Temple Hill Surgery

Updated 22 November 2016

Temple Hill Surgery is located in a residential area on the outskirts of the urban town centre area of Dartford, Kent and provides primary medical services to approximately 6,500 patients. The practice is based in a purpose built building which is part of a Living Well Centre, which also houses a church and children’s services. There are limited parking facilities but road side parking is available in the local vicinity. The building is accessible for patients with mobility issues and those with babies/young children.

The practice patient population has significantly more 0 – 14 year old children both male and female than the national average. There are less male patients between the age of 14 - 29 than the national average and a lower percentage of 45 – 85+ year old patients, except that 85+ females are slightly higher than the national average. There are a higher number of working age patients that the national average. It is in an area where the population are mixed in terms of levels of deprivation, but overall it is recognised as being in a more deprived area. The area has a broad ethnic and socio-economic mix. There are people who live in the area who do not have English as their first language and there is transience in the population.

There are two GP partners at the practice both male and a salaried GP who is female. The practice is registered as a GP training practice, for doctors seeking to become fully qualified GP’s and currently has one trainee. There are five female members of the nursing team; two Advanced Nurse Practitioners, a practice nurse and two health care assistants/phlebotomists. GP’s and nurses are supported by a practice management team and reception/administration staff.

The practice is open from Monday to Friday between 8.am and 6.30pm, except for Wednesday when the practice closes at 2pm. There is a GP available for emergencies between 2pm and 6.30pm on a Wednesday afternoon. Extended hours appointments are available on Monday evening until 8pm and Tuesday and Thursday morning from 7am. In addition to pre-bookable appointments that can be booked up to two weeks in advance, urgent appointments are also available for people that need them. Appointments’ can be booked over the telephone, online or in person at the practice. There are arrangements with other providers (Integrated Care 24) to deliver services to patients outside of the practice’s working hours.

The practice runs a number of services for its patients including; diabetes care, asthma and chronic obstructive pulmonary disease (COPD) management, minor surgery, family planning, phlebotomy, NHS health checks, ante and post-natal care, immunisations and travel vaccines and advice. It also offers Health Trainer appointments for weight loss, exercise, smoking cessation and befriending services.

Services are provided from St Edmunds Road, Dartford, Kent, DA1 5ND. The practice has recently added two locations to its conditions of registration, being Ivy Bower surgery and West Kingsdown Medical Centre. These are currently separate practices from Temple Hill Surgery, but a merger is in process and once concluded the locations will be removed from the conditions of registration and will become branch sites.

Updated 22 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Temple Hill Surgery on 5 October 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 for reporting and recording significant events and learning from these was discussed and shared at practice meetings.
• 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.
• Data from the national GP patient survey rated the practice higher than the clinical commissioning group (CCG) and the national average for telephone access.
• The practice had good facilities and although originally built to serve approximately 2,500 patients rather than the 6,500 currently registered, had made good use of all available space and was well equipped to treat patients and meet their needs.
• The practice had made ultra-sound scanning available at the practice for patients and the wider population, as a replacement for scanning at the local hospital which had been closed.
• 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.

We saw one area of outstanding practice:

• Best interest meetings for patients with a learning disability were 20 minutes long and held outside of regular appointment times. Family members, advocates, social services and a GP attended these meetings.

The areas where the provider should make improvement are:

• Continue working to recruit patients to the Patient Participation Group.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 22 November 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.
• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015), was 83% which was higher than the CCG average of 77% and the national average of 78%.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2014 to 31/03/2015) was 87% which was higher than the CCG average of 76% and the national average of 78%.
• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 95% which was higher that the CCG average of 87% and the national average of 88%.
• Longer appointments and home visits were available when needed, including 15 minute appointments for immunisations.
• 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 22 November 2016

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.
• Immunisation rates were high 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.
• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 82% which was comparable to the CCG average of 87% and the same as the national average at 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 22 November 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 patient population, for example, end of life care and dementia care management.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Older people had a dedicated GP for continuity of care; however they were also able to see any GP of their choice.
• Quarterly multi-disciplinary meetings were held to discuss the care and treatment needs of patients, including end of life care.
• There was a system to help ensure patients in local residential and nursing homes had continuity of care.

Updated 22 November 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 patient population, those recently retired and students had been identified and the practice had adjusted the services it offered to help 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.

Updated 22 November 2016

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

• 99% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the CCG average of 82% and the national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months (01/04/2014 to 31/03/2015) was 100% which was higher than the CCG and national average of 90%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• 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 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 22 November 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.
• Homeless patients were able to register using the practice’s address.
• The practice offered longer appointments for patients with a learning disability.
• Best interest meetings for patients with a learning disability were 20 minutes long and held outside of regular appointment times. Family members, advocates, social services and a GP attended these meetings.
• 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.