The Orchard Surgery

Updated 15 May 2018

The Orchard Surgery offers general medical services to the population of Lancing, Sompting and East Worthing. The practice is situated in the centre of Lancing village and is purpose built being managed by an external company. The practice shares its accommodation with staff from the Sussex Community Trust. There are approximately 6,900 registered patients. The practice operates from the following location:-

Lancing Health Centre

Penstone Park

Lancing

West Sussex

BN15 9AG

The practice population has a slightly higher number of patients between 60 and 85 years of age than the national average and slightly lower than average compared to the local clinical commissioning group (CCG). Its population has a higher than average deprivation score compared to the CCG for both children and older people.

The practice is run by one partner GP and one non clinical partner. There are two salaried GPs who at the time of the inspection were on maternity leave. The practice also employs an advanced nurse practitioner, two practice nurses and a health care assistant. There is a team of receptionists, administrative staff, a practice manager and an assistant practice manager.

The practice is a training practice for foundation level two doctors and medical students.

The Orchard Surgery is open between 8.30am to 6.30pm from Monday to Friday. The practice provides same day and phone appointments with GPs and nurses. It also offers pre-bookable, routine appointments outside of core hours on Thursday evenings from 6.30pm. Saturday morning appointments are provided on a rota basis with other local surgeries.

During the contracted hours of 8am to 6.30pm from Monday to Friday when the practice is closed, patients are directed to an out of hour’s provider.

The practice is registered to provide the regulated activities of diagnostic and screening procedures; treatment of disease, disorder and injury; maternity and midwifery services; family planning and surgical procedures.

Updated 15 May 2018

Letter from the Chief Inspector of General Practice

The Orchard Surgery was previously inspected on 22 January 2015 and was rated as good overall and for safe, effective, caring, responsive and well-led services.

At this inspection on 20 March 2018 the practice is rated as good overall.

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 recently retired and students – Good

People whose circumstances may make them vulnerable – Good

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

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.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Due to a GP partner vacancy and maternity leave the practice had had to limit the number of pre-bookable appointments. However, on the day appointments, home visits and phone consultation services were available. Urgent appointments for those with enhanced needs were also provided the same day and patients were able to pre-book appointments on line. We saw that the practice regularly reviewed its appointment system to ensure there was sufficient capacity to meet patient needs.
• There was an active patient participation group in place who told us that they had seen improvements within the practice.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. The practice worked closely with other services in order to provide and improve care for their patient populations.
• Staff were positive about working in the practice and were involved in planning and decision making.
• Patient survey results were positive and higher than average in a number of areas.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 March 2015

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. 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 medicine needs were being met. The GPs followed national guidance for reviewing all aspects of a patient’s long term health. 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. The practice nurses were trained and experienced to support patients with managing their conditions and preventing deterioration in their health. Diabetic patients were supported by the advanced nurse practitioner who managed their condition but was able to encourage patients to monitor their own condition and set health goals. Flu vaccinations were routinely offered to patients with long term conditions to help protect them against the virus and associated illness.

Updated 26 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, for example, children and young people who had a high number of A&E attendances. Monthly meeting were held with a lead health visitor to discuss any children of concern. 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 patients we spoke with on the day of the inspection confirmed this. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors. 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 26 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 patients. The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, in dementia and end of life care. Elderly patients with complex care needs all had personalised care plans that were shared with local organisations to facilitate the continuity of care. The practice was responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs. 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 safeguarding lead for vulnerable adults. The practice had good relationships with a range of support groups for older patients. There were arrangements in place to provide flu and pneumococcal immunisation to this group of patients. Clinics included diabetic reviews and blood tests. Blood pressure monitoring was also available.

Updated 26 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. 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 NHS health-checks and advice for diet and weight reduction. Nurses were trained to offer smoking cessation advice and patients could request routine travel immunisations.

Updated 26 March 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients with severe mental health needs had care plans and received annual physical health check. New cases had rapid access to community mental health teams. The practice regularly worked with multi-disciplinary teams in the case management of patients 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. We noted that staff had taken part in a dementia workshop and recently had attended training in the Mental Capacity Act 2005.

Updated 26 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 for example those who were housebound or with complex health needs. The practice ensured that patients classed as vulnerable had annual health checks. It offered longer appointments for patients when required. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. 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. 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 were signposted to the local carers support team.