Archived: Herstmonceux Integrative Health Centre

Updated 31 January 2017

Herstmonceux Integrative Health Centre is situated in the village of Herstmonceux near the town of Hailsham, East Sussex. It serves approximately 4,200 patients living in Herstmonceux and surrounding villages. The health centre was purpose built by its owner and individual provider Dr John Simmons in order to provide a sustainable calm and relaxing environment for patients. Its design maximises natural light and reduces the impact on the environment.

The practice is owned and managed by an individual GP. In addition to the lead GP, they employ two part-time female salaried GPs. There are two practice nurses and a health care assistant. There is a practice manager and a team of administrative and reception staff. The practice is a training practice providing placements for GP registrars, who are fully qualified doctors gaining experience in general practice.

Data available to the Care Quality Commission (CQC) shows the practice serves a significantly higher proportion of patients over the age of 65 (23%) when compared to the national average (17%) although this is similar to the clinical commissioning group (CCG) average (26%). The proportion of patients under the age of 18 (19%) is similar to the CCG average (19%) and the national average (20%). Income deprivation is significantly lower than the national average which means that the population is relatively affluent. The ethnicity is predominantly white English.

The practice is open from 8.30am until 1pm and 2.30pm until 6.30pm Monday to Friday. Extended access is available one Saturday per month for patients who cannot attend during normal working hours. Appointments can be booked over the telephone, on line or in person at the surgery. Between 6.30pm and 8.30am the telephone lines are covered by the out of hour’s service. During the hours of 1pm and 2.30pm there is a mobile telephone number given to patients for contacting the practice’s duty GP. Details about how to access the out of hour’s service are made available to patients on the practice website, the practice leaflet or by calling the practice. The out-of-hours emergency cover is provided by Integrated Care 24. 

The practice provides a full range of NHS services and clinics for its patients including smoking cessation, asthma, diabetes, cervical smears, childhood immunisations, family planning, minor surgery and new patient checks. One of the GPs also provides medical acupuncture. A community cardiology service is also provided from the health centre premises. The practice aims to provide integrative medicine and there is a range of complementary medicine available from independent practitioners who are based at the health centre. This includes a medicinal herbalist, acupuncturist, counsellor, osteopath and physiotherapist. Patients can also access a range of classes at the health centre which include tai chi, yoga, medicinal Pilates and meditation on a private basis.

The practice provides services from the following location:-

Herstmonceux Integrative Health Centre

Hailsham Road

Hailsham

East Sussex

BN27 4JX

Updated 31 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Herstmonceux Integrative Health Centre on 29 September 2016. Overall the practice is rated as outstanding.

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

• 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.
• There was a strong focus on providing integrative care (based on treating the whole person rather than just the illness and the symptoms with a combination of medical and social prescribing) and the practice used innovative and proactive methods to improve patient outcomes. For example, it worked closely with other organisations to provide a full range of NHS services as well as a number of different social prescribing and community based schemes including singing workshops and walking for health.
• Feedback from patients about their care was consistently positive. The practice scored above average in all areas of the national GP survey.
• The practice placed a strong emphasis on addressing the wider social and lifestyle and community aspects of their patient’s health and worked closely with other organisations and with the local community to do this. For example in conjunction with members of its patient participation group and members of the parish council it had established ‘Vitality Villages’ as a platform to promote recreational and well-being activities within the parish to the public, ensuring that all ages and genders were catered for.
• 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). For example, the practice provided Saturday morning appointments and a dedicated flu clinic on Saturdays for working patients in response to patient feedback.
• 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 to deliver high quality integrated care working in conjunction with its partners in the community and to empower patients in achieving their health goals 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.
• The health centre had been purpose built and designed to support the practice’s vision to provide a sense of calm and relaxation for both patients and staff alike. It had been built with the patient experience in mind, to maximise natural light and reduce the impact on the environment. Patients told us that the practice environment promoted a sense of well-being whenever they visited.

We saw several areas of outstanding practice:

• There was a strong emphasis on providing integrative care which combined safe, effective medical treatment with a range of social prescribing initiatives. This enabled the practice to address the wider social and lifestyle and community aspects of their patients’ health. The practice endeavoured to empower patients to achieve their health goals through a number of different social prescribing and community based schemes. This included the prescribing of books from its patient library, singing workshops, healthy walks and a monthly coffee morning for elderly, isolated patients. The practice was able to demonstrate improved patient outcomes as a result.
• Working with the community and other organisations was integral to the practice’s vision to provide integrated care. In conjunction with its PPG and the parish council it established a group called ‘Vitality Villages’ which promoted recreational activities within the parish to the public, ensuring that all ages and genders were catered for and to ensure those who felt vulnerable or lacked confidence were enabled to make connections. Vitality Villages held a number of regular events targeting particular patient groups including men, older people, families and children and those who were vulnerable or isolated. The practice was able to demonstrate increased uptake of community well-being activities and reduced social isolation as a result.

The areas where the provider should make improvement are:

• Ensure that blank prescription forms for use in printers are tracked in accordance with national guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 January 2017

The practice was rated as outstanding for caring, responsive and well led services. These ratings apply to everyone using the practice, including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Practice performance against indicators for the management of long term conditions was better than the local and national averages. For example the percentage of patients on the diabetes register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 92% compared to the clinical commissioning group (CCG) average of 81% and the national average of 78%.
• 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 practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice encouraged patients with chronic lung disease, asthma and respiratory issues to attend its singing workshops as result of proven health benefits for this group of patients.

Updated 31 January 2017

The practice was rated as outstanding for caring, responsive and well led services. These ratings apply to everyone using the practice, including this population group.

• The waiting room at the health centre was designed to be a family friendly waiting room with a special play area for children, baby changing facilities on both floors, wide corridors, large consulting rooms and breastfeeding space on request.
• 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 relatively high for all standard childhood immunisations.
• The practice provided a full range of family planning services and cervical screening.
• The number of women aged between 25 and 64 who attended cervical screening in 2016/2016 was 87% compared to the clinical commissioning group (CCG) average of 82% and the national average of 81%.
• The practice had a flexible appointment system, including after school hours appointments and Saturdays.
• Child immunisation appointments could be made at parent’s convenience and not solely at the children’s clinic.
• In response to patient feedback the practice offered asthma clinics in the school holidays to help enable young people to attend.
• The community midwife held a fortnightly clinic from the health centre for the local community to access.
• The practice had developed good links with the local primary, senior school and pre-school, hosting visits to the health centre and first aid sessions for the younger children. For the older children the practice hosted visits for sixth form pupils who had an interest in medicine and nursing.
• We saw that the practice had planned a week of health events for families including talks by nutritionists, a talk on cyber safety, singing workshop for families as well as first aid and defibrillator training to take place in November 2016.

Updated 31 January 2017

The practice was rated as outstanding for caring, responsive and well led services. These ratings apply to everyone using the practice, including this population group.

• 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 had a GP lead for identifying vulnerable patients and those at risk of unplanned admission. Detailed care plans were developed for these patients whose needs were regularly reviewed at monthly multidisciplinary meetings.
• The GPs held weekly ward rounds at two local nursing homes and met regularly with staff to ensure patient needs were met.
• The practice hosted a regular podiatry clinic provided by a national charity for the elderly which provided a service to the practice’s older patients at a much reduced rate.
• The practice regularly referred isolated and lonely patients to a local befriending scheme.
• The local carer’s support organisation held weekly drop in sessions for carers at the health centre.
• The practice provided information in larger font and there was a portable hearing loop for patients with sensory disabilities.
• There was a special raised seating area in the reception for patients with mobility issues and wheelchairs were available on both floors of the building.
• In conjunction with ‘Vitality Villages’ the practice hosted monthly coffee mornings aimed at its older, vulnerable, often isolated patients, providing them with a chance to socialise, listen to speakers and take part in activities such as a quiz and have something healthy to eat.
• Every year, in conjunction with local community organisations, the practice held an ‘Older Persons Day’ inviting patients to take part in a number of healthy activities including crafts and singing workshops. This was aimed at reducing social isolation and encouraging the uptake of social activities in order to improve well-being. The practice was able to demonstrate improved uptake of activities as a result of these initiatives.

Updated 31 January 2017

The practice was rated as outstanding for caring, responsive and well led services. These ratings apply to everyone using the practice, including this population group.

• 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. For example, the practice provided Saturday morning appointments and a dedicated flu clinic on Saturdays for working patients.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 31 January 2017

The practice was rated as outstanding for caring, responsive and well led services. These ratings apply to everyone using the practice, including this population group.

• One of the GPs had a post-graduate qualification in dementia care and specialised in this area. They ran weekly memory assessment and diagnosis clinics at the health centre for all local patients in the clinical commissioning group (CCG) cluster area.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• 92% of patients with severe and enduring mental health problems had a comprehensive, agreed care plan documented in the record, in the preceding 12 months compared to the CCG average of 88% and the national average of 90%.
• 85% of patients with dementia had their care reviewed in the last 12 months which was higher than the CCG average of 81% and the national average of 84%.
• 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. All staff had been trained as ‘Dementia Friends’ and the practice was part of a local alliance looking to promote dementia friendly practices in the parish.
• The building was specifically designed to create a calm relaxed environment for patients with natural lighting and a non-clinical feel, which helped put patients who may be experiencing anxiety, putting them at ease.
• One of the GPs had a special interest in childhood mental health and behavioural conditions. The practice was developing well-being programmes which focused on teenage health and two of its GPs had recently delivered a workshop to 200 head teachers alongside the local county council.

Updated 31 January 2017

The practice was rated as outstanding for caring, responsive and well led services. These ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Vulnerable patients were highlighted on the practice’s electronic records.
• The practice offered longer appointments or home visits for patients with a learning disability according to their preference.
• 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.