Archived: Lamorna Surgery

Updated 19 February 2015

Lamorna Surgery is part of the NHS Dartford, Gravesham and Swanley Clinical Commissioning Group.

The practice is situated in a residential area of Gravesend, Kent and has a registered patient population of approximately 2,600. There is ample parking nearby. The Practice has two consulting rooms and a treatment room. One of the consulting rooms is on the first floor. There is waiting room on ground floor. Primary medical services are provided Monday to Friday between the hours of 8.00am and 6.00pm. The practice is closed to appointments between 1pm and 3 pm.

The practice staff comprises two partner GPs, one male one female, and a female practice nurse there are four receptionist, one of whom is also a healthcare assistant and a practice manager. The practice provides nine GP sessions and four nurse sessions each week. The practice is not a training practice. The practice has a general medical services (GMS) contract with NHS England for delivering primary care services to local communities.

Regulated activities are delivered from;

Lamorna Surgery

Thomas Drive

Gravesend

Kent

DA12 5PZ

There are no branch surgeries.

The practice has opted out of providing out-of-hours services to their own patients. Information is available to patients about how to contact the local out of hours services.

Updated 19 February 2015

This was a scheduled inspection which took place on 15 October 2014. We found the overall rating for this service was good.

Our key findings were as follows:

Patients had access to GPs and nurses, patients found making appointments very easy and said that they were usually seen at or soon after the time of the appointment. Patients liked the fact that this was small practice and that staff knew most of the patients. Arrangements were in place to ensure safe patient care, including learning from significant events, errors and complaints. The practice was clean and, whilst the fabric of the building was in need of modernisation, there were systems to ensure that standards of hygiene were maintained. Patients spoke highly of doctors, nurses and receptionists and said that they were treated with respect.

However there is action the provider should take:

• There was no patient participation group and one would help the practice to gather and respond to needs of its patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 February 2015

Support for patients with term conditions included dedicated nurse sessions with a recall system that alerted patients as to when they were due to re-attend. The practice supported patients to manage their own long term conditions through advice and specific health promotion literature was available.

There was a spirometry service available. This service was there to support patients with chronic obstructive pulmonary disease(COPD), asthma management and smoking cessation issues. There was an electrocardiogram service for patients with long term heart conditions.

The practice regularly checked on patients with long term conditions. For example they recently reviewed the patients on the heart failure register they saw that a medicines review had been undertaken for all and all had had their heart functionality tested according to the best practice. They carried out a similar exercise for They carried out a similar exercise for COPD this identified patients who had not had a recent COPD review and these patients were sent letters asking them to attend. 

The practice provided an enhanced service in respect of patients who were at high risk of unplanned admissions to hospital. Many of these were patients with long term conditions. We saw this included, in some cases, a personalised care plan involving the patient and which was supervised. Patients who had unexpectedly attended the emergency department were telephoned by staff from the practice to see if any further follow up was required.

The practice used the Quality and Outcomes Framework (QOF) to measure their performance. QOF is a voluntary system where GP practices are financially rewarded for implementing and maintaining good practice.  The QOF data for this practice showed that in 15 specific areas it was significantly outperforming the national standards. These areas included the treatment of many long term conditions, such as diabetes, asthma, heart disease and COPD.

There were annual flu vaccination clinics for patients with long term conditions.

Updated 19 February 2015

Services for families, children and young people included; health visitor care, contraception and family planning - including coil insertions. There was specific health promotion literature available at the practice. Nurse appointments included cervical and post natal checks. We saw there were regular audits of gynaecology referrals where staff checked that the referrals were appropriate.

When a child did not attend for immunisation reminder letters were sent. All children who request appointments were reviewed by a GP on the day by telephone consultation or surgery consultation. The practice had carried out an audit of patients of less than 15 years of age who had attended the emergency department (A&E). The reasons were identified and patients followed up as required.

Updated 19 February 2015

Patients over the age of 75 had been allocated a dedicated GP to oversee their individual care and treatment requirements. Staff had been trained in recognising the signs of abuse in older patients and they knew how to report it. Specific health promotion literature was available as well as details of other services for older people.

The practice provided an enhanced service in respect of patients who were at high risk of unplanned admissions to hospital. Many of these were older patients. We saw this included, in some cases, a personalised care plan involving the patient and which was supervised. Patients who had unexpectedly attended the emergency department were telephoned by staff from the practice to see if any further follow up was required.

There were telephone consultations available, on the day, for older patients. There were annual flu vaccination clinics for older patients. We looked at a complaint. It did not relate directly to service provided by the practice but rather to a community service. However the practice’s response to the complaint showed that the practice was very aware of the need to maintain healthcare for the elderly.

Updated 19 February 2015

The practice is rated as good for the population group of the working-age people (including those recently retired and students). Nurse appointments included the NHS health check for patients aged between 40-74. The practice had introduced a “commuter surgery” on a Friday evening for patients who had difficulty in coming to the practice because of their working commitments. However, the practice had cancelled it after a few months because it had been poorly attended. The practice provided a telephone consultation service for those patients who were not able to attend the practice.

Updated 19 February 2015

We saw that the practice worked in co-operation with the local mental health team in the trying to manage patients with mental health problems who were frequent attenders at the local Accident and emergency department. The practice was working with other providers, including the local mental health trust, to provide integrated primary care teams to help mental health patients who moved between providers.

There were leaflets at the practice referring patients to help form organisations such as MIND, SANE and the Mental Health Foundation.

The prevalence of patients with mental health problems, that is those diagnosed with a mental health problem, had, historically, been much lower in the practice that locally and nationally. The practice had recognised this and had, over the last few years, worked hard to identify patients with mental health issues. In consequence the practice’s prevalence of patients with mental health problems was now closer to that expected locally.

Updated 19 February 2015

The practice is rated as good for the population group of people whose circumstances may make them vulnerable. Patients not registered at the practice could access services and interpreter services were available for patients whose first language was not English.

We were told that the practice would accept homeless people as patients by using the surgery address or the address of a relative in any registration paperwork.

There was a ramp so that patients with disabilities could access the practice.

There were documented plans to reconfigure the reception area to provide better access to the toilet for people with disabilities. There were arrangements so that patients with disabilities, who had difficulty with the stairs, were seen in the downstairs consulting room. There was a hearing loop to help the hard of hearing to hear what the reception staff were saying.