Archived: Dr RF Cullen & Partners

Updated 1 October 2015

Dr R F Cullen & Partners also known as Church Lane and Dymchurch Surgery is a purpose built premise and located in the residential area of New Romney. Wheelchair access to the building is through the front door. The inspection was undertaken at Church Lane. We did not visit the practice branch at Dymchurch.

A team of two GP partners (male), one salaried GP (female) and two locum GPs (one male and one female), three nurse practitioners, three practice nurses, two healthcare assistant (HCA), a phlebotomist, a practice manager, receptionists, practice secretaries and administrative staff provide care and treatment for approximately 9,000 patients. The practice has a General Medical Services (GMS) contract.

The nurse practitioners are qualified nurses who have undertaken advanced education and training in the assessment and treatment of patients suffering from a wide range of common or minor illnesses, including diabetes and chronic obstructive pulmonary disease (COPD), respiratory medicine and cardiology (heart related diseases). They can diagnose and prescribe, will arrange investigations and make referrals to other health professionals. They may also refer patients to the doctor if appropriate.

The practice nurses are qualified and registered nurses. They help with health issues such as family planning, healthy living advice, blood pressure checks and dressings. The practice nurses run clinics for long-term health conditions such as asthma or diabetes, minor ailment clinics and carry out cervical smears. The healthcare assistants support practice nurses with their daily work and carry out tasks such as phlebotomy (drawing blood), blood pressure measurement, dressings and NHS Health Checks. They may act as a chaperone when a patient or doctor requests one.

The practice is open Monday to Friday from 8.15am until 6.30pm. The practice provides an out-of-hours service and patients are advised to call NHS 111 when the practice is closed.

Updated 1 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr RF Cullen & Partners on 17 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring, safe and responsive services. It was also good for providing services for the care of older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable, people experiencing poor mental health (including people with dementia).

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 October 2015

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 practice employs practice nurses and nurse practitioners who have undergone specialist training for long- term conditions, such as diabetes, asthma, chronic obstructive pulmonary disease (COPD).

Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice matron aided by the district nurses and intermediate care team and multidisciplinary teams ensured that the housebound patients or in residential homes also received their regular health reviews. Those at risk of unplanned hospital admissions had been identified with care plans in place to reduce the potential risk of re-admission.

Updated 1 October 2015

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 in line with the local CCG rates 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with the local district nursing team. There was an allocated GP who reviewed young people for their health checks, and communicated with the health visitor on a regular basis. The practice continued to promote and interact with services such as ‘Sure Start’ (a government programme which provides a range of support services for parents and children under the age of four) available in both primary schools locally for children and their families.

Updated 1 October 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. From July 2014 the practice collaborated with four other Romney Marsh practices via Invicta Health, and obtained the services of a dedicated practice matron to review the health and long term conditions of the older patients.

Updated 1 October 2015

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 and dedicates some of their late afternoon appointments to working age patients.

Updated 1 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 49 out of 65 of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. The practice held a register of 104 patients with dementia and 71 (68.2%) had received a review.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. For people experiencing poor mental health the practice had the option to refer them to the Mental Health Care Team (MHCT) and local dedicated NHS counselling services. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 1 October 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of 76 patients living in vulnerable circumstances including those with a learning disability. It had carried out annual health checks for people with a learning disability and 25 of these patients had received a follow-up. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

They had regular meetings with the palliative care hospice team and district Nurses to discuss the patients who were currently on the end of life register. It had told 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.