Archived: Yalding Surgery

Updated 15 May 2018

Yalding Surgery (also known as Burgess Bank Surgery) is a GP practice based in Yalding, Kent. There are approximately 5,800 patients on the practice list. The practice is similar across the board to the national averages for each population group. For example, 21% of patients are aged 65 years of age or over compared to the national average of 17%. The practice is in one of the least deprived areas of Kent.

There are two partner GPs (one male and one female) and three salaried GPs (one male and two female). The GPs are supported by a practice manager, a reception manager, one assistant practitioner, one practice nurse, two healthcare assistants, three dispensers and an administrative team.

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

The practice has a general medical service (GMS) contract and also offers enhanced services for example; minor operations, ultrasound scans and joint injections.

The practice is able to provide dispensary services to those patients on the practice list who live more than one mile (1.6km) from or have difficulty accessing their nearest pharmacy premises. This service is delivered by a dispensary team of two dispensers

Services are delivered from;

Yalding Surgery, Burgess Bank, Benover Road, Maidstone, Kent, ME18 6ES.

Updated 15 May 2018

This practice is rated as requires improvement overall. (Previous inspection 25 July 2016 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced comprehensive inspection at Yalding Surgery on 22 March 2018, under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had implemented a system to ensure safety alerts were disseminated and acted on.
• The practice was unable to demonstrate that all appropriate recruitment checks had been undertaken prior to employment of staff.
• Risks to patients, staff and visitors were not always assessed and managed in an effective and timely manner.
• The practice had implemented a system to manage significant events. When incidents did happen, the practice learned from them and improved their processes. However, the completed significant event forms we reviewed lacked detail of the lessons learned and follow-up of the event.
• The practice was equipped to treat patients and meet their needs. However, not all equipment for use in an emergency was sterile and fit for purpose.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• The practice had used clinical audit to drive improvements in patient outcomes.
• The practice had continued to identify and support more patients who were also carers.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use.
• Governance arrangements were not always sufficient or effectively implemented.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue to ensure that a member of the practice management team completes legionella awareness training.

• Continue to monitor and improve systems for reporting childhood immunisation rates.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 July 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.

• Performance for diabetes assessment and care was 94.9%, which was better than the local clinical commissioning group (CCG) average of 91.45% and the national average of 91.43%.

• 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.

Updated 25 July 2016

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

• There were systems in place 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 high for all standard childhood immunisations, meaning that the majority of children registered at the practice received their immunisations.

• Performance for reviews of patients diagnosed with asthma was 88.91%, which was better than the local clinical commissioning group (CCG) average of 86.2% and the national average of 75.78%.

• 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.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The practice’s uptake for the cervical screening programme was 86.67%, which was above the national average of 83.5%.

Updated 25 July 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.

Updated 25 July 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 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.

Updated 25 July 2016

The practice is rated as good 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.

• 100 % of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is considerably higher than the national average.
• 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 in place 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 25 July 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• 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.