Archived: Ninfield Surgery

Updated 21 April 2016

Ninfield Surgery offers general medical services to the people of Ninfield and the surrounding area. There are approximately 2000 registered patients. The practice is able to dispense medicines to its patients living in a one mile radius of the practice.

Ninfield Surgery is a branch surgery of Collington Surgery which has approximately 5000 registered patients. Collington Surgery also has another smaller branch at Windmill Hill. Staff can work across any of the three surgeries with the exception of dispensary staff who work at Ninfield Surgery. Quality Outcome Framework (QOF) data for Ninfield Surgery also includes patients registered at the Collington Surgery and Windmill Hill. The Collington Surgery has previously been inspected and a separate report is available on the CQC website.

The Ninfield Surgery is run by three partner GPs (male) who at the time of the inspection, had just appointed a further (female) partner. The practice is also supported by one salaried GP (female). The practice were also in the process of employing a Nurse Practitioner. They were also supported by three practice nurses, two health care assistants, and a team of receptionists, administrative staff, four dispensers, a finance manager and a practice manager. Nursing staff and reception staff from the main surgery in Collington would cover staff on annual leave.

The practice is a training practice for GP registrars (qualified doctors who are undergoing further specialist GP training) and medical and nursing students from Brighton and Sussex Medical School.

The practice runs a number of services for its patients including asthma clinics, child immunisation clinics, well women and well man clinics, diabetes clinics, new patient checks and travel health clinics. The practice also carries out minor surgical procedures on the premises.

Services are provided from three locations:

Main Surgery:-

Collington

23 Terminus Road, Bexhill-on-Sea, TN39 3LR

Branch Surgeries

Ninfield

High Street, Ninfield, Near Battle, East Sussex, TN33 9JP.

Windmill Hill

Victoria Road, Windmill Hill, Hailsham, East Sussex, BN27 4SZ

This report only relates to the inspection at Ninfield Surgery.

Opening hours are Monday to Friday 8.15am to 12 am and from 2pm to 6pm. There is extended opening on Saturday mornings from 8.30am to 11.30am, one weekend in four and patients have access to appointments at the Collington site for the remaining three out of four Saturdays. This is for pre-bookable appointments only. When the practice is closed patients are advised to access the 111 service who, if necessary, will contact IC24 an out of hours provider.

The practice population has a higher number of patients aged between 55 and 85+ than the national average. There is also a lower than average number of patients aged 44 or less. There is a higher 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 lower than average for England.

Updated 21 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ninfield Surgery on 15 March 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 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.
• Patients said they found it easy to contact a GP 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 should make improvement are:

• To review the system in place for the daily temperature check and recording for dispensary fridges.

• Should analyse QOF returns to assess whether exception reporting could be reduced.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 April 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, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 77.2% (national average 78%)

• Longer appointments and home visits were available when needed.

• All these patients had a lead 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 lead GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Unplanned admissions in to hospital were discussed at monthly clinical meetings.

Updated 21 April 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 high for all standard childhood immunisations.

• The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months was 82.4% (national average 75.3%)

• 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 screening test had been performed in the preceding 5 years was 77.2% (national average 81.8%)

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

• We saw positive examples of joint working with other health and social care professionals.

Updated 21 April 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 patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice were involved in a recent Clinical Commissioning Group (CCG) initiative to produce concise care plans for those older patients with complex needs. Care plans were personalised and each patient had been involved in writing them.

• Elderly patients with complex needs were identified and flagged on the computer records. Any elderly patients with additional needs would be discussed at the monthly multi-disciplinary team (MDT) meetings and their personalised care plans would be shared to facilitate continuity of care.

• The practice had its own dispensary and provided weekly blister packs of medicines to nursing homes and to individual patients where appropriate. Housebound patients could have their medicines delivered by the dispensary.

Updated 21 April 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 provided pre-bookable appointments on Saturday morning

• 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.

Updated 21 April 2016

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

• 87% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months which was above 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 93.5% (national average 89.5%)

• 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.

Updated 21 April 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 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.

• The practice said that they would register patients if they were homeless.