Archived: Rochester Road Surgery

Updated 24 November 2017

Rochester Road Surgery has approximately 3446 patients and is located in Gravesend, Kent. The practice has a branch surgery, Beaumont Drive Surgery. The branch surgery is located 2.5miles away and a ten minute drive from the other surgery. There is unrestricted on street parking at both surgeries and local transport. The branch surgery was not visited during our inspection on 11 July 2017.

The practice is owned and managed by the lead GP (female). The clinical team consists of the female GP who works full time and a male GP providing consultations and minor surgery on Tuesday afternoon/evenings and Wednesday mornings. The practice nurse works 16 hours a week flexibly. They are supported by a multilingual administrative team overseen by the practice manager.

The surgeries provide care to a deprived, culturally diverse and multi lingual community. It is densely populated with patients from Indian Punjab and eastern Europe. The majority of their patients are aged from 0-65years.

Rochester Road Surgery is open between 10.30am and 1pm Monday, Tuesday, Thursday and Friday. On Wednesday the surgery opens at 9am and closes at 12noon. The surgery opens late on a Thursday 4.10pm to 7pm. In addition to pre-bookable appointments may be booked up to a month in advance, urgent appointments were also available for patients that needed them.

Patients could also attend the practice branch surgery at Beaumont Drive. Beaumont Drive opens from 8.10am to 10.10am Monday, Tuesday, Thursday and Friday and 4.10pm to 7pm on Monday, Tuesday and Friday. On Wednesday afternoons when they are closed patients may attend The Forge Surgery. However, they told us patients rarely use the services of The Forge Surgery.

The practice has a comprehensive website, detailing staff and services. It can be translated into a number of languages and includes health information and signposting to specialist health provision.

Services are delivered from;

Rochester Road Surgery, 115 Rochester Road, Gravesend, Kent DA12 2HU

Beaumont Drive Surgery, 177 Beaumont Drive, Northfleet, Kent DA11 9NY

Updated 24 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rochester Road Surgery on 11 July 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Rochester Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection on 28 September 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 11 July 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• An infection control audit had been conducted to identify risks where action was required. There was an enhanced cleaning schedule for the equipment and treatment room used for minor surgery procedures.
• Emergency medicines were accessible and there was a system to check they were in date. Emergency equipment was checked monthly.
• Blank prescription forms and pads were securely stored with a system to monitor their use.
• The practice had established a system to identify, manage and mitigate infection prevention and control risks.
• Documents seen demonstrated that learning from clinical audits and significant events was shared at the practice.
• There were systems to help ensure the safety of services. For example, the recording of fire evacuation rehearsal procedures and the checking of emergency equipment.
• The practice provided the personnel file information for one GP after the comprehensive inspection on 11 July 2017, to demonstrate that they had assured themselves that the clinician was safe to practice.
• The practice had identified an increased number of patients as carers. There were 34 patients on the carers register, 1% of the patient list.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 August 2017

The practice is rated as requires improvement for the care of people with long term conditions. The provider is rated as requires improvement for safe and well led services and good for providing effective, caring and responsive services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• All these patients had a named GP.
• Patients had been appropriately reviewed, receiving annual checks, blood test monitoring and health screenings.
• 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 17 August 2017

The practice is rated as requires improvement for the care of families, children and young people. The provider is rated as requires improvement for safe and well led services and good for providing effective, caring and responsive services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• We found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had failed to attend their immunisation appointments.
• Children were given health surveillance and developmental assessments.
• Mothers were offered post natal checks after the birth of their child and the practice conducted emotional and mental health screening.
• The practice actively encouraged patients to participate in national screening programmes and followed up on non-attendance.
• Immunisation rates were comparable with national averages for all standard childhood immunisations.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Young people were offered appropriate immunisations, such as meningitis and HPV vaccinations. They were also offered chlamydia testing and long acting reversible contraception.

Updated 17 August 2017

The practice is rated as requires improvement for the care of older people. The provider is rated as requires improvement for safe and well led services and good for providing effective, caring and responsive services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population. They offered health checks for patients 75 years and older and vaccinations for influenza and pneumococcal.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible

Updated 17 August 2017

The practice is rated as requires improvement for working age people. The provider is rated as requires improvement for safe and well led services and good for providing effective, caring and responsive services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, they provided extended opening hours on four days a week.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. For example, health checks for patients 40-74 years of age at risk of developing heart disease, stroke, type 2 diabetes, kidney disease and dementia.

Updated 17 August 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider is rated as requires improvement for safe and well led services and good for providing effective, caring and responsive services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• The practice provides an accessible service to meet individual patient’s needs.
• Patients experiencing poor mental health are offered regular physical and mental health reviews.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs to mitigate the risks of abuse.
• Dementia assessments were offered to help patients with early diagnosis.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

Updated 17 August 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider is rated as requires improvement for safe and well led services and good for providing effective, caring and responsive services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable.