Archived: Old School Surgery

Updated 2 August 2016

Old School Surgery is a GP practice based in Cranbrook, Kent. There are approximately 3,102 patients on the practice list, 250 of which are children at a local boarding school.

The practice is similar across the board to the national averages for each population group. For example, 17% of patients are aged 0 -14 years of age compared to the CCG national average of 17%. Scores were similar for patients aged under 18 years of age and those aged 65, 75 and 85 years and over. The practice is in one of the least deprived areas of Kent.

The practice holds a General Medical Service contract and consists of two partner GPs (male). The GPs are supported by a team of locum GPs (who cover two sessions per week), a practice manager, a practice nurse (female), a dispenser and an administrative team. A wide range of services and clinics are offered by the practice including asthma and diabetes.

The practice building is arranged over two storeys, with all the patient accessible areas being located on the ground floor. The practice is accessible to patients with mobility issues, as well as parents with children and babies.

Old School Surgery is open 8.30am to 6.00pm Monday to Friday. Morning appointments are from 9.00am to 11.30am and afternoon appointments are from 4.00pm to 5.50pm. There is an early morning clinic every Tuesday and Thursday from 7.30am to 8.00am. The practice operates a duty doctor system to ensure there is GP cover from 6.00pm to 6.30pm and urgent and emergency cases, as well as test results are monitored and responded to appropriately.

The practice is able to provide dispensary services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy premises. This service is delivered by a two dispensers.

The practice is not a teaching or training practice (teaching practices have medical students and training practices have GP trainees and FY2 doctors).

There are arrangements with other providers (Integrated Care 24) to deliver services to patients outside of the practice’s working hours.

Services are provided from:

• Old School Surgery, Rectory Fields, Cranbrook, Kent, TN17 3JB

Updated 2 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Old School Surgery on 19 May 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.
• Risks to patients were assessed and well managed. However, the practice did not have a defibrillator to use in the event of a medical emergency. There was no risk assessment to show that the practice had access to a defibrillator located within a mile of the practice.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example in their professional interactions with the local boarding school.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• 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 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice provided services to a local refugee centre, which accommodated approximately 40 male patients aged under 18 years. The GPs held weekly clinics at the centre, with the support of interpreters. Where patients were in need of longer term medical attention, the GPs work closely with the staff from the centre, to ensure the patients remained there until courses of treatment had been completed.

The areas where the provider should make improvement are:

• Revise the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 August 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.

• Performance for diabetes related indicators were comparable when compared to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c (a blood test to check blood sugar levels) is 64 mmol/mol or less in the preceding 12 months was 79% compared with the national average of 78%.

• 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 2 August 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 A&E attendances.

• Childhood immunisation rates for the vaccinations given were comparable to clinical commissioning group (CCG) averages. For example, childhood immunisation rates for the vaccinations given to five year olds ranged from 82% to 100% compared to the CCG averages which ranged from 81% to 94%.

• 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 96%, was higher than the national average of 81%.

• 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.

• The practice served the needs of boarders at a nearby boarding school. To provide for this group there was a weekly clinic at the school medical centre, for which the practice received a fee. Older children were able to consult the practice independently.

• The practice provided services to a local refugee centre, which accommodated approximately 40 male patients aged under 18 years. The GPs held weekly clinics at the centre, with the support of interpreters. This ensured that this vulnerable patient group received appropriate care and treatment.

Updated 2 August 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.

• Patients over the age of 75 years had been allocated to a designated GP to oversee their care and treatment requirements.

Updated 2 August 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.

Updated 2 August 2016

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

• One hundred percent of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84%.

• Performance for mental health related indicators were higher than the national average. For example, 100% of the practice’s patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their records in the preceding 12 months compared with the national average of 88%. One hundred percent of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months compared to the national average of 89%.

• 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 2 August 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 refugees 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.