New Hayesbank Surgery

Updated 28 April 2017

New Hayesbank Surgery is a well-established doctor’s practice with a purpose-built surgery, situated on the North side of Ashford town centre in Kent. Their training practice has a catchment area of 17,500 patients and provides a wide range of medical support services for all the family, with easy parking and full disabled access. The practice building has undergone three refurbishments/extensions (one of which was recent and completed in December 2016) and is arranged over two storeys, with all the patient areas being accessible as there is a lift to the upper floor.

The practice is in one of the least deprived areas of Kent and has a mainly White British Population. A total of 6403 patients have English as their first language recorded in their notes, 707 patients have English recorded as a second language and 351 patients of this 707 have Nepalese recorded as second language.

The practice is similar to the national averages for each population group. For example, 7% of patients are aged 0 - 4 years of age compared to the clinical commissioning group (CCG) average of 6% and the national average of 6% and 34% are 5 to 18 years of age compared to the CCG average of 35% and the national average of 32%. Scores were similar for patients aged 65, 75 and 85 years and over.

The practice holds a General Medical Service contract and consists of six GP partners (four female and two male), three salaried GPs (female), three long term locum GPs (male) and one trainee GP (female). The primary care team are supported by three specialist primary care nurses (two female and one male), six practice nurses (female), four healthcare assistants (female), a practice manager, an assistant practice manager, 19 receptionists which includes four team leaders, medical secretaries and administrators.

A wide range of services and clinics are offered by the practice including:

• Minor Surgery,

• Ophthalmology, (The nine eye clinic ophthalmologists include four ophthalmology partners, 13 theatre nurses, six healthcare assistants and four receptionists),

• Ultrasonography - a diagnostic imaging technique based on the application of ultrasound. It is used to see internal body structures,

• Counselling

• Joint injections,

• DMARDs (disease modifying anti rheumatic drugs),

• Vascular, diabetes, (COPD) and asthma,

• The practice is a training practice which takes foundation year three registrar GPs and there was one GP Registrar working at the practice. The practice regularly host student nurses, medical student placements and offered apprenticeship training.

  The practice is open Monday 8am to 8pm, Tuesday and Friday 8am to 6.30pm, Wednesday and Thursday 7am to 7.30pm. During the hours of 8am to 8.15am and 6pm to 6.30pm all calls to the practice are handled by the out of hours provider.

  The out of hour’s service is provided by Integrated Care 24, available 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 their website.

  Services are provided from:

  New Hayesbank Surgery, Cemetery Lane, Bybrook, Ashford, Kent, TN24 9JZ

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at New Hayesbank Surgery on 11 January 2017. Overall the practice is rated as outstanding.

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.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. There was a very wide range of services, both clinical and non-clinical. The practice was a multi-speciality community provider with an ethos to bring services to the patient rather than sending patients to the service.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.The practice was an approved host for NHS outpatient clinics and services in East Kent and a wide range of services and clinics are offered in the practice.

• The practice was part of a vanguard site combining with other providers to deliver services across a substantial area of East Kent.

• 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.
• Patients said they 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.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.The practice was an approved host for NHS outpatient clinics and services in East Kent and a wide range of services and clinics are offered in the practice.

• 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 practice had strong and visible clinical and managerial leadership and governance arrangements.

• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• The practice had employed three specialist community nurses, with a community matron background, who visited patients to ensure they received the best possible support and prevent unplanned admissions. The most recent evidence of their impact on the practice’s over 75 patients shows the downward trend in hospital admissions for over 75’s registered at New Hayesbank Surgery, compared to last year.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, an ophthalmology clinic was set up in 2007 as part of a practice based commissioning service.The service was developed in order to achieve 18 week targets for first out-patient appointments.The service offers a more tailored personal service closer to home for patients registered in the local area. The ophthalmology clinic now offers a service to a wider group of patients within Ashford CCG and other neighbouring CCGs.

• The practice provided services to women accommodated at a local refugee centre. Whilst mainly transient, the 12 women had been registered as permanent patients with a PO Box address, thereby ensuring continuity of care and safeguarding of their personal information.

• The practice funded a community ‘virtual’ ward which met once a fortnight. Team members included GPs, an elderly care consultant, social care staff, community nurses and representatives from the voluntary sector. The aim of the virtual ward was to help to ensure that patients’ emotional and social needs were met and given equal importance.

The areas where the provider should make improvement are:

• 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 28 April 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding 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. For example, asthma, diabetes, insulin Initiation, (COPD).

• The practice had specially organised DMARDs (disease modifying anti rheumatic drugs) clinics to follow up patients. One of the Specialist Nurses oversaw the prescribing of Methotrexate (a medicine that is used to treat certain cancers, severe psoriasis, and rheumatoid arthritis) to ensure continuity for patients and accurate recording of blood tests in monitoring books.

• Performance for diabetes related indicators were above the local and national average. For example, 85% of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol (a blood test to check blood sugar levels) or less in the preceding 12 months (local average 80% and national average 78%).

• 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 28 April 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding 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. 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, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 85%, which was comparable to the CCG and national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. baby clinics run by nurses and doctors every Wednesday between 10.00am and 3.30pm by appointment. Additionally, appointments were available for young people aged 18 and under to offer free confidential advice concerning relationships, how to stop smoking, safer sex advice and contraceptive advice from the nursing team. They were encouraged to bring along a friend, partner or parents if they wished to.

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

Updated 28 April 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of older patients.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice provided care and treatment for 28 patients who lived in a residential home, who often had complex needs, dementia and were vulnerable. The practice offered a weekly ward round to the care home and unlimited telephone consultations. This involved registering all the patients (with their consent) with one of two lead GPs who looked after that home. Weekly and as required visits to the residential home were conducted.

• There was a community ‘virtual’ ward which met every fortnight. The majority of these patients were elderly. Team members included GPs, an elderly care consultant, social care staff, community nurses and representatives from the voluntary sector. The ward’s purpose included ensuring that patients’ emotional and social needs were met and given equal importance alongside their healthcare needs.

• The practice employed three specialist primary care nurses, with a community matron background, who visited patients to ensure they received the best possible support and prevent unplanned admissions. The most recent evidence of their impact on the practice’s over 75 patients shows the downward trend in hospital admissions for over 75’s registered at New Hayesbank Surgery, compared to last year.

Updated 28 April 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding 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 remained open throughout the day and offered a ‘Commuter’s Clinic’ Monday 8am through to 8pm and Wednesday and Thursday 7am until 6.30pm for working patients who could not attend during normal 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 28 April 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia).

• Performance for dementia related indicators were similar to the national average. For example, 75% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 79% and national average of 84%.

• Performance for mental health related indicators were similar to the national average. For example, 96% of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (local average 91% and national average 89%), which is comparable to other practices.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice regularly accommodated allied health professionals to be able to provide reviews of patient’s with severe mental health problems and eating disorders to enable them to receive follow up and care closer to home.

• Those recently discharged from hospital received a follow up call.

• 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 28 April 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding 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 dementia, frailty, blindness, deafness, a learning disability and those with a carer.

• The practice provided services to women accommodated at a local refugee centre. Whilst mainly transient, the 12 women had been registered as permanent patients with a PO Box address, thereby ensuring continuity of care and safeguarding of their personal information.

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

• The practice offered proactive, personalised care to meet the needs of the people in its population. It had a scheme for patients, who lived in five local learning disability homes. This involved registering all the patients (with their consent) with one of two lead GPs who looked after the homes. The practice had in-house learning disability nurse lead clinics.

• 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.