Ball Tree Surgery

Updated 31 March 2015

Ball Tree Surgery offers general medical services to the population of Sompting, Lancing and East Worthing. The practice is involved in the education and training of doctors, practice staff and other healthcare professionals. There are approximately 8,500 registered patients.

The practice is run by four partner GPs. At the time of the inspection a new partner was registering with the Care Quality Commission and we saw evidence of this. The practice was also supported by a salaried GP, practice nurses, healthcare assistants, a team of receptionists, administrative staff, finance and operations manager and a business manager.

The practice runs a number of services for it patients including asthma clinics, diabetes clinics, child immunisation clinics, new patient checks and holiday vaccinations and advice.

Services are provided from:                                                                                                   Western Road North,                                                                                                                 Sompting,                                                                                                                               Lancing,                                                                                                                                       West Sussex,                                                                                                                                         BN15 9UX

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 was a GP training practice and supported new registrar doctors in training. At the time of inspection there were two doctors who were receiving general practice training.

The practice population has a higher number of patients between 60 and 85 years of age than the national and local CCG average, with a significant higher proportion of 65-69 year old than the national average. There are a higher number of patients with long term health conditions. The CQC intelligent monitoring placed the practice in band six. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

Updated 31 March 2015

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Ball Tree Surgery on the 6 January 2015. The practice has an overall rating of good.

Ball Tree Surgery provides primary medical services to people living in Sompting, Lancing and East Worthing. At the time of our inspection there were approximately 8,500 patients registered at the practice with a team of four GP partners. A fifth GP was in the process of registering as a partner with CQC. The practice was also supported by a salaried GP, nurses, healthcare assistants and a team of reception and administrative staff. Ball Tree Surgery is a GP training practice and at the time of the inspection was providing training and support to two registrars.

The inspection team spoke with staff and patients and reviewed policies and procedures implemented throughout the practice. 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:

• GPs had their own patient lists and where possible encouraged continuity of care by patients seeing their named GP.
• Patient feedback about the practice and the care and treatment they received was very positive.
• Infection control audits and cleaning schedules were in place and the practice was seen to be clean and tidy.
• There was evidence the practice was listening to its patients and responding to any concerns or suggestions in a timely and effective manner.
• The practice had systems to keep patients safe including safeguarding procedures and means of sharing information in relation to patients who were vulnerable.
• There were a range of appointments to suit most patients’ needs.
• Patients with palliative care needs were supported using the Gold Standards Framework.
• The practice had been a training practice for 25 years and there was a culture of continuous development.

• The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.
• Innovative use of the practice computer system allowed for information to be recorded, stored and shared in a pro-active way which was both beneficial to the practice and its patients

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2015

The practice is rated as good for the care of people with long-term conditions. There were emergency processes in place and referrals were made for patients whose health deteriorated suddenly. Longer appointments and home visits were available when needed. All patients had a named GP and a structured annual review to check that their health and medication needs were being met. Where patients had more than one long term condition all of their needs were reviewed in one longer appointment to avoid multiple visits. The practice nurses were trained and experienced to support patients with managing their conditions and preventing deterioration in their health. For those people with the most complex needs, the named GP worked with relevant local health and care professionals to deliver a multidisciplinary package of care. Patients with palliative care needs were supported using the Gold Standards Framework. Flu vaccinations were routinely offered to patients with long term conditions to help protect them against the virus and associated illness.

Updated 31 March 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 living in disadvantaged circumstances and who were at risk. Immunisation rates were relatively high for all standard childhood immunisations. Specific services for this group of patients included family planning clinics, antenatal clinics and childhood immunisations. The practice offered contraceptive implants and coil fitting. Appointments were available outside of school hours and the premises were suitable for children and babies. Younger patients needing support and counselling were referred for early intervention support. We saw good examples of joint working with midwives and health visitors. Emergency processes were in place and referrals were made for children and pregnant women whose health deteriorated suddenly. 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. The practice ensured that children needing emergency appointments would be seen on the day.

Updated 31 March 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 were good for conditions commonly found in older people. Patients were able to speak with or see a GP when needed and the practice was accessible for patients with mobility issues. The practice had a housebound register and those patients had annual reviews. The practice used computerised risk stratification tools to identify patients at risk including those at risk of hospital admissions and worked closely with the proactive care team which included district nurses, community matron, physiotherapists, occupations therapists and pharmacists 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 dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. There were arrangements in place to provide flu and pneumococcal immunisation to this group of patients. Clinics available included diabetic reviews and blood tests. The practice also monitored blood pressure.

Updated 31 March 2015

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. Patients were able to request a GP to telephone them instead of attending the practice. 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. The practice offered a travel clinic for advice and vaccinations, which included yellow fever. Patients could be referred to the ‘wellbeing’ service, ‘why weight’ and the local alcohol support service to support patients with lifestyle modifications. The practice ran day and evening smoking cessation clinics and offered NHS health checks.

Updated 31 March 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 practice’s computer system and had an annual review. The practice had access to the ‘living well with dementia’ team and the dementia crisis team to provide extra support. Patients with severe mental health needs had care plans where both physical and mental health were 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. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice worked closely with local counsellors, the mental health team and consultants.

Updated 31 March 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 those with a learning disability. GPs carried out 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. 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. Patients could be referred to a local service for drug and alcohol abuse and also to the “friends and family support” service for families who may be affected by drug and alcohol. 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. Carers and those patients who had carers were flagged on the practice computer system and when registering with the practice were signposted to the local carers support team.