Archived: The Practice North Street

Updated 9 September 2016

The Practice North Street offers general medical services to people living and working in central Brighton. It is a practice with two male locum GPs providing a total of 10 sessions a week. In addition a lead locality male GP for The Practice Group/Chilvers and McCrea Ltd was available to support the practice and the locum GPs. The lead locality GP was employed for four sessions a week at one of the other Brighton based The Practice Group/Chilvers and McCrea Ltd locations and had an additional two sessions to provide support to the other four Brighton based members of the group. There are approximately 2100 registered patients.

The practice was run by The Practice Group/Chilvers and McCrea Ltd. The practice was supported by central management functions from the head office, including human resources, health and safety and clinical locality leads. The practice also had two part time practice nurses, a part time pharmacist and a team of receptionists. Operational management was provided by the practice manager and assistant practice manager.

The practice runs a number of services for its patients including asthma clinics, child immunisation clinics, diabetes clinics, new patient checks, and weight management support.

Services are provided from:

The Practice North Street, c/o Boots, 129 North Street, Brighton, BN1 2BE

The practice has opted out of providing Out of Hours services to their patients. There are arrangements for patients to access care from an Out of Hours provider (111).

The practice population has a lower proportion of patients over the age of 65 and a lower proportion of patients under the age of 18, compared with the England average. The practice population also has a lower number of patients compared to the national average with a long standing health condition and with health related problems in daily life. The practice population has higher than average levels of employment and a lower than average proportion of unemployment.

Updated 9 September 2016

Letter from the Chief Inspector of General Practice

The Practice North Street was inspected in June 2015 where they were rated requires improvement in safe, effective, responsive and well-led services. They were rated as good in caring. As a result we carried out a further announced comprehensive inspection at The Practice North Street on 24 May 2016. We found the practice to require improvement in safe, effective, caring, responsive and well-led services. Overall the practice is rated as requires improvement.

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

• The practice had taken positive action following a previous inspection including ensuring that medicines were stored securely and that the use of high risk medicines was monitored and managed. They had also worked to improve the use of care plans for patients with long term conditions.
• The practice had also ensured that staff, clinical and multi-disciplinary meetings were being held regularly.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and well managed, with the exception of those relating to fire safety.
• Infection control was not always being managed effectively and not all staff were appropriately trained or up to date with infection control training.
• Published data showed patient outcomes were low compared to the national average, however unverified data from the practice from 2015/16 showed significant improvements in this area.
• Some audits had been carried out and we saw evidence that audits were driving improvements to patient outcomes. However, there was no clear programme of continuous clinical audit.
• Patients said they were treated with compassion, dignity and respect. However, results from the GP patient survey showed that not all patients felt listened to or involved in their care in relation to GP consultations.
• There were some issues with availability of nursing appointments and there was no healthcare assistant in post so health checks were not being offered proactively unless a patient requested one.
• The practice had only recently begun to identify which of their patients were also carers and there was some information in the practice on support for carers.
• There was no clear vision, strategy or business plan.
• The practice approach to engaging with patients continued to be limited, with no PPG and unclear action as a result of patient surveys and information collated from patient feedback sources.

The areas where the provider must make improvements are:

• Ensure that fire risk assessments are actioned and updated.
• Ensure that the results of infection control audits are appropriately actioned to ensure evidence of continuous improvement.
• Ensure that all staff are appropriately trained and updated in relation to infection control, including the lead for infection control having attended appropriate training for this role.
• Ensure that there is a centralised system in place to monitor the adoption of NICE guidance.
• Ensure that the practice engages with patients through the use of patient participation and patient surveys and that there is clear action taken to improve the patient experience, particularly in relation to GP consultations.
• Ensure there is clear leadership and adequate staff to meet patient needs within the practice and that staff roles and responsibilities are clear during a period of change.

In addition the provider should:

• Ensure that there is a programme of continuous clinical audit in place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 September 2016

Due to the issues identified within the practice the service is rated as requires improvement for the care of people with long-term conditions.

• Performance for diabetes related indicators was lower at 68% compared to the national average 89.2%. However, the practice showed evidence of improvement to these figures in their 2015/16 unverified data.
• Longer appointments and home visits were available when needed. Patients had a named GP, and the practice had provided additional locum GP cover to ensure that all patients with a long-term condition had received a structured annual review to check that their health and care needs were being met.

Updated 9 September 2016

Due to the issues identified within the practice the service is rated as requires improvement for the care of families, children and young people.

• Immunisation rates for the standard childhood immunisations were mixed. For example childhood immunisation rates for the vaccinations given to under two year olds ranged from 65% to 88% and five year olds from 63% to 68%.
• Appointments were available outside of school hours and the premises were suitable for families, children and young people because.
• The practice’s uptake for the cervical screening programme was 60% which was below the CCG average of 72.4% and the national average of 76.7%. This was largely due to difficulties recruiting nurses.

Updated 9 September 2016

Due to the issues identified within the practice the service is rated as requires improvement for the care of older people.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data for 2014/15 showed that outcomes for patients for conditions commonly found in older people were lower than local and national averages. For example, performance for chronic obstructive pulmonary disease (COPD) was 47% compared with 93.9% (CCG) and 96% (national). However, the practice had worked to improve these figures during 2015/16 and the current year.

Updated 9 September 2016

Due to the issues identified within the practice the service is rated as requires improvement for the care of working-age people (including those recently retired and students).

• The practice offered extended opening hours for appointments during weekday evenings and on Saturdays through a local project where appointments could be offered at a local practice.
• Patients were able to book appointments and request repeat prescriptions online.
• Telephone appointments were available.
• Health promotion advice was offered and there was health promotion material available in the practice.

Updated 9 September 2016

Due to the issues identified within the practice the service is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia).

• 75% of people experiencing poor mental health had received an annual physical health check and had a comprehensive care plan in place compared with 82.9% (CCG) and 88.3% (national).
• Practice performance in relation to mental health was at 72.7% compared with a national average of 92.8%; however there was evidence of improvement in this area from unverified data from the practice.
• The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental.
• The percentage of patients with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 100% which was 26.4% higher than local average and 23% above the national average.

Updated 9 September 2016

Due to the issues identified within the practice the service is rated as requires improvement 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, 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. They used a community navigator to provide additional support to enable patients to access such services.
• 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.