Archived: Dr Paul Downie Also known as Orchard House Surgery

Updated 20 August 2015

Doctor Paul Downie is a GP practice located in the centre of the small town of Lydd, Kent. It provides care for approximately 3,900 patients. The practice’s population of patients between 65 and 85 years of age is a third higher than the national average. Levels of deprivation are somewhat higher than nationally. The number of nursing home patients is two and a half times the national average.

There is one male GP who is the principal and a female salaried GP. The principal was due to retire at the end of March 2015 and the salaried GP due to take over from that date. Both work full time. There are 15 GP clinical sessions each week, one session being half a day. There is currently no practice nurse, as the position is vacant. There are two healthcare assistants (HCA) providing about 14 sessions weekly. The practice has a general medical services (GMS) contract with NHS England for delivering primary care services to local communities.

Services are delivered from:

Bleak Road,

Lydd,

Romney Marsh,

Kent.

TN29 9AE.

Telephone: 01797 320307

The practice has opted out of providing out-of-hours services to their own patients. There is information available to patients on how to access out of hours care. Out of hours care is provided by Integrated Care 24.

Updated 20 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Paul Downie on 26 February 2015. During the inspection we gathered information from a variety of sources. For example we spoke with patients, interviewed staff of all levels and checked the right systems and processes were in place.

Overall the practice is rated as good. This is because we found the practice to be good for providing effective, caring, responsive and well-led services. We found we found the practice to require improvement for providing safe services. It was good for providing services for the patient population groups of; older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents. Information about safety was recorded, monitored, reviewed and addressed. However there were areas such as infection control and recording of significant incidents where improvements are needed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and additional training planned.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should

• Ensure that all staff understand that they should consider reporting incidents that have the potential to be significant events.
• Review patient specific directions to help ensure that the time they are valid for was clear to staff.
• Complete the actions identified in their own infection control audit and in particular review: the use carpets throughout the practice, the use of fabric covered chairs in clinical rooms and the storage of clinical waste.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 August 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 medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of

Updated 20 August 2015

The practice is rated as good for the care of families, children and young people. 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 a high number of accident and emergency (A&E) attendances. Historically immunisation rates were relatively high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw examples of joint working with midwives, health visitors and school nurses.

Updated 20 August 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were above average for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 20 August 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 help to ensure these were accessible, flexible and provided continuity of care. 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.

Updated 20 August 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 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. It had a system to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Some staff had received training on how to care for people with mental health needs and dementia.

Updated 20 August 2015

he 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 those with a learning disability. It had carried out annual health checks for people with a learning disability and all of these patients had received a follow-up. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. 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.