Dr LM Wright and Partners Also known as Lydden Surgery

Updated 25 April 2016

Dr LM Wright and Partners (also known as Lydden Surgery) provides services from a purpose built property located the village of Lydden, Kent, supporting a largely rural community. There are just under 5000 patients on the practice list. The practice population is close to national averages, although there are slightly more patients aged between 40 and 70.

The practice holds a General Medical Services contract (a contract between NHS England and general practices for delivering general medical services). There are three GP partners, two males and one female and one long term locum GP (male). Dr LM Wright and Partners is a training practice so alongside their clinical roles, the GPs are training one doctor to become a GP. There are two practice nurses (female) and one health care assistant (female).

Dr LM Wright and Partners 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 dispensary manager and two dispensers. The GPs, nurses and dispensers are supported by a practice manager and a team of administration and reception staff.

The practice is open 8am to 6.30pm Monday to Friday. Patients from Dr LM Wright and Partners are able to access extended hours appointments at the Buckland Hospital in Dover from 8am to 8pm seven days a week.

An out of hour’s service is provided by Integrated Care 24, outside of the practices open hours and there is information available to patients on how to access this.

Services are delivered from:

Lydden Surgery,

Dover,

Kent

CT15 7ET

Updated 25 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr LM Wright and Partners on 24 February 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 effective systems for reporting and recording significant events. However, whilst near misses in the dispensary were discussed they were not always recorded.
• 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 skills, knowledge and experience 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.
• Feedback from patients about their care was consistently and strongly positive.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were available on the same day and patients had access to daily morning walk in clinics.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff we spoke with told us they felt supported by management. 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.

We saw one area of outstanding practice:

• The nursing team regularly visited and telephoned patients in local care homes to monitor their health and wellbeing and ensure that care plans reflected individual needs. These patients and their carers had direct access to the nursing team for support. This initiative had helped reduce unplanned admissions to secondary care for patients over 75 years from 44 in 2013/14 to 33 in 2014/15.

The areas where the provider should make improvement are:

• Review how near misses are recorded in the dispensary to reduce the risk of errors in the future.
• Review Standard Operating Procedures in the dispensary to ensure that recorded dates reflect review dates.
• Review patient confidentiality in the waiting room.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 April 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.
• 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.
• The nursing team collaborated with the CCG to deliver an educational program on Chronic Obstructive Pulmonary Disease (the name for a collection of lung diseases, including chronic bronchitis and emphysema) to other local health care providers.

Updated 25 April 2016

The practice is rated as good for the care of families, children and young people.

• The practice had 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 we spoke with told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• 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.

Updated 25 April 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.
• There was a weekly pharmacy delivery service for patients who were not able to attend the surgery.
• The nursing team regularly visited and telephoned patients in local care homes to monitor their health and wellbeing and to ensure that care plans reflected individual patient’s needs. These patients and their carers had direct access to the nursing team for support, which had helped prevent unnecessary admissions to secondary care. This initiative had helped reduce unplanned admissions to secondary care for patients over 75 years from 44 in 2013/14 to 33 in 2014/15.

Updated 25 April 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 offered online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• There was a daily morning walk in clinic.
• The practice was piloting a text message service to remind patients about their appointments.

Updated 25 April 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of people 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. The nursing team had developed an information sheet to support staff, patients and their carers in difficult aspects of care such as consent. Information included how to contact health care professionals, various support groups and voluntary organisations.

Updated 25 April 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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability; this had recently been extended to 40 minutes for nursing appointments.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.
• There was a hearing loop and braille signs for visually or hearing impaired patients.
• A counselling service was available for patients at the practice.