Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the GP service provided by Royal Hants Hospital known as and referred to in this report as Nicholstown Surgery on 22 June 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and managed with the exception of managing expiry dates of equipment and medicine in the GPs bag; monitoring and security of prescription forms and pads and ensuring regular fire drills took place.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Staff tailored care for patients with diabetes particularly for those who identified themselves as Muslim. This included visiting local mosques to educate patients on the importance of a healthy diet. Nurses worked with diabetic Muslim patients to tailor their treatment plans during the month of Ramadan, a religious festival whereby individuals fast for a month during daylight hours.
• Patients said they found it difficult to make an appointment with a named GP. Urgent appointments were available the same day.
• Patients reported difficulties in making an appointment via the telephone. The system currently cuts off patients after 6 minutes of being on hold.
• The practice created links with local organisations to help provide additional support for patients in the community particularly for young Muslims with Type 2 diabetes.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Ensure that there is a robust review of all medicines management at the practice including checking the expiry dates of medicines and calibration of equipment stored within the GP bag.
• Ensure the practice follows guidelines set out by the Solent NHS Trust particularly around actioning learning points from significant events around monitoring prescription forms security.
• Ensure all staff required to undertake chaperoning duties have received training, this includes for non-clinical staff.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Solent NHS Trust provides inpatient services on two wards at Royal South Hants Hospital. Lower Brambles Ward (24 beds) primarily provides intermediate care as a step-down facility following discharge from the local acute hospital. Fanshawe Ward (19) beds provides intermediate care as a step-down facility following discharge from the local acute hospital or for patients admitted from home for a period of rehabilitation. The ward also has allocated step- up beds used to avoid admission to the local acute hospital.

Patients and their relatives commented favourably on the care and treatment they or their relative received on the wards. Patients (and/or relatives where appropriate) were involved in decisions about their care and their plans for discharge.

We found the wards delivered safe care and people were protected from abuse and avoidable harm. There were systems and processes in place for identifying, investigating and learning from incidents. Patients’ needs were assessed and records indicated that treatment, care and support was provided to meet those needs. There was effective multidisciplinary and multi-agency working to ensure that people received care that met their needs, at the right time and without delay. Discharge planning was comprehensive and consistent.

Staff followed best practice guidelines when treating and supporting people. They showed great enthusiasm and motivation in their work, which resulted in positive care, treatment and rehabilitation outcomes for people.There were audit systems in place to check on the quality of care, including the prevention of infections. We saw staff using good hand washing techniques and there were sufficient hand washing facilities throughout the wards.

We found that the care was delivered by caring and compassionate staff. We observed staff treating patients with dignity and respect. The service was responsive to the views and needs of people who used the service and staff gave us examples of how services had been developed in response to patient feedback.

The two wards at the Royal South Hants Hospital were well-led. Staff told us they felt able to raise concerns and were supported to carry out their job role. Staff were very passionate and proud to work at the service and aware of the vision and values of the organisation. We saw evidence of good integrated team work and regular monitoring of the quality of the service being delivered.