New Lyminge Surgery

Updated 12 September 2016

New Lyminge Surgery serves a small rural area in and around Lyminge from purpose built premises. There are approximately 3800 patients on the practice list. The practice has more patients aged over 64 years and fewer patients aged nine and under than national averages.

The practice holds General Medical Service contract and consists of three GP partners (one male and two female). There is one practice nurse (female), a nurse care coordinator (female) and one healthcare assistant (female).

New Lyminge 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 premises. There are currently 1800 dispensing patients registered to use this service. This service is delivered by four part-time dispensers. The GPs, nurses and dispensers are supported by a practice manager and a team of administration and reception staff. A wide range of services and clinics are offered by the practice including: asthma, diabetes, and minor surgery and child health / baby clinics. There is access to a physiotherapist on site.

The practice is open from 8am to 6pm on a Monday and 8.30am to 6pm. The practice submits a duty GP rota with contact details to Integrated Care 24(IC24) so that patients have access to a GP between 8am and 8.30am (Tuesday to Friday) and 6pm and 6.30pm (Monday to Friday). There are extended hour’s clinics alternate Tuesday evenings until 7pm and Saturday mornings 9am until 12noon.

An out of hour’s service is provided by IC24, outside of the practices open hours, and there is information available to patients on how to access this at the practice, in the practice information leaflet and on the website.

Services are delivered from:

Greenbanks, Folkestone, Kent, CT18 8NS.

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at New Lyminge Surgery on 21 June 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Data from the Quality and Outcomes Framework showed patient outcomes were similar to local and national averages (QOF - is a system intended to improve the quality of general practice and reward good practice).
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Urgent appointments were available the same day. However, some patients told us they had difficulties in accessing routine appointments.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Staff told us that translation services were available for patients who did not have English as a first language and there was a translation facility on the practice’s website.
• There was a clear leadership structure. The practice sought feedback from staff and patients, which it acted on. Staff we spoke with told us they felt supported by management.
• The patient participation group (PPG) was active and representatives told us on the day of the inspection that they were able to suggest changes which the practice actioned when possible.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice:

• The care co-ordinator role was undertaken by an experienced nurse who had developed individualised and comprehensive care plans for patients at risk of hospital admission. When necessary the care co-ordinator visited these patients at home to ensure care plans remained current so that these patients received timely and appropriate support.
• The PPG was working with a nearby charity to look at how they could work together in order to improve outcomes for older patients. The PPG had visited the local charity and volunteers from the charity were due to attend a PPG meeting to see how older patients in the community could be better supported.

The areas where the provider should make improvement are:

• Review the appointment system to ensure the care needs of all population groups are met.
• Review how infection prevention audits are carried out to help ensure effectiveness.
• Review how near misses are recorded in the dispensary to help reduce the risk of errors in the future.
• Review standard operating procedures(SOPs) to ensure they contain a date for future review.
• Revise the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 September 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 related indicators were similar to local and national averages.
• 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 from this group could loan clinical equipment including glucose monitors and nebulisers.

Updated 12 September 2016

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.
• The practice’s uptake for the cervical screening programme was 79%, which was similar to the CCG average of 83% 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.
• One of the GP partners had a lead role in the local CCG and worked with Child and Adolescent Mental Health Services (CAMHS), commissioners and providers, chairing local operational meetings to improve outcomes for children in the area.

Updated 12 September 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.
• The care co-ordinator role was undertaken by an experienced nurse who had developed individualised and comprehensive care plans for patients at risk of hospital admission. When necessary the care co-ordinator visited these patients at home to ensure care plans remained current so that these patients received timely and appropriate the support.
• A member from the PPG was working with a local charity to improve outcomes for older people.
• The practice identified patients receiving palliative care and with the support of the local community nurses issued them with ‘just in case boxes’ to ensure that certain medicines were available when required.
• One of the GP partners was working with the clinical commissioning group (CCG) to redesign the local palliative care pathway.

Updated 12 September 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. However, some patients told us they had difficulties in accessing routine appointments.
• The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group. The practice had 550 patients signed up to online services, which was 14% of the practice list. The practice was consulting with the patient participant group (PPG) on how to promote online services and improve uptake.

• Extended hours available outside of core hours and an emergency walk in clinic on Friday afternoons.
• Availability of telephone appointments for those unable to attend the surgery during working hours.

Updated 12 September 2016

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

• 100% of patients diagnosed with dementia had received a face to face review of their care in the last 12 months, which was better than local and national averages.
• Performance for diabetes related indicators were better than local and national averages.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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 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 12 September 2016

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 those with a learning disability.
• 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.
• There was a GP lead for learning disabilities and the practice provided easy to read materials for this patient group.
• There were joint appointments with GPs and the health care assistant to provide annual health checks in order to reduce waiting times and visits for patients with learning disabilities.
• The practice website contained a translation facility.