Archived: The Coach House Surgery

Updated 28 March 2017

The Coach House Surgery is located in a residential area of Herne Bay, Kent and provides primary medical services to approximately 5200 patients. The surgery is a two story building with consulting and treatment rooms on the ground floor. The building had a major rebuild in 1991 keeping the exterior features but extending the building considerably. The rebuild included a new waiting room, facilities for disabled patients, a car park and treatment rooms.

The age of the population the practice serves is different to the national averages. There are fewer infants and young children (aged less than 10 years) and fewer people aged 25 to 40 years of age. There more people aged to 85 years and over. The number of people over 85 years is significantly higher than that nationally. Income deprivation and unemployment are close to the national average.

There are two GP partners at the practice, one female and one male. There is one female nurse practitioner and two female practice nurses. The GPs and nurses are supported by a practice manager and a team of nine reception/administration staff.

The practice is open from Monday to Friday between 8am and 6.30pm. Appointments are from 8.30am to 11.30am and from 4pm to 5.30pm.

The practice is not a teaching or a training practice (teaching practices take medical students and training practices have GP trainees and foundation year two doctors).

Appointments can be booked over the telephone, online or in person at the practice. Patients are provided with information on how to access an out of hour’s provider by calling the surgery and on the website. Telephone consultations are also available from 11.30am and can be booked over the telephone.

Services are provided from

The Coach House Surgery

27 Canterbury Road

Herne Bay

CT6 5DQ.

The practice has opted out of providing out-of-hours services to their own patients. This is provided by Primecare through the NHS 111 service. There is information, on the practice buildings and website, for patients on how to access the out of hours service when the practice is closed.

Updated 28 March 2017

We carried out an announced comprehensive inspection at The Coach House Surgery on 17 January 2017. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety but incidents that ought to have been reported had not been reported. There was no system for monitoring the actions necessary to mitigate the risks identified from safety alerts.
• Most staff assessed patients’ needs and delivered care in line with current evidence based guidance. However we found that not all GPs were able to demonstrate familiarity with NICE guidance and was unaware of some local 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. However some decisions and diagnoses entered in patients’ records were not coded so the records were incomplete.
• 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 no programme of clinical audit or plan for continuous improvement.
• There was a clear leadership structure and some staff felt supported by management but the management team was divided and clinical governance was ineffective. The practice 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.

There were areas of practice where the provider must make improvements:

• Ensure that patients’ assessments are carried out in accordance with current evidence based guidance and standards.
• Ensure that there is an effective scheme of governance to assess, monitor and improve the quality and safety of the services provided
• All GPs should be trained to child protection or child safeguarding level three.

We saw one area of outstanding practice:

• There was an over age 75’s health check and frailty assessment offered in the patient’s home. These checks were carried out by health care assistants. The practice said that this helped with the early identification of patients who were becoming confused, frail or socially isolated.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 28 March 2017

The practice is rated as requires improvement for the care of people with long term conditions. The provider was rated as requires improvement for providing safe and effective services, good for providing caring and responsive services and inadequate for providing well-led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• There are11 indicators for the best management of diabetes. When these figures were correlated the practice achieved 100% which is 6% above the clinical commissioning group and 10% above the national average.
• 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 28 March 2017

The practice is rated as requires improvement for the care amilies, children and young people. The provider was rated as requires improvement for providing safe and effective services, good for providing caring and responsive services and inadequate for providing well-led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• 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 practice’s uptake for the cervical screening programme was 84%, which was better than the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 28 March 2017

The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for providing safe and effective services, good for providing caring and responsive services and inadequate for providing well-led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• 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.
• There was an over age 75’s health check and frailty assessment offered in the patient’s home. These checks were carried out by health care assistants. The practice said that this helped with the early identification of patients who were becoming confused, frail or socially isolated.

Updated 28 March 2017

The practice is rated as requires improvement for the care of working age people (including those recently retired and students). The provider was rated as requires improvement for providing safe and effective services, good for providing caring and responsive services and inadequate for providing well-led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• 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 28 March 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider was rated as requires improvement for providing safe and effective services, good for providing caring and responsive services and inadequate for providing well-led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
• The percentage of patients with specific diagnosed mental health problems who had had an agreed care plan was 94% which is 4% above the CCG and 5% above the national average.
• 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.

Updated 28 March 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable The provider was rated as requires improvement for providing safe and effective services, good for providing caring and responsive services and inadequate for providing well-led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• The practice held a register of patients living in vulnerable circumstances including 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.