Archived: The Practice Willow House

Updated 25 June 2015

The Practice Willow House offers general medical services to people living in the Lower Bevendean region of Brighton and Hove. It is a single handed practice with one salaried GP and there are approximately 1980 registered patients.

The practice was run by The Practice Group. The practice was supported by central management functions from the head office, including human resources, health and safety and clinical locality leads. The practice was also supported by one salaried GP, a long term locum GP, a nurse, healthcare assistant and a team of receptionists. Operational management was provided by the practice manager.

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

Services are provided from:

The Practice Willow House

50 Heath Hill Avenue

Lower Bevendean

Brighton

BN2 4FH

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.

The practice population has a higher number of patients under the age of 18, compared with the England average but comparable with the CCG average. The practice population also has a higher number of patients claiming disability allowance compared with the England and CCG average, plus a higher percentage of unemployment and percentage of patients with a long standing health condition.

Updated 25 June 2015

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of The Practice Willow House on 28 April 2015.

The practice has an overall rating of good.

The Practice Willow House provides primary medical services to people living in the Lower Bevendean region of Brighton and Hove. At the time of our inspection there were approximately 1977 patients registered at the practice with one salaried GP and locum cover. The practice was also supported by a nurse, a healthcare assistant and a team of reception and administrative staff.

The inspection team spoke with staff and patients and reviewed policies and procedures. The practice understood the needs of the local population and engaged effectively with other services. There was a culture of openness and transparency within the practice and staff told us they felt supported. The practice was committed to providing high quality patient care and patients told us they felt the practice was caring and responsive to their needs.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• The practice had systems to keep patients safe including safeguarding procedures and means of sharing information in relation to patients who were vulnerable.
• Infection control audits and cleaning schedules were in place and the practice was seen to be clean and tidy.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles, with the exception of chaperone training for administrative staff. Any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had responded to concerns from patients about not being able to get appointments, and a high level of non-attendance by developing a same day only appointment system. They had implemented online appointment booking for patients unable to call in and this was working well for the majority of patients we spoke with.
• 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.
• Patients with palliative care needs were supported using the Gold Standards Framework.
• The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.
• 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 (PPG).

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should;

• Ensure all staff acting as chaperones have received appropriate training.
• Ensure that repeat prescribing protocols are reviewed and shared with all GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 June 2015

The practice is rated as good for the care of people with long-term conditions. The practice nurse had a lead role and was trained in chronic disease management, including asthma, chronic obstructive pulmonary disease (COPD), and diabetes. Patients at risk of hospital admission were identified as a priority and the practice monitored the Urgent Care Dashboard regularly to identify patients using Accident and Emergency services. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Patient records were flagged so that GP’s were aware when a patient had a care plan in place. Patients with palliative care needs were supported using the Gold Standards Framework and a register was kept of these patients. Flu vaccinations were routinely offered to patients with long term conditions to help protect them against the virus and associated illness.

Updated 25 June 2015

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 who were at risk. Immunisation rates were good for all standard childhood immunisations, although better (90%) for children up to 2 years than those up to 5 years (70%). Specific services for this group of patients included family planning clinics, antenatal clinics and childhood immunisations. The practice would refer pregnant women to a midwife and share their care during the pregnancy. Appointments were available outside of school hours and the premises were suitable for children and babies. There were children’s activities available in the waiting area of the practice. Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse. Safeguarding policies and procedures were readily available to staff and processes to follow were clearly visible on notice boards in staff areas. The practice ensured that children needing emergency appointments would be seen on the day.

Updated 25 June 2015

The practice is rated as good for the care of older people. Patients had a named GP which allowed for continuity of care. Nationally reported data showed that outcomes for patients for conditions commonly found in older people were mixed, for example their QOF score for diabetes was 66%, for hypertension 57%, yet they scored 100% for rheumatoid arthritis, heart failure and atrial fibrillation. Patients were able to speak with or see a GP when needed and the practice was accessible for patients with mobility issues. The practice identified patients at risk including those at risk of hospital admissions and developed care plans involving the patient, their family and carers. Multidisciplinary meetings were held to discuss patients and the practice worked closely with the proactive care team to plan care accordingly. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in diabetic and end of life care. The surgery also had a community volunteer ‘Navigator’ who would signpost elderly patients to relevant services such as voluntary organisations like age concern. The practice was responsive to the needs of older people, and offered home visits and telephone appointments for patients who found it difficult to get into the surgery. The practice also provided a weekly service to the local nursing homes and provided individual patient reviews according to need. There were arrangements in place to provide flu and pneumococcal immunisation to this group of patients and the practice were in the process of inviting patients aged 78 and 79 for a shingles vaccination.

Updated 25 June 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice acknowledged that their open hours would not always meet the needs of working age people due to it being a single handed practice and the majority of appointments were ‘on the day’ appointments which the practice felt met the needs of the majority of their patients. However, the practice participated in a government scheme called EPIC so that patients could be offered appointments every evening until 20.00 and between 09.00 and 14.00 at weekends. The scheme was a locality scheme where patients would see a GP at another practice in the locality. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs of this age group. Patients could be referred to smoking cessation and for weight management and healthy eating advice.

Updated 25 June 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients at risk of dementia and those with dementia were flagged on the practices computer system and had an annual review. Patients with severe mental health needs had care plans where both physical and mental health was assessed as well as annual reviews. New cases had rapid access to community mental health teams. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia and we saw that 88% of annual dementia reviews had been carried out at the time of our inspection. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. We were told that there was a 6 week waiting list for talking therapies within the local community but that the community mental health team were often able to see patient’s on the day if the referral was urgent.

Updated 25 June 2015

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 those with a learning disability. GPs carried annual health checks for people with a learning disability and where necessary the practice offered longer appointments for vulnerable patients. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. The practice worked closely with community navigator volunteers who attended the practice patient participation group meetings and provided links in the local community. These community navigators worked particularly with vulnerable patients in the community to signpost them to relevant services and support them in accessing the care and support that they needed. 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. Translation services were available for patients who did not use English as a first language. The practice could accommodate those patients with limited mobility or who used wheelchairs.