Archived: Benfield Valley Healthcare Hub

Updated 29 March 2017

The Benfield Valley Healthcare Hub is situated in the Portslade and Hove areas of Brighton. It is based at two locations The Portslade County Clinic and Burwash Medical Centre. It provides general medical services to approximately 7000 patients.

There are three GP partners, two non-clinical partners and four salaried GPs. There are two nurse practitioners, three practices nurse and one health care assistant. There is one pharmacist. There is a practice manager and a team of secretarial, administrative and reception staff.

The practice has a contract with Here Limited, (formerly known as Brighton Integrated Care Services, a not-for-profit social enterprise and primary care federation) for the provision of some of its back office functions including human resource management, finance, health and safety and the provision of some of its policies and procedures. It also has a contract with an independent provider of health and social care for the provision of GP telephone consultation services.

Data available to the Care Quality Commission (CQC) shows the practice serves a higher than average number of patients between the ages of 0 and 18. It has a lower than average population over the age of 85. There is a much higher level of income deprivation affecting both children and older people when compared to the national average.

The Benfield Valley Healthcare Hub is open at the Portslade County Clinic site from 8.30am until 12.30pm and 2pm until 6pm Monday to Friday. There is extended access on Tuesday evenings between 6.30pm and 7.15pm. The Burwash Medical Centre is open from 8.30am until 12.30pm and 2pm until 6pm on Mondays, Tuesdays Wednesdays and Fridays and from 8.30am to 12.30pm on Thursdays. All GP appointments are triaged which means that when a patient phones the practice, the receptionist takes their phone number and the GP or nurse practitioner calls them back. The patient speaks directly with a GP or a nurse practitioner who assesses their clinical need and either deals with it on the phone or, if necessary, makes an appointment for the patient to be seen that day. Phone triage appointments can be booked over the phone, on line or in person at the surgery. Patients are provided with information on how to access the out of hours service on the practice website or by calling the practice. The out of hours service is provided by Integrated Care 24 Limited.

The practice provides a number of services and clinics for its patients including smoking cessation, cervical screening, childhood vaccines and immunisations, family planning and minor surgery.

The practice provides services from the following locations:-

Portslade County Clinic

Old Shoreham Road

Portslade

Brighton

East Sussex

BN41 1XR

Burwash Medical Centre

14 Burwash Road

Hove

East Sussex

BN3 8GQ

Updated 29 March 2017

Letter from the Chief Inspector of General Practice

The practice was rated good overall and is now rated good for providing safe services.

We carried out an announced comprehensive inspection of this practice on 23 June 2016. A breach of legal requirements was found during that inspection within the safe domain. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the legal requirements. We conducted a focused inspection on 9 March 2017 to check that the provider had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

During our previous inspection on 23 June 2016 we found the following areas where the practice must improve:

• Implement systems for assessing, monitoring and acting on risks in relation to the health and safety of patients, staff and visitors.
• Take action to address identified concerns with infection prevention and control.
• Improve the security of blank prescription stationery.

Our previous report also highlighted the following areas where the practice should improve:

• Continue to take action in order to address areas where lower levels of patient satisfaction have been identified.
• Ensure that plans to ensure all staff have an annual appraisal are successfully implemented.
• Keep higher than average exception reporting rates for the quality and outcomes framework under review and ensure action is taken to reduce rates where clinically appropriate.(Exception reporting is the removal of patients from Quality and Outcomes Framework calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• Build on the work undertaken so far to identify carers within the practice in order to increase the number of carers known to the practice and help ensure they receive appropriate support.
• Ensure that risk assessments accurately identify staff who are likely to be left alone with patients and that appropriate recruitment checks are undertaken

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

During the inspection on 9 March 2017 we found:

• Systems were now in place for monitoring and acting on risks in relation to the health and safety of patients, staff and visitors.
• Concerns identified at the last inspection in relation to infection prevention and control had been addressed.
• Arrangements were now in place for the tracking of blank prescription stationery.

We also found in relation to the areas where the practice should improve:

• Results from the national GP Survey published in July 2016 showed that patient satisfaction had improved in some areas. For example during this inspection we found that 80% of patients who responded were able to get an appointment or speak to someone last time they tried compared to 63% from the results published in January 2016. However, patient satisfaction was still lower than average in a number of key areas including patients being able to see a preferred GP, GPs involving patients in decisions about their care, treating them with care and concern and explaining tests and treatments. Patient satisfaction with their overall experience of the practice and the number of patients who would recommend the practice was also lower than average. The practice should therefore continue to take action in order to address areas where lower levels of patient satisfaction have been identified.
• We saw that plans to ensure all staff had an annual appraisal had been implemented.
• Exception reporting rates had reduced in a number of areas, for example in mental health. However, exception reporting rates for asthma had increased to 30% and were significantly above the national average of 7% and the clinical commissioning group average of 10%. The practice should therefore continue to review exception reporting rates for the quality and outcomes framework and ensure action is taken to reduce rates where clinically appropriate.
• The practice had built on its work to identify the number of carers on its list and ensure they were signposted to the various avenues of support. For example, the NHS health check template now included a hyperlink to the local carers support information so that this could be printed off for patients. The practice had identified a further 50 carers since our last inspection. The practice had updated its risk assessment to ensure that it accurately identified staff that were likely to be left alone with patients. We saw that appropriate recruitment checks had been undertaken as a result.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 September 2016

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

• Nursing staff had lead roles in chronic disease management.
• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification was 94% compared to the clinical commissioning group (CCG) average of 87% and the national average of 88%.
• Longer appointments and home visits were available when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• There were personalised care plans in place for patients with diabetes and chronic lung disease.

Updated 14 September 2016

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 living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed was 77% compared to the CCG average of 81% and the national average of 82%.
• Appointments were available outside of school hours.
• The practice was able to work closely with midwives, who were based in the same premises.
• The practice employed a nurse practitioner with a special interest in women’s health who ran weekly clinics for contraception and sexual health.

Updated 14 September 2016

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

• The practice worked with other practices and health and social care providers in the locality to identify patients at risk of avoidable, unplanned admission to hospital to ensure that they had a plan of care in place in order to prevent this.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 14 September 2016

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 and flexible.
• Appointments were available in the evenings and at weekends via an extended hour’s service which was shared with three neighbouring practices. This included a comprehensive contraception, women’s health and sexual health service in the evening.
• The practice had recently implemented an electronic prescribing system which enabled people to obtain medication from a pharmacist close to their place of work.
• 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.

Updated 14 September 2016

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

• The percentage of patients with a severe and enduring mental health problem who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (04/2014 to 03/2015) was 79% compared to the CCG average of 83% and the national average of 88%.
• The practice was able to refer patients to memory assessment services based in the same premises. The specialist nurses who ran this service provided the GPs with easy access to advice and guidance as required.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had invested in making its premises at the Portslade County Clinic location more ‘dementia friendly’, for example having contrasting colours for doors and door frames.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 September 2016

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

• The practice identified patients living in vulnerable circumstances including homeless people, and those with a learning disability.
• The practice provided care to young male patients who were being provided with accommodation and support by a national Christian organisation.
• The practice worked closely with local drug and alcohol services to support patients struggling with substance misuse.
• The practice hosted a ‘community navigator’ who supported vulnerable patients with accessing various support groups and voluntary organisations.
• 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.