and 6pm and is closed for lunch between 1pm and 2pm. Appointments are from 8am to 11.50am every morning and 2.20pm to 5.50pm in the afternoon.

The practice offers extended surgery hours on Monday, Tuesday, Wednesday and Friday morning from 7am to 8am and from 6.30pm to 7.30pm on Thursday at Victoria Road Surgery.

In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments were accessible on the day for people that needed them. Telephone consultations were bookable and online bookings become available from 8am each day.

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

The practice population has a slightly higher number of patients under 18 than the national average. There is also a lower than average number of patients of 65+ years. There are an average number of patients with a long standing health condition and an average number of patients with a caring responsibility. There are a lower than average number of patients in paid work or full time education. The percentage of registered patients suffering deprivation affecting children is lower than average for England. The percentage of registered patients suffering deprivation affecting adults is higher than average for England.

Updated 25 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Victoria Road Surgery on 24 May 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.
• Patients said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.
• The practice ran a walk in clinic for one hour every weekday afternoon for children under five years of age.
• 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.

We saw some areas of outstanding practice including:

• The practice employed a Practice Patient Lead who represented and supported older and vulnerable patients and also those with long term conditions. This included helping them with any difficulty that they may have had with medicines.

• The practice carried out, and acted upon, an annual staff survey.

The areas where the provider should make improvement are:

• To assess the reasons for, and ways of, improving on the lower than average uptake of some childhood vaccines.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Updated 25 July 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.

• The percentage of patients with diabetes, on the register, whose last measured total cholesterol was 5 mmol/l or less was 80% (clinical commissioning group average 80%, national average 81%).

• 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.

• Pro-active care admission avoidance meetings were held every two weeks.

• There was an on-line facility to monitor test results for patients with long term conditions. This helped patients participate in their care.

• The practice was involved in the locality diabetes Year of Care planning, which involved a different approach to the management of diabetes.

• The practice had access to the MIAMI (minor injuries assessment and minor illness) clinic which, as part of their role, provided extra chronic disease appointments at weekends.

Updated 25 July 2016

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

• The practice provided an in house well-being service. This was a social prescribing service that provided social, emotional and practical support to patients via a range of non-clinical services.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, the practice held minuted multi-disciplinary team meetings regularly to discuss vulnerable children and families. Immunisation rates were comparable to local averages for all standard childhood immunisations for two and five year olds, but a bit lower than average for 12 month olds.

• 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 record that a cervical screening test has been performed in the preceding 5 years was 96% (clinical commissioning group average 83%, national average 82%). These statistics were not the same as those quoted by the National Cancer Intelligence Network as they are measured in a different way.

• 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, health visitors and school nurses.

• The practice ran a walk in clinic on Monday to Friday from 3pm to 4pm for children five years and under.

• The practice had access to the MIAMI service which ran a children’s walk in service from 4pm to 7.30pm Monday to Friday at various sites across the locality.

• The practice provided contraceptive services.

Updated 25 July 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.

• They provided on-line access for appointments, medical records and medicine requests and also participated in electronic prescribing.

• Each patient had a named GP.

• There was an on-line patient participation group as well as an in-house group. This allowed house bound patients to also feedback to the practice should they wish to.

Updated 25 July 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 and electronic prescribing as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice offered text reminders of appointments.

• Appointments were available outside normal surgery hours.

Updated 25 July 2016

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

• 74% 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 national average (84%).

• The percentage 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 89% (national average 88%).

• The practice visited care homes for patients with dementia and carried out annual reviews and care planning.

• There was on-line access available to appointments and medicine requests for patients by their named and consented carers.

• 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.

• All staff had attended a Dementia Friends training day.

Updated 25 July 2016

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

• The practice employed a Practice Patient Lead who represented and supported older patients and those with long term conditions. This included helping them with any difficulty that they may have had with medicines.

• The practice held a register of patients with a learning disability.

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

• Annual health reviews were carried out for all patients with learning disabilities and the practice worked with the local learning disability team.

• 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.

• The practice was responsive to the needs of vulnerable patients. For example health care assistants (HCAs) or reception staff often ensured wheelchair bound patients got home safely by accompanying them home on foot.

• 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.