Downlands Medical Centre

Updated 1 September 2016

Downlands Medical Centre is located in Polegate with a branch site, Lower Willingdon Surgery, located two miles away in a residential area.

The practice operates from:

Downlands Medical Centre

77 High Street

Polegate

East Sussex

BN26 6AE

Opening hours:

Monday to Friday: 8.30am to 6.30pm. An emergency phone line to the practice is in place from 8am to 8.30am.

Appointments are available from 8.30am to 11.20am and 3pm to 5.20pm, with extended hours appointments available on Wednesdays from 7.30am.

Patients can book appointments in person, by phone or on line.

The branch site is at:

Lower Willingdon Surgery

4 The Triangle

Lower Willingdon

Eastbourne

BN20 9PJ

Opening hours:

Monday to Friday: 8.30am to 12.30pm and 2pm to 5.30pm

Appointments available from 8.30am to 11.20am and 3pm to 5.20pm, with extended hours appointments available on Mondays from 6.30pm to 8.30pm.

Patients can book appointments in person, by phone or on line.

We visited both surgeries during this inspection.

The building where Downlands Medical Centre is based is a converted shop and has restricted space. All consulting rooms are on the ground floor, and waiting areas are in the front of the building and in the corridor. The practice is unable to expand due to space constraints and is working with the local council to find suitable new premises. This is planned to be in a new housing development which is scheduled to be completed by 2018.

Lower Willingdon Surgery is based in a small converted shop and has two consulting rooms and a waiting area.

There are approximately 10,500 patients registered at the practice. Statistics show little income deprivation among the registered population. The registered population has a much lower than average number of 0-49 year olds and a higher than average for those aged 55-64, and much higher than average for those aged 65 and over. The number of patients aged 85 and above is three times the national average. A large number of older patients live in their own homes, and the practice looks after about 115 older patients in nursing homes.

The practice has seven partners (six male and one female). Four of the doctors work full time and the other three work part time. There are four practice nurses and three health care assistants. The practice manager leads a team of 16 reception and administration staff.

Patients requiring a GP outside of normal working hours are advised to contact the NHS GP out of hours service on telephone number 111.

The practice has a General Services (GMS) contract. GMS contracts are nationally agreed between the General Medical Council and NHS England.

Updated 1 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Downlands Medical Centre on 4 August 2016. Overall the practice is rated as good.

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 well managed.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had reasonable 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 practice had a high number of older patients (three times the national average) and had put in place a number of processes to support these patients including having a high doctor to patient ratio.

The areas where the provider should make improvement are:

• Ensure that liquid nitrogen is stored safely in accordance with safety regulations.
• Introduce a reporting system for significant events for all staff to use.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 September 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.
• Nurses carried out home visits where necessary to do diabetic checks, blood tests and vaccinations.
• The practice ran multi-morbidity clinics for patients with long-term conditions which saved patients from having to attend several review appointments and ensured that patients’ conditions were dealt with as a whole.
• 92% of patients on the diabetes register had a record of a foot examination and classification which was above the clinical commissioning group (CCG) average of 90% and national average of 88%.
• 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 1 September 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 higher than the clinical commissioning group average 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.
• 88% of eligible female patients had a cervical screening test which was better than the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 1 September 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 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.
• The practice provided medical support to patients in six local care homes and feedback from the homes was positive.
• The practice had a high number of older patients, 59% of their patients were over 65, and 6.6% over 85, three times the national average. They had put in place a number of processes to support these patients including having a high doctor to patient ratio.
• There was a dedicated telephone line for care homes and patients to ring to request a home visit and a roving GP system where there was a doctor who focussed on carrying out home visits early in the day to ensure problems were dealt with promptly.

Updated 1 September 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.
• Electronic prescribing allowed prescriptions to be sent to a pharmacy near to a patient's workplace.
• Appointments were available on Wednesday mornings from 7am, and Monday evenings until 8.30pm for those who could not attend during normal surgery hours.

Updated 1 September 2016

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

• 82% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was similar to the national average of 84%.
• 96% of patients experiencing poor mental health had an agreed care plan, which was better than the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Doctors ran personal lists of patients which meant there was good continuity of care.
• 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 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 dementia.

Updated 1 September 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 people, 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.