Dr CR Dewing and Partners

Updated 22 June 2017

Dr CR Dewing and Partners (also known as Wish Valley Surgery) is a GP practice based in rural Hawkhurst, Kent with a catchment area of approximately 4,615 patients.

The practice is similar across the board to the national averages for each population group. For example, 18% of patients are aged 0 -14 years of age compared to the CCG national average of 17%. Scores were similar for patients aged under 18 years of age and those aged 65, 75 and 85 years and over. The practice is in one of the least deprived areas of Kent and has an almost exclusively white British population.

The practice holds a General Medical Service contract and consists of four partner GPs (three male and one female). The GPs are supported by two part-time GPs (both female), a practice manager, three practice nurses (female), two healthcare assistants (female), two dispensers, a dispensing assistant and an administrative team. A wide range of services and clinics are offered by the practice including minor surgery, asthma and diabetes.

The practice is arranged over three storeys, with all the patient accessible areas being located on the ground and basement floors. The practice is accessible to patients with mobility issues, as well as parents with children and babies.

Dr CR Dewing and Partners is open 8am to 6.30pm Monday to Friday. Extended hours are available on Monday or Tuesday evenings from 6.30pm to 9pm.

The practice 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. This service is delivered by a dispensary team of two dispensers and a dispensing assistant.

There are arrangements with other providers (Integrated Care 24) to deliver services to patients outside of the practice’s working hours.

Services are provided from:

• Dr CR Dewing and Partners, The Surgery, Wish Valley, Hawkhurst, Kent, TN18 4NB

Updated 22 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr CR Dewing and Partners on 19 October 2016. The overall rating for the practice was requires improvement. The practice was rated as requires improvement for providing safe and well-led services and rated as good for providing effective, caring and responsive services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Dr CR Dewing and Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements, in relation to the breaches in regulations that we identified in our previous inspection on 19 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had improved its systems and processes in order to ensure that, risks were assessed and implemented well enough to ensure patients, staff and visitors were kept safe. Action had been taken to address the areas of concern identified in the infection control audit, as well as actions required from risk assessments relating to fire safety and legionella checks.

• Routine checks for the storage and expiry dates of medicines were suitably risk assessed, recorded and appropriately maintained. Repeat prescription medicines were dispensed in a safe manner.

• Recruitment arrangements had been improved in order to ensure they included all necessary pre- employment checks for all staff.

• Staff had received up to date training in safeguarding children.

• The structure of governance meetings had been enhanced to include all departments and staff within the practice, in order to further drive improvement.

The practice had also taken appropriate action to address areas where they should make improvements:

• The practice had developed the system that identified patients who are also carers to help ensure that all patients on the practice list are offered relevant support if required.

• The system for responding to complaints had improved, in order to ensure it included acknowledgement of receipt of complaints and provides clarity to complainants as to contacting the ombudsmen.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 June 2017

The provider had resolved the concerns for safe and well-led identified at our inspection on 19 October 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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 comparable to the local and national average. For example, 78% 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.

  Patients with long-term conditions had comprehensive care plans where necessary.

Updated 22 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 19 October 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 76%, which was comparable to the CCG average of 84% 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.

• The practice provided patients aged 24 and under with access to free condoms, under the Kent C - Card scheme and chlamydia screening for those under 25.

Updated 22 June 2017

The provider had resolved the concerns for safe and well-led identified at our inspection on 19 October 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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.

• Care and treatment of older people reflected current evidence-based practice.

• Older people had comprehensive care plans where necessary.

• The leadership of the practice had a good understanding of the needs of older people, there was good engagement with this patient group and they were continually looking at ways to improve the service for them.

• Contingency planning had been implemented, to take into account the imminent increase in list size, with the opening of a 90 bed care home in the village of Hawkhurst next year.

Updated 22 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 19 October 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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 offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice offered a ‘Commuter’s Clinic’ on Monday or Tuesday evenings from 6.30pm to 9pm for working patients who could not attend during normal opening hours.
• Telephone consultations were also available.

Updated 22 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 19 October 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• Performance for mental health related indicators were comparable or above the local and national averages. For example, 81% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 100%, which was higher than the national average.

• 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 22 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 19 October 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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. Administrative staff had now received Level 1 training in safeguarding children.

• The practice had developed the system that identified patients who are also carers to help ensure that all patients on the practice list were offered relevant support if required. The practice had introduced a carer’s protocol, carer’s notice board, poster and added information about identifying carers on their website and in the new Patient Participation Group (PPG) newsletter which was distributed to local shops.