Archived: Ocean Health

Updated 19 January 2017

Ocean Health is located in Plymouth, Devon and has an NHS England general medical services (GMS), personal medical services (PMS) and alternative provider medical services (APMS) contracts to provide health services to approximately 22020 patients. Ocean Health was formed in June 2016 from three practices; Collings Park, Stirling Road and Chard Road. Collings Park had been inspected by the CQC before the merger and operates as a stand alone GP practice in another part of the city. Stirling Road and Chard road provide care to patients within the same deprived urban area and have been divided into an acute hub (Chard Road) and routine care centre (Stirling Road).

Patients access appointments by calling in to the practices or by using the telephone system which directs calls either to Collings Park or Ocean Health. The calls at Ocean Health are answered by a call handler who then directs calls to the most suitable appointment. Pre-bookable appointments can be made four weeks in advance or patients who need to be seen on the same day can be referred to the triage list which is managed by the acute care team.

The practice is open between 8am and 6pm during the week. The practice have an arrangement in place to transfer calls between 6pm and 6.30pm to the out of hours provider. Patients are advised of accessing this by using the 111 telephone number. In addition to routine appointments, walk in clinics are offered to children under five years of age twice a day. Telephone triage and telephone appointments are also available. Patients can also use a web based internet consultation service. Extended hours are offered between 7am and 8am on Tuesday, Wednesday and Thursday.

The practice has opted out of providing out-of-hours services to their own patients and refers them to an out of hours provider via the NHS 111 service. This information is displayed on the outside of the practice and on their website.

Data from public health England showed that the mix of patient’s gender (male/female) is almost 50% each. 8% of patients were above the age of 75 which is comparable to the England average of 8%. 2% of the patients are aged over 85 years old which is comparable to the England average of 2%. There was no data on ethnicity however staff said they thought the majority of practice patients are white British. The deprivation score for the practice area is recorded as three on a scale of one to ten. One being more deprived and ten being less deprived.

The practice is a teaching practice for medical students and foundation doctors with good feedback from the medical school practice visit report. The practice hope to start a GP registrar training programme.

At the time of inspection there was an established team of six GP partners (two male and four female). The practice manager is also a partner. GPs partners hold managerial and financial responsibility for running the business. The GP partners are supported by two salaried GPs and a long term locum GP (Three female). The GPs are supported by seven clinical practitioners/independent prescribers. There are also three staff working on the emergency care team who were paramedics. There are nine nursing staff who worked across the three locations. Five are based at Stirling Road, two at the acute care hub and two at Collings Park. The nursing team are supported by five healthcare assistants. There are five members of the management team; a managing partner, practice manager, office manager, clinical IT manager and nursing manager. There are additional reception and administration staff.

Ocean Health provide the regulated activities from three sites:

Acute Care Hub, Chard Road, St Budeaux, Plymouth PL5 2UE

Collings Park Medical Centre, 57 Eggbuckland Road, Hartley, Plymouth PL3 5JR

Ocean Health Centre- Stirling Road, St Budeaux, Plymouth PL5 1PL

We visited the Stirling Road location for this inspection.

Updated 19 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ocean Health on Tuesday 20 December 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. Feedback from the NHS friends and family tests was also positive.

• 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. Staff had access to guidance to whistleblowing policies and contact details within staff areas.

• Patients said they found it difficult to get through on the telephone to make an appointment. As a result the practice were in the process of introducing additional telephone lines and call handlers.
• Patients said they were able to speak with a GP or emergency practitioner on the same day but sometimes had to wait to see a GP of their choice if they wanted continuity of care.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Text reminders were used to remind patients of their appointment. Patients could use text messages to cancel appointments in an attempt to reduce any ‘did not attend‘(DNA) appointments and in the process making more appointments available to other patients.

• 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 practice had started to introduce systems to identify military veterans and to ensure their priority access to secondary care in line with the national Armed Forces Covenant 2014.

• The practice merger had identified gaps in data collection and had resulted in the introduction of computer software and a consistent approach to identifying conditions which aimed to improve the quality outcome framework (QOF) results.

We saw one area of outstanding practice:

The practice had responded to the needs of ill children and offered a walk in service for children under the age of five years. Parents and guardians could bring their child without appointment to twice daily children’s clinics. The service had received positive feedback from patients. Data from the practice showed that the service had seen an average of between 12 and 18 children per day with an increasing trend of attendances. Data showed there had been a reduction of patient numbers in this age group attending the emergency department (ED) during the day. For example ED day time admissions for practice children between 2013/14 was 40. This figure reduced to 35 in 2014/15 after the service had started. This showed a reduction of 12.5%.

The areas where the provider should/must make improvement are:

• Consider managing complaints in the same manner as significant events, as appropriate, to ensure learning is shared across the whole team.

• Introduce a system to ensure all clinical equipment which moves around the practice is included on the calibration checking programme.

• Inform patients of the action being taken as a result of their feedback.

• Ensure a system is in place for checking GP bags for expiry dates of medicines and equipment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 January 2017

The practice is rated as good for the care of people with long-term conditions.

• The practice had a higher than national average number of patients with long term conditions. For example 16% of the practice population had high blood pressure compared to the national average of 14%. 3% of patients had chronic obstructive pulmonary disease (COPD) compared to the national average of 1.8%.
• Nursing staff had lead roles in chronic disease management and diabetic nurses were able to initiate insulin treatment plans.
• 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.
• All patients with chronic obstructive pulmonary disease were issued with rescue packs and care plans.
• Patients had access to spirometry tests. (Spirometry is a test that can help diagnose and monitor various lung conditions.)
• Longer appointment times and home visits were available if needed
• Patients at risk of hospital admissions were identified as a priority and a care plan was in place.
• INR monitoring was available at the practice. (The test used to monitor the effects of warfarin is called the International Normalised Ratio, or INR. It is a blood test that checks how long it takes for blood to clot.)
• The practice staff worked with the community long term conditions (LTC) matron to coordinate the care of patients who had more than one LTC.

Updated 19 January 2017

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

• The practice provided care for a significant number of patients involved with child safeguarding and domestic violence and had effective working relationships with children’s social workers.
• 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.
• 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.
• 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.
• Children’s walk in clinics were available in the mornings and afternoons for children under 5. This service had seen a reduction in day time emergency department admissions.
• The duty GP was available throughout the day to deal with children and young people who needed immediate attention.
• A baby change and breast feeding room was available for use.
• Young people were signposted to the local drop in centre and the young person’s weight management service.
• Parents were encouraged to access a paediatric app which gave guidance on how to identify and treat common ailments and potentially life threatening conditions including sepsis.

Updated 19 January 2017

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.

• Rapid access appointments and care was available for those with enhanced needs.

• Patients had access to pneumococcal, Influenza and shingles vaccines.

• The practice worked with community nurses to follow-up hospital discharge to ensure all patient needs were met.

• There was effective liaison with local care homes to provide appropriate health and medicines reviews and treatment escalation plans. Ward rounds at those homes were carried out every one to two weeks.

• Care homes and local pharmacies had been provided with the practice telephone by pass number for quick access to help and support.

• There was a carers lead and signing posting for local support services.

• The practice nurse visited all housebound patients requiring chronic disease management and vaccinations.

Updated 19 January 2017

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 reflects the needs for this age group.
• Private medicals and Heavy Goods Vehicle medicals were offered.
• Patients had access to abdominal aortic aneurysm screening on site.
• The practice offer vaccinations for students in line with guidance.
• Military veterans were identified for priority access to Secondary Care in line with the National Armed Forces Covenant 2014
• Text message appointment reminding service and appointment cancelling services were available.

Updated 19 January 2017

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

• 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 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. Staff had worked at the practices for many years and had built up relationships with vulnerable patients, those with mental health issues and frequent attenders.
• GPs at the practice prescribed medicines for the treatment of drug addiction in liaison with the local drug and alcohol treatment centre. GPs worked with the drugs worker for medicines prescribing and care planning.
• Patients were supported to access the Plymouth options anxiety and depression service and were supported to complete on line forms if required.
• The practice supported an in house counselling charity by providing a room free of charge.
• One of the GPs was involved in setting up a new counselling service for young people through the education authority and clinical commissioning group (CCG).

Updated 19 January 2017

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, military veterans and those who were housebound. Homeless patients and refugees were identified and an alert added to the patient records to ensure they received appropriate support.
• Annual Health Checks for patients with Learning Disabilities provided and care plans in place. There was a flexible approach to where reviews took place. For example, at home or in the surgery.
• The practice offered longer appointments for patients with a learning disability and practice staff worked effectively with the 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.
• 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.
• Weekly prescriptions were available for patients at risk of over using medicines.