Downs Way Medical Practice

Updated 28 October 2016

Downs Way Medical Practice is a GP practice based in Istead Rise, Kent. It is part of the NHS Dartford, Gravesham and Swanley Clinical Commissioning Group (CCG). A CCG is an NHS body of GP’s and other clinicians/health care professionals who are responsible for the planning and commissioning of healthcare services in their local area.

The practice is structured over three sites, the main site of Downs Way Medical Practice is Istead Rise Surgery and there are two branch sites, Shorne Village Surgery and Summerhouse Surgery. The administration for the practice is centralised at Istead Rise, however there are independent reception teams at each site.

There are eight partners at Downs Way Medical Practice which include six GP’s (four male and two female), the practice manager and an advanced nurse practitioner. The practice manager works across all three sites, as does the advanced nurse practitioner, however the six GP’s all work across two sites and cover a third as required. Each site has a specified clinical lead GP.

The partners are supported at by a deputy practice manager, a finance manager and two business admin assistants, two practice nurses, two health care assistants, a phlebotomist, four dispensing staff and an administrative team.

Two of the branch surgeries at Downs Way Medical Practice dispense medicines, Istead Rise Surgery and Shorne Village Surgery. There is a dispensing lead GP.

The practice is a training practice and there are three GP trainers who oversee two GP trainees each.

The practice has a general medical services contract via NHS England for delivering primary care services to local communities. It has a registered patient population of approximately 12,500 and is in an area of low deprivation.

Istead Rise Surgery is open from Monday to Friday between the hours of 8.30am and 6.30pm; however, the phones are operated from 8am. Extended hours are offered on Wednesday and Thursday from 6.30pm to 8.30pm. Primary medical services are available to patients via an appointments system which includes emergency book on the day appointments. As the main practice, telephones at Istead Rise Surgery are operated between 8.00am and 6.30pm.

Shorne Village Surgery is open from 8.30am to 12 noon and 3.30pm to 6.30pm Monday, Tuesday and Thursday and from 8.30am to 12 noon on Wednesday and Friday. There is an open surgery in the morning, whereby all patients who attend by 10.30am are seen by either a doctor or the nurse practitioner. An appointment system operates in the afternoon. The telephone is diverted to Istead Rise Surgery during lunchtime closure and on Wednesday and Friday afternoons.

Summerhouse Surgery is open from Monday to Friday between the hours of 8.30am and 6.30pm, except Thursdays when services are provided between 8.30am and 12.00 noon. Extended hours are available on alternate Tuesday evenings between 6.30pm and 8.30pm. Summer house Surgery operates an appointment system which includes book on the day, emergency and advance appointments.

Telephones at Downs Way Medical Practice are operated between 8.00am and 6.30pm. There are arrangements with other providers - Integrated Care 24 (known as IC24) – to deliver services to patients outside of the practice’s working hours.

Services are delivered from:

Downs Way Medical Practice, Istead Rise Surgery, Worcester Close, Istead Rise, Gravesend, DA13 9LB

Shorne Village Surgery, Crown Lane, Shorne, Gravesend, Kent DA12 3DY

Summerhouse Surgery, Beaconsfield Road, Bexley, Kent, DA5 2AE.

The main site at Istead Rise Surgery was inspected; however the branch sites were not. Shorne Village Surgery dispensary was visited and inspected.

Updated 28 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Downs Way Medical Practice on 18 February 2016. Breaches of the legal requirements were found. Following the comprehensive inspection, the practice wrote to us to tell us what they would do to meet the legal requirements in relation to the breaches.

We undertook this focussed inspection on 06 September 2016, to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting ‘all reports’ link for Downs Way Medical Practice on our website at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 May 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.

• 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 carries out medication reviews every six months.

• Regular multi-disciplinary meetings were held which included other health professionals who specialised in the care of people with long-term conditions.

Updated 25 May 2016

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. 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to31/03/2015)was 82% which is the same as the England national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice had in-house Long Acting Reversible Contraception (LARC) fitting by suitably trained and qualified staff.

• We saw that midwives and health visitors were available at the practice.

• The practice carried out 6-8 week baby checks and post-natal checks.

• Immunisation indicators were comparable or slightly higher that CCG and England averages.

• An audit was undertaken regarding Attention deficit hyperactivity disorder (ADHD) medicine and how monitoring and prescribing was carried out and reviewed.

Updated 25 May 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.

• People over 75 had a designated GP to oversee their care and treatment.

• The practice operated an unplanned admissions enhanced service to help avoid older people being admitted to hospital unnecessarily.

• The practice had a process to identify and review patients repeat attending at A and E.

• The practice had a care co-ordinator to support older people and signpost relevant services.

• Regular multi-disciplinary meetings were held which included other health professionals who specialised in the care of older people.

• Dispensing services were available for those patients that were eligible.

• A minor operations service was offered by the practice.

• (AAA) clinic was offered by the practice.

Updated 25 May 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.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.

• Appointments, travel vaccination appointments and repeat prescriptions could be booked on-line.

• The practice offered appointments outside of normal working hours.

• A minor operations service was offered by the practice.

Updated 25 May 2016

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

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

• The practice carried out advance care planning for patients with dementia in liaison with the mental health team for older people.

• Patients newly diagnosed with dementia were routinely referred to the memory clinic and an alert placed on their notes.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and the care co-ordinator at the practice was involved in this.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• The practice provided access to a counsellor.

Updated 25 May 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 had a specific GP to lead on the care and treatment of people with a learning disability.

• People with learning disabilities had an annual review of their care, treatment and medication and their care plan updated.

• The practice offered longer appointments (20 minutes) for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and there was a community mental health nurse attached to the practice who attended multi-disciplinary meetings.

• 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 had a list of patients on the mental health register and care plans were being put in place for these patients.

• An ‘Immediate and necessary’ appointment was available to ensure that everyone had access to care and treatment that needed it.

• The practice used ‘docman’ as a means of sharing information between clinicians to ensure that people were safeguarded.