Cornerways Medical Centre

Updated 11 January 2018

Cornerways Medical Centre is located in a purpose built building in a residential area of Poulner, Ringwood in Hampshire.

The practice provides services to just under 12,000 registered patients and is part of NHS West Hampshire Clinical Commissioning Group (CCG). The practice is based in an area of low deprivation compared to the national average for England and the majority of patients at the practice identify themselves as being from a White British background. A total of 29 percent of patients at the practice are over 65 years of age, which is higher than the CCG average of 22% and national average of 17%. Older patients may have higher health care needs.

Care to patients is provided over two floors at Cornerways Medical Centre. The practice has a lift to support patients who are unable to manage stairs. Access for patients is via a level pathway, with automatically operated doors. The practice has eight GP consulting, three nurse consulting rooms and three treatment rooms including a minor operation room.

Cornerways Medical Centre also houses community midwives, district nurses and health visitors.

The practice has six GP partners, two of whom are female and four are male. The practice also employs two female and one male salaried GP. The GPs are supported by three practice nurses, one of whom is also an independent prescriber, and three health care assistants who provide a range of treatments. The practice employs a phlebotomist so that patients can have blood samples taken at the practice. The clinical team are supported by a management team and secretarial and administrative staff. The practice is a training practice for doctors training to be GPs (registrars) and a teaching practice for medical students. At the time of our inspection, two GP registrars were also working at the practice.

The practice is open between 8am and 6.30pm Monday to Friday. Reception closes every day between 1pm and 2pm, however phone lines remain open during this time. Extended hours appointments are available alternate Mondays and Thursdays from 6.30pm until 7.30pm and every fourth Saturday from 8am until 12pm. The GPs also offer home visits to patients who need them; typically each GP conducts three home visits per day. The practice has opted out of providing out-of-hours services to their own patients and refers them to the Dorset and Hampshire Urgent Care services via the NHS 111 service. The practice offers online facilities for booking of appointments and for requesting prescriptions.

The practice operates a branch surgery a few miles away located at 1 Pine Drive, St Leonards, Dorset, BH24 2LN. We did not visit the branch surgery on this inspection. The branch surgery is open every weekday morning from 8.30am until 12pm and also Monday, Wednesday and Friday afternoons. Patients are able to make appointments at either location, and staff work across both sites. We visited Cornerways Medical Centre as part of this inspection, located at:

Parkers Close

Gorley Road

Ringwood

Hampshire

BH24 1SD

Updated 11 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cornerways Medical Centre on 4 July 2017. The overall rating for the practice was good. However the rating for the well-led section was requires improvement. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Cornerways Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 December 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 4 July 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good overall and is now rated good in the section for well-led.

Our key findings were as follows:

• Governance arrangements had improved in relation to health and safety processes and staff training.

• The provider had reviewed their complaints process since the last inspection and the correspondence sent to patients now clearly explained the guidance for further action if required.

• The significant events process had been reviewed and a new computer system has been installed that supported the reporting and learning of all events in a timely manner.

• The practice had increased the levels of nursing staff in order to be able to increase the quality and quantity of health checks for all population groups, with particular reference to those with learning disabilities and mental health conditions. Since the last inspection the practice had employed one new practice nurse so that there were now four practice nurses. There were also now three health care assistants that could help undertake checks.

• The practice website was regularly updated, with information for all patients on services provided at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 August 2017

The provider is now rated as good 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.

• A total of 71% patients with asthma had an asthma review in the preceding 12 months compared to the CCG average of 75% and national average of 76%. Exception reporting was 4% which was lower than the CCG rate of 12% and national rate of 8%.
• 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 medicine 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 1 August 2017

The provider is now rated as good for 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.

• 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.
• Immunisation rates were above the expected national standard for all standard childhood immunisations.
• 81% of eligible women attended for a cervical screen examination which is similar to the national average of 82% and clinical commissioning group average of 82%.
• The practice participated in a local scheme to provide free condoms to patients under 25 years of age to encourage positive sexual health.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had a private breast-feeding area and play area in the waiting room designed for young children.
• The practice liaised with local schools and had conducted health talks to children focussing upon obesity, internet pornography (senior school) exercise, smoking, drugs and anxiety.
• One of the GPs had an additional qualification to provide counselling for sexual health disorders.
• We saw positive examples of joint working with midwives, health visitors and school nurses through multi-disciplinary working. For example, the practice held regular clinics for families to see health visitors alongside childhood immunisation clinics.

Updated 1 August 2017

The provider is now rated as good for older people.

• 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.
• Nationally reported data showed that outcomes for patients with conditions commonly found in older patients were similar or better than the national average. For example, the practice had a higher number of patients with stroke compared to the national average. A total of 97% of patients with a stroke were on the correct medication to prevent further blood clots which was in line with the national average of 97%. Exception reporting for this indicator was lower at 4.7% compared to the the national average of 5.4%.
• The practice employed a dedicated GP for two sessions per week to support patients living in nursing homes registered at the practice and other elderly patients with increased needs.

Updated 1 August 2017

The provider is now rated as good for 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 extended hours appointments aimed at people unable to attend in usual hours.
• The practice offered telephone advice for patients unable to attend the surgery in the usual opening hours. Patients could book appointments and order repeat prescriptions online.
• The practice supported and provided a meeting point for a local Healthy Walks scheme.

Updated 1 August 2017

The provider is now rated as good for people experiencing poor mental health (including people with dementia).

• Staff had a good understanding of how to support patients with mental health needs and dementia.
• One of the GPs had additional qualifications to support patients with complex mental health conditions and received regular clinical supervision from a psychiatrist.

• A total of 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, compared to the clinical commissioning group (CCG) and national average of 84%.
• A total of 87% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in the preceding 12 months compared to the CCG and national average of 89%. Exception reporting for this indicator was 0%, compared to the CCG average of 14% and national average of 13%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and substance addiction.
• The practice 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 had ran an open session on mental health led by a GP aimed at anyone living in the community.
• 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.
• All patients with mental health conditions were offered a physical health check. Of the 60 patients registered with a severe mental illness, 42 of them had received a physical health check (70%).

Updated 1 August 2017

The provider is now rated as good for people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability. The practice allowed patients who were homeless to use the practice address as their address for any correspondence.

• The practice offered longer appointments for patients with a learning disability. The practice provided medical care to five adult learning disability homes.
• A total of 23 of 45 patients (approximately 51%) with a learning disability on the practice register had received an annual health check.
• 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.