Balmoral Surgery

Updated 4 May 2016

Balmoral Surgery is located in a residential area in Walmer, Deal. There are 12,611 patients on the practice list. The practice population is close to national averages, although there are slightly less patients under 21 and slightly more older patients (people aged over 64).

The practice holds a General Medical Services contract (a contract between NHS England and general practices for delivering general medical services) There are eight GPs, seven male and one female. One of the GPs has undergone further training to become a GP with a special interest in cardiology. There are three practice nurses (female) and three health care assistants (female). Balmoral surgery is a training practice so, 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 practice manager and a team of administration and reception staff. A wide range of services is offered by the practice including weight management, diagnostic ultrasound and teenage sexual health clinics.

The practice is open 8.30am to 6.30pm Tuesday and Thursday, 8.30am to 8pm on Mondays and 7.15am to 6.30pm Wednesday and 7.15am to 6pm on a Friday, telephone calls are accepted until 6.30pm. Pre-booked appointments are available from 6pm to 8pm on a Monday. The practice web site details individual GP’s area of interest such as dermatology, cardiology, men’s health and learning disabilities and their availability subject to annual leave and other commitments.

The practice does not provide out of hours services to its patients and there are arrangements with another provider, Integrated Care 24 (IC24), to deliver services when the practice is closed. Details of how to access this service are available at the practice and on the website.

Services are delivered from:

Balmoral Surgery

Canada Road,

Deal,

Kent

CT14 7EQ.

Updated 4 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Balmoral Surgery on 22 December 2015. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example taking the lead with the local clinical commissioning group to develop Medical Interoperability Gateway (MIG).

• Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.

• Staff had lead clinical roles for example in safeguarding and infection prevention control, but also undertook patient supportive roles such as a care co-ordinator, online champion and carer’s champion.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). The PPG met regularly and facilitated outside speakers such as a representative from the clinical commissioning group.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority.

• The practice supported its younger population with open access drop in sexual health clinics every day after school hours, whether they were patients at the practice or not.

We saw several areas of outstanding practice including:

• The practice consulted with its patients and supported an active patient participation group (PPG). There was a member of the PPG in the practice waiting room on most days to assist patients, particularly the elderly or vulnerable, with access to services.

• Staff had lead roles that improved patient’s access to services such as the online champion this had led to an increase of over 2000 patients using online services. It supported specific population groups.

• Staff had lead roles that improved outcomes for patients such as a care co-ordinator and a carer’s champion. Patients had access at the practice to drop in clinics from outside agencies such as: Age Concern, Carer’s Support and Cruse Bereavement Care.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 4 May 2016

The factors that led to the overall rating of outstanding applied to patients in this population group therefore the practice is rated as outstanding 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.
• 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. There was an alert system on the computer to help to ensure these patients received the correct tests and medication.
• The practice maintained disease registers for patients with long term conditions such as diabetes and rheumatoid arthritis and monitored patient outcomes.

Updated 4 May 2016

The factors that led to the overall rating of outstanding applied to patients in this population group therefore the practice is rated as outstanding 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 attendances.

• Immunisation rates were relatively high for all standard childhood immunisations. The practice found patients from this population group were missing appointments for child immunisations. They consulted with the patients and changed the appointment times. Attendance rates had increased.

• Patients 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 including designated baby changing facilities.

• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice had identified an issue with the attendance of some healthcare professionals and had taken appropriate action including informing the clinical commissioning group.

• The practice offered online support and leaflets for teenagers. There was a daily drop in sexual health clinic from 4pm for young people including those who were not on the practice patient list. This had been promoted in local schools.

Updated 4 May 2016

The factors that led to the overall rating of outstanding applied to patients in this population group therefore the practice is rated as outstanding for the care of older people.

• The practice offered personalised care to meet the needs of the older people in its population and provided drop in clinics from outside agencies such as Age concern.
• 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 care co-ordinator to support patients in this population group. This included supporting them if they were admitted to hospital and contacting them on discharge to assess if more help was required.
• The practice manager had worked with local clinical commissioning group to develop the use of a computer system to improve patient care pathways.
• The practice had invited the local community nurses to have their lunchtime handover at the practice to improve multidisciplinary working and information sharing.

Updated 4 May 2016

The factors that led to the overall rating of outstanding applied to patients in this population group therefore the practice is rated as outstanding 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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.
• There were extended hours (two early mornings and one late evening) for patients who had difficulty in accessing services due to work commitments.
• The practice used choose and book so working patients had a greater choice for referrals to fit with work commitments.
• Patients who were no longer registered because they have moved to attend university were routinely seen as temporary residents and were not required to re-register.

Updated 4 May 2016

The factors that led to the overall rating of outstanding applied to patients in this population group therefore the practice is rated as outstanding for the care of people experiencing poor mental health (including people 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 when 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 a drop in session for dementia sufferers’ and their carers and was working with local Dementia Cafes to improve dementia services.

• Through the clinical commissioning group, the practice had access to the primary care mental health nurse when patient needs exceeded the practices ability to respond.

• The practice changed information about dementia after feedback from the patient participation group.

Updated 4 May 2016

The factors that led to the overall rating of outstanding applied to patients in this population group therefore the practice is rated as outstanding 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.
• The practice regularly worked in 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 and documentation of safeguarding concerns. Staff knew how to contact relevant agencies in normal working hours and out of hours.
• There was a care co-ordinator to support this group of patients and they had access to a direct phone line.
• If vulnerable patients did not respond to letters or telephone calls the practice asked the local disability nurse to call on them at home. They asked this individual to accompany patients to appointments if necessary and to act as an advocate when needed.
• The practice maintained a list of carers and had a designated member of staff to act as a carers’ champion. The practice collaborated with carers’ support organisations to provide drop in clinics.