Grosvenor Medical Centre

Updated 25 July 2017

Grosvenor Medical Centre is situated in Tunbridge Wells, Kent. The practice has a general medical services contract with NHS England for delivering primary care services to the local community.

The practice has a patient population of 10,069. The proportion of patients who are aged 10 to 19 years and 55 to 69 years is lower than national averages and the proportion of patients aged 25 to 44 years is higher than the national average. The practice is in an area with a low deprivation score and lower than average levels of unemployment.

Consultation and treatment rooms are located on the ground and first floors. The ground floor is fully accessible to patients with mobility issues, as well as parents with children and babies. There is no lift access to the first floor. Staff told us that they arrange for patients who have difficulty using the stairs to be seen in one of the ground floor consulting rooms. There is a small car park with a dedicated disabled parking space. The practice is located in the town centre with easy access to public transport.

There are five GPs (three male, two female) who are partners, and two salaried GPs (female). There is an advanced nurse practitioner as well as three practice nurses and two health care assistants (all female). In addition there is a practice manager and various reception and administrative staff.

The practice is a training practice for GPs and nurses (GP training practices have GP trainees and Foundation Year Two trainee doctors) and currently has two trainee GPs based at the practice.

The practice is open between 8am and 6.30pm Monday to Friday. Extended hours appointments are offered on Tuesday evening from 6.30pm to 8.30pm. The practice’s telephone lines are closed between 12.30pm and 2pm daily. During this time, patients are able to contact the duty doctor on a dedicated telephone number.

There are arrangements with other providers (Integrated Care 24) to deliver services to patients outside of the practice’s working hours.

Services are provided from:

• Grosvenor Medical Centre, 23 Upper Grosvenor Road, Tunbridge Wells, Kent, TN1 2DX.

Updated 25 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grosvenor Medical Centre on 13 October 2016. The overall rating for the practice was good. The practice was rated as requires improvement for providing safe services and rated as good for providing effective, caring, responsive and well-led services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Grosvenor Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 15 June 2017, to confirm that the practice had carried out their plan to meet the legal requirements, in relation to the breaches in regulations that we identified in our previous inspection on 13 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good.

Our key findings were as follows:

• Records showed that all staff were trained to the appropriate level in safeguarding and relevant staff were up to date with infection prevention and control training.
• Records showed that all staff who acted as chaperones had received a Disclosure and Barring Service (DBS) check (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• The practice carried out annual audits of infection control and implemented improvements where these were identified.
• There was a system for monitoring and recording blank prescription pads and forms at the practice.
• The practice was able to demonstrate that they were carrying out all necessary recruitment checks prior to employing staff.
• The practice was able to demonstrate that risks to patients, staff and visitors from fire were being assessed and well managed. Records showed a legionella risk assessment had been carried out by an external company on 14 June 2017. Legionella is a germ found in the environment which can contaminate water systems in buildings). However, the practice had yet to receive the results or address any issues identified.
• The practice had introduced a system that helped ensure all staff received mandatory training and had annual appraisals.
• Privacy in the treatment room had been improved by the use of a screen around the examination couch.
• The practice had implemented measures to increase the number of patients who were known to be carers and had now identified 153 patients as carers (2% of the practice list).

The area where the provider should make improvements is:

• On receipt of the legionella risk assessment results the practice should develop and implement an action plan to address any issues identified.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 January 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 95%, which was higher than the local Clinical Commissioning Group (CCG) and national average of 88%.
• 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. Patients who were prescribed more than eight different medicines had their medicines reviewed regularly.
• The doctors involved patients in care planning and patients received a copy of their written care plan.
• One of the doctors worked with the pharmacy adviser at the CCG to review a patient with complex needs to rationalise their medicines which led to an improvement in their condition.

Updated 12 January 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.
• 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 98%, which was higher than the 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.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 12 January 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 doctors involved patients in care planning and patients received a copy of their written care plan. Patients living in nursing homes had enhanced care plans which were written in conjunction with patients, relatives and the staff in their homes.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 12 January 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 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.
• Early and late appointments were available, and the practice offered a commuters’ clinic for patients who found it difficult to attend during the practice’s core working hours.

Updated 12 January 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 local Clinical Commissioning Group (CCG) (85%) and national average (84%).
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 89% This was comparable to the CCG and national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. A mental health nurse was assigned to the practice and attended monthly to work with mental health patients.
• 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. Staff had undergone dementia awareness training and the Patient Participation Group (PPG) had organised a dementia awareness campaign.

Updated 12 January 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 homeless people, travellers and those with a learning disability.
• The practice offered services for patients resident at the local YMCA hostel and other nearby short-term accommodation in the local area.
• 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.