Thornhills Medical Practice

Updated 2 February 2017

Thornhills Medical Practice is serving over 14,800 patients in Larkfield, East Malling, Ditton, parts of Aylesford and Leybourne. The practice is based in Larkfield Health Centre, a large health facility, which provides a wide range of medical and community services. The deprivation score for the practice population is eight on a scale of one to ten where ten is the least deprived decile. The practice population’s age distribution is close to the England average. The practice provides its services under a General Medical Services (GMS) contract.

There is ample parking in the car park adjacent to the practice, including accessible parking bays. There is easy access for wheelchair users and parents with young children in pushchairs. The building has lifts and assisted toilet facilities.

At the time of our inspection the practice had six GP Partners (four males, two females), two assistant GPs (females), a GP registrar, five nurses, four health care assistants and a phlebotomist. The practice manager and the assistant practice manager manage a team of 20 non-clinical staff.

The practice is open between 8am and 6:30pm from Monday to Friday. Extended hours for pre-booked appointments are offered at the following times: 6:30pm to 7:30pm Monday and Wednesday, 6.30pm to 7.45pm Thursday and 7am to 8am on Tuesday. Out of hours services are accessible via NHS 111. Information about how patients can access these services is available on the practice’s website and at the practice’s entrance. Appointments are available with the GPs, nurses and health care assistants. In addition to pre-bookable appointments, same day appointments are available via walk-in clinics.

Thornhills Medical Practice is a training practice which means GP Registrars and Foundation Year 2 doctors joined the practice to gain experience and training in general practice. The practice also have medical students on placement. There was one GP registrar at the practice at the time of our inspection.

Updated 2 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thornhills Medical Practice on 14 December 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 in place 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.
• 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.
• 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 and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• Thornhills Medical Practice was the biggest provider of Skilled Primary Care Surgery in West Kent. The practice accepted referrals from all West Kent practices and were the sole provider of this service for many of them. The practice had six GP’s who were accredited and performed Skilled Primary Care Surgery. Of these, four were qualified skin cancer surgeons and two performed carpal tunnel decompression surgery. On average there were seven minor surgery operating lists carried out each week. Staff told us that patients had said they liked the service because it offered short waiting times, easy access, a friendly and efficient service and there was good communication with the patients’ own GP.

The areas where the provider should make improvement are:

• Keep the appointment system under review in order to meet patient demand for the various types of clinical appointments.

• Ensure that written risk assessments regarding all substances that are hazardous to health are in place to aid the effective management of the related risks.

• Ensure the on-going implementation of the infection prevention and control programme and keep related records readily available.

• Continue to improve patient outcomes for those with long term conditions.

• Ensure that carers are identified and supported appropriately.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 February 2017

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 operated recall systems to ensure that patients were reviewed at least annually.
• The practice’s performance for most diabetes related indicators were similar or better than the local and national average. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 88% compared to the clinical commissioning group average of 88% and the national average of 88%.
• 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. The practice’s palliative care lead met with hospice and district nurses in every three months. The practice also worked with the long term condition nurse to help improve care for housebound patients with complex needs.
• The practice sought advice from local consultants regarding care and treatment issues where necessary.
• The practice carried out medication reviews at least annually to help ensure medicines ware linked to the condition and that patients were clear regarding the purpose and aims of treatment.
• The practice encouraged influenza vaccines, used prescription for exercise widely and provided home and ambulatory blood pressure machines to patients.

Updated 2 February 2017

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. There was a practice-wide awareness of safeguarding and a nominated lead who met regularly with the health visitor and school nurse.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 84% and the national average of 82%.
• Appointments were offered after school hours and walk-in or book on the day appointments were made available for more urgent issues. Telephone consultations were also offered.
• Six week mother and baby checks were offered.
• The premises were suitable for children and babies.

Updated 2 February 2017

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 practice used the monitored dosage systems, and worked with a local pharmacy to help ensure medication was delivered to patients’ who could not collect their medicines.
• The practice maintained a register of high risk patients and these patients had personal care plans in place. The practice was also in regular contact with district nurses and hospice nurse to help support patients.
• The practice provided in-house chiropody, influenza vaccines, minor surgery and joint injection clinics.
• The practice referred patients to health and social care coordinators and signposted them to other support services and transport services as needed.

Updated 2 February 2017

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 first and last routine appointments in the normal working day were 8:20am and 5:30pm from Monday to Friday. The nurse team had some lunchtime appointments and extended hours doctor and nurse clinics were provided offering evening and early morning appointments. (6:30pm to 7:30pm Monday and Wednesday, 6.30pm to 7.45pm Thursday and 7am to 8am on Tuesday)
• 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. The practice promoted the use of online systems for booking appointments, prescription requests and for access to patient records. The practice also made use of electronic prescribing.

Updated 2 February 2017

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

• Performance for mental health related indicators were similar or better than the local and national average. Patients with chronic mental health problems were reviewed at least annually for addressing physical as well as mental health care.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice made use of a consultant advice line for medication queries, worked with the local pharmacy to monitor medication and prescribed limited quantity where appropriate to reduce the risk of misuse.
• 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 use of online access to psychology websites was encouraged. Positive lifestyle changes including smoking cessation clinics and prescription for exercise was promoted.
• Staff had a good understanding of how to support patients with mental health needs and dementia. The reception team were trained by the Alzheimer’s Society and they had become ‘Dementia Friends’.
• There was an on-site community mental health worker and counselling service available.

Updated 2 February 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 those with a learning disability. Personal care plans for patients with a high risk of hospital admission were in place.
• The practice offered annual reviews and 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 encouraged vulnerable patients’ carers or support workers to attend consultations.
• 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.
• The practice’s electronic patient record system alerted staff if a patient had specific needs, for example literacy issues, a visual/auditory impairment, requiring an interpreter, difficulty with noise or waiting.