Archived: William Street Surgery

Updated 6 July 2017

William Street Surgery is a GP practice in Herne Bay Kent and has a registered patient population of approximately 4,700. The practice staff comprises three GPs (two female and one male). There are two practice nurses both female, one healthcare assistant (female), a practice manager as well as administration and reception staff.

There is a reception and waiting area on the ground floor. There are consulting and treatment rooms on the ground floor and a consulting room on the first floor. All the ground floor patient areas are accessible to patients with mobility issues, as well as parents with children and babies.

The age of the population the practice serves is close to the national averages. There are marginally less infants (aged less than 5 years) and slightly more older people (aged over 64 years). Income deprivation and unemployment are close to the national average.

The practice is not a teaching or a training practice (teaching practices take medical students and training practices have GP trainees and foundation year two doctors).

The practice has a personal medical services contract with NHS England for delivering primary care services to the local community.

The practice is open Monday to Friday between the hours of 8.30am to 6.30pm, though the telephone lines open at 8am. Extended hours surgeries are offered on Tuesdays and Thursdays from 6.30pm to 8pm. Patients’ appointments can be made by telephone, in person at reception or on line.

There is a range of clinics for all age groups as well as the availability of specialist nursing treatment and support. There are arrangements with other providers (Nestor Primecare Services) to deliver services to patients outside of the practice’s working hours.

Services are provided from:

William Street Surgery,

Kingstone Cottage

Herne Bay

CT6 5NX

And

The Surgery

St Alban's Road

Hersden

Canterbury

Kent

CT3 4EX.

We visited both surgeries as part of the inspection. The Hersden surgery 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.

We last inspected this practice on 16 February 2016. We rated the practice as good overall. We found that it required improvement for providing safe services and that the practice must ensure that systems to assess, monitor and improve the quality and safety of the services are operated effectively. On this (16 May 2017) inspection we found that the practice had achieved this.

Updated 6 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at William Street Surgery on 16 February 2016. The overall rating for the practice was good but it required improvement for providing safe services. Specifically we determined that the practice must ensure that systems to assess, monitor and improve the quality and safety of the services were operated effectively.

We carried out an announced comprehensive inspection at William Street Surgery on 16 May 2017. We found that the concerns identified at the previous inspection had been rectified. Overall the practice is rated as good and this includes providing safe services.

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

• There was an open and transparent approach to safety and a system for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. Although not all staff were up to date with safeguarding training and basic life support training.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. However informally resolved complaints were not recorded.
• Patients we spoke with and the national GP survey confirmed that patients found it easy to make an appointment with a named GP and 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.
• The provider was aware of the requirements of the duty of candour. We reviewed an example that showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Update the practice contingency plan.

• Should continue to develop systems for support patients who are caring for others.

• Record, analyse and learn from informally resolved complaints.

• Further develop processes to enable patients to feedback about the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 July 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• There are 11 indicators for management of diabetes, these can be aggregated. Performance for the aggregated indicators was 100% which was six percent higher than the CCG average and 10% than the national average.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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 6 July 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 Accident and Emergency (A&E) attendances.
• The child protection register was reviewed in the practice meeting and with Health Visitors.
• Immunisation rates were high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 6 July 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns and we saw evidence that they had done so.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services, such as the out of hours provider.
• The practice shared a healthcare assistant, with the federation of Herne Bay practices, who visited patients over 85 years of age when necessary. There was a named nurse who was responsible for the care of patients over the age of 74 years.

Updated 6 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.
• 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.

Updated 6 July 2017

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

• The practice carried out advance care planning for patients living with dementia.
• Ninety percent of patients diagnosed with dementia had had their care needs reviewed in a face to face meeting in the last 12 months, which is better than the clinical commissioning group average (CCG) of 85%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example the practice reviewed a section of dementia patients in care homes and were able to reduce or stop certain modifications which, having liaised with the local psychiatrist, they had identified as no longer necessary.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• There are seven indicators for management of mental health these can be aggregated. Performance for the aggregated indicators was 100% which was five percent higher than the CCG average and seven percent than the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment. The practice had identified this as a priority and their prevalence for dementia (a measure of success in diagnosing the condition) had increased more rapidly than the local or national comparators.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended Accident and Emergency (A&E) where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 6 July 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.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability. There were 61 patients on the learning disability register all of whom had had an annual review of their treatment to help ensure that their needs were being met.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.