Canterbury Medical Practice Also known as Bridge and Littlebourne Medical Practice

Updated 10 March 2017

Canterbury Medical Practice is a GP partnership. It consists of two merged practices, the Cossington House Surgery and the Canterbury Medical Practice. This was formalised in April 2016.

Before the merger the Canterbury Medical Practice was located in the village of Bridge approximately four miles from the centre of Canterbury and three miles from the Cossington House practice. It had two branch surgeries, London Road, in Canterbury and Littlebourne surgery, Littlebourne. Its patient population, of approximately 13000, reflected its less urban setting with more patients over the age of 65 years through to over 85 years.

The Cossington House Practice was located in the city of Canterbury and comprised some 7200 patients. It had a patient population which was much younger than the national average and the number of patients in age ranges from 40 to 79 was less that that nationally, reflecting its location in a university city.

The newer larger Canterbury Medical Practice, still located in the village of Bridge, has a practice population therefore of approximately 20500. This is spread over a wide geographical area and its population, though now closer to the national average in age is diverse geographically, with both urban and quite rural environments. The practice as a whole is not in an area of deprivation though there are pockets of urban and of rural deprivation within it. The majority of the patients describe themselves as white British but the student population is drawn from a wide range of nationalities.

The practice holds a General Medical Services contract (a contract between NHS England and general practices for delivering general medical services). The practice is a partnership of eight GPs. The practice employs other GPs and has trainee GPs working under supervision. There are eight male GPs and seven female GPs. There are two nurse practitioners, one nurse manager and a senior nurse. There are eight practice nurses. All the nursing staff are female. There are three healthcare assistants and a phlebotomist, all female.

As a training practice, alongside their clinical roles, the GPs and nurses provide training and mentorship opportunities for trainee GPs, student nurses and allied healthcare professionals.

The GPs and nurses are supported by a management team and a team of administration, dispensary and reception staff.

The practice is a member of a “Vanguard”. Vanguard sites are being developed as part of implementing the NHS Five Year Forward View. Part of the objective is to support improvement and integration of services. Canterbury Medical Practice’s particular Vanguard site is called Encompass.

The practice is open 8am to 6.30pm Monday to Friday. There are extended hours with both GP and nursing staff appointments from 6.30pm to 8.30pm Tuesdays and Thursdays.

The practice does not provide out of hours services to its patients and there are arrangements with another provider, Primecare, to deliver services when the practice is closed. Details of how to access this service are available at the practice and on the website.

Main site (the Bridge Surgery)

Bridge Health Centre

Patrixbourne Road

Bridge,

Canterbury

Kent

CT4 5BL

London Road Surgery

49 London Road

Canterbury

Kent

CT2 8SG

Littlebourne Surgery

The Corn Stores

Nargate Street

Littlebourne

Canterbury

Kent

CT3 1UH

Cossington Road

51 Cossington Road

Canterbury

Kent

CT1 3HX

We visited all the premises except the London Road surgery on the day of the inspection. The branch surgery at Littlebourne is dispensing, that is, it is able to provide pharmaceutical services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy premises.

The merged practice was created so recently that much of the data publicly available relates to the separate practices. Sometimes it has been possible to aggregate the data sometimes it has not. Where it has not we have said so and the data appears under the title of either “former Canterbury Medical Practice” or “former Cossington House Practice”.

Updated 10 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Canterbury Medical Practice on 13 December 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. There was a positive attitude towards reporting events with substantial numbers of reported events from across all the teams working in the practice.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the experience, and had been trained to provide them with the skills and knowledge, 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.
• 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 areas of outstanding practice:

• There was a small but increasing contingent of refugees and asylum seekers with on the practice list. There was a lead GP and lead nurse appointed to manage their needs which were recognised as being both physical and psychological.

• All correspondence of any patient less than 18 years old was scrutinised by the lead GP for safeguarding to help promote an holistic approach to family care. The practice had developed a contraceptive template for prescribing for patients aged under 18. This included an assessment of competence.

• There was a quarterly governance report. It summarised significant events, complaints, changes to national and local guidance (including changes to referral pathways) and audits.

• Patients with care plans, in addition to a named GP, had a named nurse and a named administrator. The latter was a point of contact for the patient, and being typically more readily available to the patients, than clinicians, they passed on messages and arranged clinical contacts or reviews.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2017

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.
• There are 11 indicators for the management of diabetes, these can be aggregated. The aggregated practice score for diabetes related indicators was between 99% and 100% compared with the clinical commissioning group (CCG) average of 94% and the national average of 90%.
• Longer appointments and home visits were available when needed.
• There were named clinical leads for the more common long-term conditions and these staff had had additional training to suit them for the role.
• 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 10 March 2017

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 relatively 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 the practice’s female patients aged 25 to 64 years whose notes recorded that a cervical screening test had been performed in the preceding five years was between 80 and 81 percent. This was comparable to the CCG and local average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• 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 referral of any patient less than 18 years old was scrutinised by the lead GP for safeguarding to help promote an holistic approach to family care.
• The practice had developed a contraceptive template for prescribing for patients aged under 18. This included assessment for Gillick and Fraser competence.

Updated 10 March 2017

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.
• The practice had patients at a number of care and nursing homes and designated GPs carried out regular, usually weekly, ward rounds to help promote continuity of care.

Updated 10 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 patient 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.
• On-line services included booking and cancelling appointments, requesting prescriptions and accessing medical records.
• The practice offered a full range of health promotion and screening that reflected the needs of this age group.

Updated 10 March 2017

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

• Between 82% and 89% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months which was comparable to the national average of 84%.
• Performance for mental health related indicators was better than the CCG and national average. For example, the percentage of patients with schizophrenia and other psychoses who had had a comprehensive care plan in the preceding 12 months, agreed between individuals, their family and/or carers was between 92% and 95%. This was better than the CCG at 90% and the national average at 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 A&E 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.
• The practice provided care to a local service for patients with severe mental health problems. This was provided by a GP who was a member of the Royal College of Psychiatry.

Updated 10 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 those with a learning disability. Patients with Learning Disability are offered an annual check in their own home. The practice offered longer appointments for these patients.
• The practice regularly worked with other healthcare professionals, social services and social prescribing via the voluntary sector in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• There was an increasing number of registered patients who were asylum seekers or refugees. The practice had a designated GP and nurse to provide continuity of care for them, in recognition that this group had emotional and psychological needs as well as physical health needs.
• 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.