Quayside Medical Practice

Updated 18 August 2016

Quayside medical practice is located in a residential area of Newhaven and provides primary medical services to approximately 9,200 patients.

There are five GP partners and three salaried GP (three male, five female). The GPs are supported by six female practice nurses, two healthcare assistants, a team of receptionists, administrative staff, business, clinical data and patient services co-ordinators and a practice business manager.

Data available to the Care Quality Commission (CQC) shows the practice serves a higher than average number of patients who are aged 45-74 years. The number of patients aged between 10-19 and 30-44 years of age is slightly lower than average. The practice delivers healthcare to the most deprived population of the CCG area. The practice had a deprivation score of 24.2 which was both higher than the CCG average of 12.1 and the national average of 21.8. The percentage of children within the practice list affected by income deprivation was 23.5% compared to the CCG average of 11.1%. The percentage of older people affected by income deprivation within the practice was 16.6% compared to the CCG average of 10%.

The practice is open Monday to Friday between 8.30am and 6pm. Appointments can be booked over the telephone, online or in person at the surgery. Arrangements are in place for IC24 to manage phone calls between 8am and 8.30am and 6pm to 6.30pm. Patients are provided information about how to access an out of hour’s service by calling the surgery or viewing the practice website. Out of hours care is provided by IC24.

The practice runs a number of services for its patients including; chronic disease management, new patient checks, smoking cessation, phlebotomy, travel vaccines and advice.

Services are provided from one location. Quayside Medical Practice, Chapel Street, Newhaven, East Sussex, BN9 9PW

The practice has a General Medical Services (GMS) contract with NHS England. (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice also offers enhanced services to their patients including minor surgery, patient participation and reducing unplanned admissions. The practice is part of NHS High Weald, Lewes and Havens Clinical Commissioning Group.

Updated 18 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Quayside Medical Practice on 10 March 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows

• Patients were protected by a strong comprehensive safety system and a focus on openness, transparency and learning when things go wrong.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, working with a local organisation in providing a workshop so people could learn how to cook on a restricted budget.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, changing the quantity of pre-bookable appointments available on a Monday as this was the busiest day for the practice with patients requiring urgent appointments following the weekend.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

• The practice had worked with nursing home staff in developing a system whereby patients with long term conditions could have deterioration in their condition recognised and care intervention started immediately by administering medicines that had been provided for such an issue. This has assisted in reducing A&E attendance by 13% and unplanned admissions by 20% for patients aged 75 years and over in the year from 2014/15 and 2015/16.
• The practice, recognised the level of deprivation their patients faced. They had collaborated in securing funding from the Clinical Commissioning Group to provide free transport for patients to enable them to attend appointments at the practice and the local hospitals, along with attending the minor injuries unit instead of A&E. The service was also available to patients of neighbouring practices. 28% of Patients using this service had reported that without this support being available they may not have attended their appointments as they may not have been able to afford to get there and 60% of transport users report improved emotional wellbeing due to this service. This service had provided 3,242 passenger trips between February 2015 and January 2016.
• The practice hosted a carers support worker who provided support and advice for patients on a range of issues once a month. This clinic ran between 9am and 5pm on one Tuesday per month and could be accessed by appointment or by dropping in on the day.
• The practice undertook an “after death” analysis on patient’s to recognise areas of good practice and to ensure any areas of development were acted upon appropriately.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 18 August 2016

The practice is rated as outstanding 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.
• Data from 2014/15 showed the percentage of patients with diabetes, on the register, who had influenza immunisation in the preceding 1 August 2014 to 31 March 2015 was 96% compared to the national average of 94%.
• 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. Multidisciplinary care team meetings were held monthly.
• The practice, recognising the level of deprivation within their patient population worked with the CCG to obtain funding for a free at the point of use transport service to ensure patients could access their service and also attend hospital appointments or the local minor injuries unit thus decreasing the pressure on A&E. Evidence seen documented that between November 2015 and April 2016 there was an average of 15 patient journeys per day. The maximum was 22 journeys. Of those patients who had utilised this service 28% report that without the transport service they would either have cancelled their appointment or simply not attend.

Updated 18 August 2016

The practice is rated as outstanding 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 the highest within the CCG area 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.
• Data showed that the percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 91% compared to the national average of 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, health visitors and school nurses.
• All clinical staff had received child safeguarding training to level three.

Updated 18 August 2016

The practice is rated as outstanding 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 has a named GP partner who has leadership responsibility for frail and elderly patients.
• All patients on the admissions avoidance register are flagged on the practice’s computer system to ensure that they receive an appointment on the same day and that they also had a personalised care plan in place.
• The practice had created specific patient care interventions and worked in partnership with nursing staff within care homes for the 35 patients that were on their list and residing in these homes. This involvement assisted in lowering both the A&E attendance and unplanned admissions for those aged over 75. The reduction, by the practice, for A&E attendance between the years 2014/15 and 2015/16 was 13% and for unplanned admissions 20%.The practice was actively involved in working with the CCG in establishing the community geriatrician service within the Havens area.
• The practice held specific multi-disciplinary team meetings monthly to discuss care plans and identify patients who may be at risk of hospital admission. This meeting was attended by GPs, staff from older people’s mental health, adult social care, Living Well, Care for the Carers and District Nurses

Updated 18 August 2016

The practice is rated as outstanding 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.
• The practice offered telephone consultations with a GP of the patient’s choice to discuss issues.
• Electronic prescribing was available for patients which allowed their prescriptions to be sent directly to a pharmacy of their choice.

Updated 18 August 2016

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

• 87% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
• Data showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 93% compared to the national average of 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, for example, Newhaven Your Way and the Sussex Community Development Association.
• 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 actively screened patients for dementia so as to enable early referral to memory assessment services.
• The practice was engaged with the CCG’s “Golden ticket for dementia” programme which ensured that carers had a point of contact within the practice ensuring that rapid support could be delivered when times become challenging for people.

Updated 18 August 2016

The practice is rated as outstanding for the care of people who 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 offered longer appointments for patients with a learning disability.
• 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 had developed partnership working with organisations such as health in mind and Sussex Community Development Association which have delivered outreach services at the practice.

• The practice held a welfare support clinic one Tuesday per month between 9am and 5pm utilising the practice’s dedicated support worker. Appointments were available to book through reception or people could just arrive on the day. All areas of support and advice could be discussed to assist people looking after someone and introductions could be made to other support organisations if appropriate.