Church Lane Surgery

Updated 8 May 2018

Church Lane Surgery is also known as Church Lane Health Centre. It is part of Invicta Health Community Interest Company (CIC) who took on the APMS contract in September 2016. The practice is located in the south of Kent and provides services to rural communities.

All clinical rooms are situated on the ground floor and there is ramp access and assisted entry doors into the premises. There is car parking at the front of the premises and unrestricted parking on the public roads.

Church Lane Surgery provides services to 6,794 patients with a weighted population of 8,174 patients. The practice has an aging population, with above the national average numbers of male and female patients 45 years to 89 years of age. The practice has higher than the local and national prevalence for some chronic diseases such as chronic kidney disease, hypertension, heart failure, rheumatoid arthritis, diabetes, cancer and epilepsy. The service also has a high number of patients cared for within assisted living accommodation, nursing or residential homes. One percent of their patient list has learning disabilities. As a popular rural and coastal location the practice experiences seasonal increases in their patient list.

The practice employs four salaried GPs (male) and six regular locum GPs (male and female). The practice employs three GPs a day, two GPs provide clinical sessions and the third GP is responsible for conducting wider clinical duties. The practice share clinicians across both their practices. There are two practice nurses (female) covering clinics five days a week, a health care assistant (female) who conducts phlebotomy four mornings a week, a nurse practitioner who works two days a week and an assistant practitioner who works four days. All members of the nursing team are salaried employees.

The practice matron (female) is employed directly by the provider and works one day a week (Monday). They also employ a paramedic practitioner (male) who works full time but shares duties across two Invicta Health CIC practices. There are two clinical pharmacists (male and female) employed by the practice. One of the clinical pharmacists works full time and the other clinical pharmacist works two days a week. The practice has two female community health visitors aligned to the practice. The clinical and administrative team (receptionists, medical secretaries, administrators) are overseen by an interim practice manager and the Invicta management team.

There are arrangements with other providers such as IC24 to deliver services to patients outside of the practices working hours.

The practice address is; Church Lane Surgery, Church Lane, New Romney, Kent, TN28 8ER.

Updated 8 May 2018

This practice is rated as Good overall. (Previous inspection October 2017 – requires improvement )

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) – Good

We carried out an announced comprehensive inspection at Church Lane Surgery on 3 October 2017. The overall rating for the practice was requires improvement. The practice was found good in providing safe, effective and well led services but required improvement for caring and responsive services. The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for Church Lane Surgery on our website at www.cqc.org.uk.

A desk-based review was carried out on 29 March 2018. This was to confirm that the practice had carried out their plan to make improvements in respect to the breach of the Health and Social Care Act 2008 identified in our previous inspection on 3 October 2017. We found the practice to be good in providing caring and responsive services.

Overall the practice is rated as good.

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

• The practice had appointed salaried GPs providing stability and onsite leadership to the clinical team.
• The practice and their patient participation group were working together to better understand and respond to patient needs.
• The practice had improved the support provided to carers.
• The practice was working with a local charity to improve their services to patients with hearing loss.
• The practice had reviewed their disease registers to accurately reflect patient’s needs.
• We found the practice had revised their coding of the resuscitation status of patients within their care plans. Therefore, ensuring the wishes of patients were appropriately represented and shared with out of hour’s services.
• The practice had a system to identify where safety alerts had not been consistently actioned.
• The practice had followed up on children who failed to attend appointments with the practice and secondary care.
• The practice identified patients who had not responded to national screening programme requests and provided them with information and support to access services should they so wish.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 May 2018

The practice is rated as good for the care of people with long-term conditions. The provider is rated as good for safe, effective, caring, responsive and well led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• Nursing staff had lead roles in long-term disease management. However, some services were provided off site at a neighbouring practice.

• The practice had revised their disease registers to ensure they were reflective of the patient’s clinical needs and appropriate reviews were being conducted.
• The practice prepared and reviewed care plans during clinical meetings in partnership with their health and social care partners.
• The practice had a diverse clinical team to respond to patients including GPs, nurse practitioners, practice nurses, paramedic practitioners, clinical pharmacists and a practice matron.
• The needs of palliative care patients were reviewed during clinical meetings.

Updated 8 May 2018

The practice is rated as good for the care of families, children and young people. The provider is rated as good for safe, effective, caring, responsive and well led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• Children living in disadvantaged circumstances and/or who were at risk were flagged on the patient record system. The practice maintained a register of vulnerable children and actively monitored their non-attendance for appointments with primary and secondary care.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us, on the day of inspection, that they were not always able to get an on the day appointment for their child.
• The practice worked with midwives and health visitors.

Updated 8 May 2018

The practice is rated as good for the care of older people. The provider is rated as good for safe, effective, caring, responsive and well led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice had a diverse clinical team consisting of GPs, practice matron, clinical pharmacist and the paramedic practitioner to respond to the needs of the older patients in its population.
• The practice offered home visits and urgent appointments were available on the day.
• The practice nurse was the clinical lead and point of contact for patients in supported living, residential and nursing accommodation.
• The needs of palliative care patients were reviewed during clinical meetings.
• Patient care plans were prepared in partnership with relevant health and social care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence.

Updated 8 May 2018

The practice is rated as good for the care of working age people (including those recently retired and students). The provider is rated as good for safe, effective, caring, responsive and well led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• The practice was reviewing their disease registers to ensure they were reflective of the clinical needs of their patients.
• The practice provided travel vaccinations.
• The practice offered health promotion and screening services.

Updated 8 May 2018

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The provider is rated as good for safe, effective, caring, responsive and well led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• The practice considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice nurse was the clinical lead for patients in supported living, residential and nursing accommodation and worked in partnership with the clinical pharmacist.

Updated 8 May 2018

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The provider is rated as good for safe, effective, caring, responsive and well led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• The care needs of patients receiving end of life care was reviewed during clinical meetings in partnership with health and social care professionals.
• Longer appointments were available on request.
• Some staff had received training of supporting patient’s 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 in normal working hours and out of hours.