The Stubbington Medical Practice

Updated 1 March 2018

The Stubbington Medical Practice is the provider for the regulated activities, at the only location, which is called is The Stubbington Medical Practice.

The Stubbington Medical Practice has approximately 13,100 patients registered. There are higher numbers of patients aged 50 years and older when compared with the national average. There are fewer patients than the national average who are aged 44 years old and under. The practice provides the medical care for approximately 200 patients who live in care homes. The practice population has few ethnic minorities and is mostly White British, in one of the least deprived parts of the country.

The practice is registered with the Care Quality Commission to provide the following regulated activities:

• Surgical procedures;

• Treatment of disease, disorder or injury;

• Family planning;

• Maternity and midwifery services;

• Diagnostic and screening procedures.

There is one location for the provider The Stubbington Medical Practice. We inspected this location:

The Stubbington Medical Practice

Park Lane

Fareham

Hampshire

PO14 2JP

Practice website: www.stubbingtonmedical.co.uk

Updated 1 March 2018

Letter from the Chief Inspector of General Practice

This practice is rated as good overall. (Previous inspection May 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Stubbington Medical Practice on 8 January 2018, as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• Care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• The practice understood the needs of its population and tailored services in response to those needs. For example extended opening hours, online services such as repeat prescription requests, advanced booking of appointments, advice services for common ailments. Weekly prescriptions were used for patients who were at risk of over-using medicines. A dedicated member of the prescription team worked with care homes and the clinical commissioning group pharmacist to monitor and reduce polypharmacy, prevent errors and improve efficiency.

• Annual reviews were offered for patients who had a learning disability. A GP acted as a link person for patients with learning disabilities who were living in care homes and would offer home visits if needed.

• Innovation and improvement was a priority among staff and leaders:

• For example the practice had introduced home visits by one of the practice nurses in March 2015 at the time of this inspection this was on two days a week. Additionally the practice had introduced Friday visits to care homes to proactively review patients to avoid unnecessary hospital admissions over the weekends.

The areas where the provider should make improvements are:

• Continue with the review of training records to demonstrate what training staff have received.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 3 October 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 and patients at risk of hospital admission were identified as a priority.
• 78% of patients with diabetes last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less (01/04/2014 to 31/03/2015). This was comparable to the Clinical Commissioning Group average of 80% and national average of 81%.
• The practice used specialist equipment to help support patients with long-term conditions. For example, patients with diabetes could upload their blood sugar results to the consultants at the hospital to allow an overview by their diabetes team. This allowed the patients to remain at home and meant the practice could better monitor them.
• 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 GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 3 October 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. Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 79%. This was comparable to a Clinical Commissioning Group average of 84% and a national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice met with these professionals on a two monthly basis to ensure the health needs of this group were met. The practice made direct contact with individual school nurses as required.

Updated 3 October 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• A practice nurse visited one nursing home linked to the practice to educate staff about the use of specific feeding methods and a healthy diet.
• A specialist in elderly medicine visited the practice every two months to support the practice to manage patients who were older and becoming frail.

The practice introduced a visiting service for older people. This consisted of one practice nurse visiting older people who had requested a GP house call on Mondays and Thursdays.

Updated 3 October 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, flexible and offered continuity of care.
• 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 3 October 2016

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

• 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was comparable to a Clinical Commissioning Group average of 85% and a national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice carried out advance care planning for patients living with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and those living with dementia.
• However, there was an exception rate in this area of clinical targets showing this practice exempted 36 out of 86 patients which was a rate of 42%. This was higher compared to the CCG average of 15% and the national average of 13%. (Information from CQC data pack).

Updated 3 October 2016

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 homeless patients, 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.
• 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.