Archived: Haven Health

Updated 13 July 2017

Haven Health is situated in the seaside town of Felixstowe. The practice provides services for approximately 7500 patients. In November 2016, the registered provider of Haven Health changed and the lead GP is now the registered provider. Haven Health holds a personal medical services contract with NHS England and is a training practice for GP registrars. GP registrars are qualified doctors who are training to be GPs.

There are three GPs (one male and two female) and two male locums who regularly provide services at the practice. There are three female nurses, three health care assistants/technicians, and two domiciliary care practitioners. The practice manager is supported a team of seven receptionists, four administrators and two medical secretaries.

We reviewed the most recent data available to us from Public Health England which showed that the practice population has a higher number of patients aged 25 to 55 and lower number of patients aged 75 and over years compared to the national averages. The practice has areas of deprivation that are higher than the national average.

Haven Health is open from Monday to Friday. The practice offers appointments from 8.30am to 6.30pm daily. Appointments can be booked six weeks in advance with urgent appointments available on the same day. Extended hours appointments for GPs and nurses are available at the practice on Thursday mornings from 7am to 8am. The practice, in collaboration with two local practices, offered same day appointments at Felixstowe Community Hospital. The practice was also part of a GP+ service; patients were able to be seen for evening or weekend appointments at Felixstowe community hospital and a location in nearby Ipswich. Out of hours care is provided by Integrated Care 24 via the NHS 111 service.

Updated 13 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Haven Health on 20 June 2017. Overall the practice is rated as good.

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

• The practice used innovative and proactive methods to improve patient outcomes, working with other providers to share best practice.
• There was a clear leadership structure, which was understood by the staff we spoke with. They told us the lead GP, and practice manager had involved them in developing their practice vision, and future development plans to offer greater services to their patients.
• The practice proactively sought feedback from staff and patients, which it acted on.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had systems to minimise risks to patient safety. A practice improvement plan was used to ensure improvements were made in a timely way and where delays occurred the risks were reviewed.
• Practice staff were aware of current evidence based guidance, and had been trained to provide the skills and knowledge to deliver effective care and treatment. The clinical staff discussed the guidance and patient cases at regular meetings.
• Results from the national GP patient survey, published in July 2016, showed patients were treated with compassion, dignity, and respect and were involved in their care and decisions about their treatment. The practice used social media to engage patients and gain feedback, and to inform patients of changes within the practice.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day. Extended hours appointments were available at the practice on Thursday mornings. The practice, in collaboration with two local practices, offered same day appointments at Felixstowe community hospital. The practice was also part of a GP+ service. This meant patients were able to be seen for evening or weekend appointments at Felixstowe Community Hospital and a location in nearby Ipswich.
• The practice had identified 3.4% of the practice list as carers. This included older people and young carers.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice was proactive in the health education of young people. They recently engaged school children in an art competition to design posters for their smoking cessation campaign. The entries were displayed in the practice and the practice reported a positive effect on patients. Annually, the practice held an open day for medical students from the Cambridge Medical School. This gave any young person who was aspiring to become a doctor the opportunity to learn more and the practice sent out the invitation to the local sixth form schools.
• The practice was proactive in health promotion and had won stop smoking awards in 2013 and 2016 for the work in promoting healthy lifestyles. They offered a C Card scheme to young people and had won two awards for the high quality of service given. C Card schemes enabled young people (including those not registered at the practice) to access free contraceptives.
• Continuous support was given to families who had suffered bereavement, and a card was sent on the anniversary of the bereavement.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Updated 13 July 2017

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

• A lead GP and a nurse with a special interest, supported by an administrator, managed the recall of patients with long term conditions. The practice were implementing a new system to further improve their service, ensuring patients received their annual checks in the month of their birth.
• All patients with a long term condition had a named GP and 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.
• Data from the quality and outcomes framework 2015-2016 showed that the practice performance in relation to diabetes was 71%. This was 21% below the CCG and 19% below the national average. The practice exception reporting rate for all indicators relating to diabetes was in line with the CCG and the national average,
• The practice performance in relation to chronic obstructive pulmonary disease was 98%; this was comparable to the CCG average and national average.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured their care plans were updated to reflect any additional needs.
• There were emergency processes in place for patients with long-term conditions who experienced a sudden deterioration in health.
• To increase uptake of annual reviews, the practice staff telephoned patients to arrange their appointments. Flexibility of appointment times was given to ensure that patients could attend at times convenient to them.

Updated 13 July 2017

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

• We found there were systems 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 accident and emergency (A&E) attendances. All correspondence received regarding children was seen by the safeguarding nurse to ensure appropriate care and follow up was in place.
• The practice offered a C Card scheme to young people and had won two awards for the high quality of service. C Card scheme enables young people (including those not registered at the practice) to access free contraceptives.
• The practice were proactive in the health education of young people, they recently engaged school children in an art competition to design posters for their smoking cessation campaign. The entries were displayed in the practice and the practice reported a positive effect on patients. Annually, the practice held an open day for pupils from the local six form school and medical students from the Cambridge Medical School attended. This gave any young person who was aspiring to become a doctor the opportunity to learn more.
• The practice had identified young carers and ensured appropriate support was given at each contact with any health professional.
• The practice had met the national target for the standard childhood immunisations.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors, and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes in place for acutely ill children and young people and for acute pregnancy complications.

Updated 13 July 2017

The practice is rated as good for the care of older people.

• Practice staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• There was a named GP for these patients and GPs and a practice nurse undertook weekly visits to ensure proactive health care to patients living in local care homes. The practice nurse supported any care home, where the community team did not attend, with their specialist skills in wound care.
• The practice identified older patients who may need palliative care as they were approaching the end of life. The practice involved older patients in planning and making decisions about their care, including their end of life care. The practice proactively used special notes to ensure other health providers were aware of the patient’s wishes in relation to their preferred place of care.
• The practice followed up on older patients discharged from hospital and ensured their care plans were updated to reflect any additional needs.
• The practice worked with voluntary agencies such as the Citizen’s Advice Bureau and Age Concern to offer additional support to older patients.

Updated 13 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, extended hours appointments were available at the practice on Thursday mornings from 7am to 8am. The practice, in collaboration with two local practices, offered same day appointments at Felixstowe Community Hospital. The practice was also part of a GP+ service; patients were able to be seen for evening or weekend appointments at Felixstowe community hospital and a location in nearby Ipswich.
• Telephone consultations were available for those who wished to access advice this way. After three telephone consultations the practice would offer a face to face appointment to ensure safe care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.
• NHS health checks were available at times convenient to the patient.

Updated 13 July 2017

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

• The practice carried out advance care planning for patients living with dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Data for the quality and outcome framework from 2015 to 2016 showed the practice performance for mental health was 68%. This was 28% below the CCG average and 25% below the national average. We review unverified data for 2016 to 2017, and saw their performance had improved significantly. The practice exception reporting rate for all indicators relating to mental health was below the CCG and national averages.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. A mental health link worker attended the practice regularly to support the GPs and ensure the patients with complex needs were well supported.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• The practice staff, including nurses and non-clinical staff, had received training and had a good understanding of how to support patients with mental health needs and dementia.

Updated 13 July 2017

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

• The practice was proactive in ensuring vulnerable patients were able to register for health care. For example, homeless patients or those who were in the care of social services.
• The practice held regular weekly meetings to ensure that patients who may be vulnerable were managed in a holistic manner.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability. The practice undertook weekly visits at a local care home that was dedicated to people with a learning disability.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations. A member of the local Citizens Advice Bureau attended the practice each week to support patients with social or financial concerns.
• Practice staff we spoke with knew how to recognise signs of abuse in children, young people, and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies during normal working hours and out of hours.
• To ensure that patients who were deaf and used sign language were involved in discussions and decision making with the health professionals, the practice routinely used on-line signing services.
• The practice had a non-clinical member of staff who was the chaperone champion. This member of staff ensured that patients were aware of the availability of chaperones. The staff member had attended an additional course on female genital mutilation.