Westerham Practice

Updated 13 March 2017

Westerham Practice is a GP teaching practice based across two sites in the North Downs area of Kent, from Limpsfield to Riverhead and Westerham to Marlpit Hill, including many small villages, Toys Hill, Brasted and Tatsfield. Westerham Practice is one of the practices within West Kent Clinical Commissioning Group (CCG) and provides general medical services to approximately 8,200 registered patients.

Services are provided from:

• Winterton Surgery, Russell House, Market Square, Westerham, Kent, TN16 1RB.

• The Medical Centre, 173 Main Road, Sundridge, Sevenoaks, Kent, TN14 6EH.

According to data from the Office for National Statistics, the area has high levels of affluence, low incidence of substance misuse and severe mental health problems and low levels of deprivation.

Ethnicity based on demographics collected in the 2011 census shows the population of Westerham and the surrounding area is predominantly White British. Although the surrounding area has a growing Eastern European community; this is reflected in the patient population list as there was a growing number of Polish and Romanian patients registered with the practice.

The practice population has a lower proportion of patients aged between 20 and 40 and a higher proportion of patients aged over 50 when compared to the national average. The prevalence of patients with a long standing health condition is 60% compared to the local CCG average of 52% and national average of 54%. This could result in an increased demand for GP services.

The practice has a dispensary based at site in Sundridge and dispenses to 18% of its patients (1,500 out of 8,200).

The practice also provides primary care GP services for a local residential homes (approximately 30 people) and a local foundation, specialist school for children and young people with physical disabilities or complex medical needs (approximately 50 people).

The practice comprises of six GP Partners (three female and three male) who are supported by a two female salaried GPs, one female FY2 Doctor, two GP Registrars (one female and one male) and a female Physician Associate. The practice is a teaching and training practice for medical students, Foundation Doctors (FY Doctors) and GP Registrars. Foundation Doctors are junior Doctors who are undertaking a GP placement as part of their speciality and GP Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine.

The all-female nursing team consists of a nurse practitioner, a senior practice nurse, an additional practice nurse and three health care assistants.

The practice manager and a team of reception, administrative and secretarial staff undertake the day to day management and running of Westerham Practice.

One of the GPs is the designated dispensary lead and the dispensary team consists of a head dispenser, a dispenser and a prescription clerk.

The main practice in Westerham is open between 8am and 6.30pm Monday to Friday (appointments between 8am and 11.30am and 3pm and 6pm). The branch surgery in Sundridge is open between 9am and 6pm Monday to Friday (appointments between 9am and 12pm and 3pm and 6pm) with the exception of Wednesday when the surgery closes at 1pm.

The dispensary has core opening hours between 9am and 12pm every weekday and additional afternoon opening hours between 3pm and 6pm every Tuesday and Thursday. Each week extended hours for pre-bookable appointments were available every Tuesday and Wednesday evening until 7.30pm at the practice in Westerham and every Thursday morning from 7am at both the practice in Westerham and the practice in Sundridge.

The practice has opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 telephone service. Advice on how to access the out-of-hours service is clearly displayed on the practice website, on both practices door and over the telephone when the surgery is closed.

Updated 13 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westerham Practice in Westerham, Kent on 24 January 2017. 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.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• An understanding of the clinical performance and patient satisfaction of the practice was maintained. The practice had reviewed clinical performance and implemented actions to improve.

• Feedback from patients relating to access to services and the quality of care was higher when compared with local and national averages. This was collaborated by written and verbal feedback collected during the inspection.

• The continued development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care. We saw evidence and staff we spoke with told us they are supported to acquire new skills and share best practice.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they are managed and responded to and made improvements as a result.
• The leadership team drove continuous improvement and staff were accountable for delivering change. There was a clear proactive approach to seek out and embed new ways of providing care and treatment.

The areas where the provider should make improvement are:

• Review the business continuity plan to include emergency contact and specific cascade contact information.

• Continue to review patient outcomes to ensure that patients receive appropriate care and treatment. This would include a review of the system in place to promote completion of dementia care plans in order to increase patient uptake.

• Formalise how training, learning and development needs are identified via re-introducing a programme of appraisals.

• Improve patient awareness of access to translation services and how to provide feedback.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 13 March 2017

The practice is rated as good for the care of people with long-term conditions.

• The number of patients registered at the practice with a long-standing health condition was higher than local and national averages. For example, 60% of patients had a long-standing health condition, this was higher than the local CCG average (52%) and national average (54%). This could result in an increased demand for GP services.

• Performance for diabetes related indicators showed the practice had achieved 100% of targets which was higher when compared to the CCG average (89%) and the national average (90%).

• Performance for Chronic Obstructive Pulmonary Disease (known as COPD, a collection of lung diseases including chronic bronchitis and emphysema) indicators showed the practice had achieved 100% of targets which was higher when compared to the CCG average (96%) and the national average (96%).

• Anticoagulant management clinics were held at the practice to monitor patients’ blood to determine the correct dose of anti-coagulant medicine. This provided better improved access, standardised delivery in monitoring dosage, ‘one-stop-visit’ testing obtaining results and adjustments in dose, with the opportunity to discuss results during the same visit.
• Longer appointments and home visits were available when needed.

Updated 13 March 2017

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 similar when compared with local averages and national averages for 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.

• The practice’s uptake for the cervical screening programme was 85%, which was similar when compared to the CCG average (83%) and the national average (82%).

• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 13 March 2017

The practice is rated as good for the care of older patients.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Older people at risk of isolation within the community were identified and discussed at meetings including multi-disciplinary meetings to address any additional support required.

• The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice identified if patients were also carers; information about support groups was available in the waiting areas.
• The practice provided GP services to a local residential home; a designated GP provided services to which included a weekly ward round. Feedback from the care home praised the service and said the service they received was professional and empathic and they were very happy with the GP service they receive.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older patients were higher when compared with local and national averages. For example, performance for osteoporosis (osteoporosis is a condition that weakens bones, making them fragile and more likely to break) indicators were higher than both the local and national averages. The practice had achieved 100% of targets which was higher when compared to the CCG average (95%) and the national average (88%).

Updated 13 March 2017

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.

• Services were flexible, provided choice and ensured continuity of care for example, telephone consultations was available for patients that chose to use this service.

• There was a range of appointments including early morning and evening appointments. These appointments were specifically for patients not able to attend outside normal working hours but there were no restrictions to other patients accessing these appointments.
• On-line booking for appointments was available for patients’ convenience. The practice website was well designed, clear and simple to use featuring regularly updated information.

Updated 13 March 2017

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

• The practice offered flexible longer appointments for patients with complex mental health needs.

• 89% of people experiencing poor mental health had a comprehensive care plan documented in their record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate. This was similar when compared to the CCG average (91%) and the national average (89%).

• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was lower when compared to the local CCG average (84%) and the national average (84%).

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. Several members of staff had additional training in recognising and supporting people with dementia.

Updated 13 March 2017

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 and those with caring commitments.

• The practice offered longer appointments for patients whose circumstances may make them vulnerable.

• The practice provided GP services to a local specialist school for pupils with physical disabilities or complex medical needs. There was specific designated GP point of contact for the school (approximately 50 people). Contact details of the designated GP were shared with the relevant staff, enabling continuity of care and quick access to the right staff at the practice.

• In January 2017, the practice patient population list was 8,200. The practice had identified 147 patients, who were also a carer; this amounted to 1.8% of the practice list.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.