Archived: The Orchard Surgery

Updated 13 March 2017

The Orchard Surgery is a single handed GP practice with dispensary services based at Langley, Maidstone, Kent. There are 2988 patients registered with the practice. Nineteen percent of patients are over the age of 65 and 48% of patients registered are living with a long-term condition. Seventy one percent of patients are in paid employment or full time education. The practice population was majority white British, with a seasonal population of European union workers (farm workers, usually during the Spring and Summer months).

The practice is on one level and accessible for those patients using a wheelchair and there is a car park adjacent to the premises with an allocated bay for disabled users.

The practice holds a General Medical Service contract and consists of a principal GP (female). The GP is supported by a part time practice nurse, a part-time healthcare assistant, a practice manager, dispensing staff and an administrative/reception team. A wide range of services and clinics are offered by the practice including asthma and diabetes.

The practice is open between 8.30am and 6.30pm Monday, Wednesday, Thursday and Friday. On Tuesdays the practice is open from 8.30am to 8pm. Appointments are offered from 8.30am to 1pm and 2pm to 5.30pm Monday, Wednesday, Thursday and Friday. On Tuesdays the afternoon clinic is extended to 7.15pm. Morning clinics are offered on a walk-in basis with some pre-bookable appointments available on Mondays and Thursdays. In addition, pre-bookable appointments can be booked up to four weeks in advance; urgent appointments are also available for people that needed them during the afternoon clinic.

Care is provided by Integrated Care 24(IC24) during weekdays between the hours of 8am to 8.30am and 6pm to 6.30pm. At all other times when the practice is closed, patients requiring care should call NHS 111.

Updated 13 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Orchard Surgery on 15 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 a system for reporting and recording significant events.
• 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 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 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.

The areas where the provider should make improvements are:

• Implement a thorough system of maintaining personnel files.
• Continue to improve the maintenance of the staff training schedule.

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.

• 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 on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 90% compared to the clinical commissioning group(CCG) average of 88% and the national average of 88%.
• Longer appointments and home visits were available when needed.
• The practice offered telephone ordering of repeat prescriptions.
• 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 13 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 82% compared to the clinical commissioning group (CCG) average of 84% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• A community midwife held weekly clinics at the practice.

Updated 13 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 offered seasonal flu and shingles immunisation.
• The practice telephoned patients to remind them of appointments and immunisations.

• The practice used the services of a local volunteer group to assist patients to attend appointments or collect prescriptions.
• The practice provided care for 22 residents of a local care home and conducted a weekly ward round to ensure effective continuity of care and care planning.

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.
• The practice delivered care to seasonal farm workers from the European union and signposted them to relevant information in a variety of languages.
• The practice was proactive in offering online services and telephone consultations, as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 13 March 2017

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

• 86% 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 clinical commissioning group (CCG) average of 85% 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 was 100% compared to the CCG average of 89% and the 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 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 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.