The Care Quality Commission
  • Doctor
  • GP practice

The Thorndike Surgery

Overall: Requires improvement read more about inspection ratings

Thorndike Medical Centre, Longley Road, Rochester, ME1 2TH (01634) 817217

Provided and run by:
Thorndike Partnership

All Inspections

21 July 2022

During a routine inspection

We carried out an announced inspection at The Thorndike Surgery on 21 July 2022. Overall, the practice is rated as Requires Improvement.

The key questions at this inspection are rated as:

Safe - Requires Improvement

Effective – Requires Improvement

Caring - Requires Improvement

Responsive – Requires Improvement

Well-led – Requires Improvement

We carried out a focused inspection looking at the responsive domain only, on 1 February 2022, in response to concerns raised about access. The practice was rated as Requires Improvement for providing responsive services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Thorndike Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection to provide the practice with an up to date rating.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected.
  • information from our ongoing monitoring of data about services.
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Requires Improvement.

We have rated the practice as Requires Improvement for providing safe services because:

  • The practice’s systems and processes did not always keep people safe and safeguarded from abuse.
  • The practice’s systems for the appropriate and safe use of medicines, including medicines optimisation, required improvement.
  • Improvements were needed to the practice’s system for recording and acting on safety alerts.

We have rated the practice as Requires Improvement for providing effective services because:

  • Patients’ needs were assessed, but care and treatment was not always delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
  • Improvements in performance related to childhood immunisations and cervical screening were required.

We have rated the practice as Requires Improvement for providing caring services because:

  • The latest National GP Patient Survey results had deteriorated and showed that the practice was performing significantly lower than the local and national averages for indicators regarding patient experience.

We have rated the practice as Requires Improvement for providing responsive services because:

  • The latest National GP Patient Survey results had deteriorated, and showed that the practice was performing significantly lower than local and national averages for several indicators regarding access to the practice.

We have rated the practice as Requires Improvement for providing well-led services because:

  • Processes for managing risks, issues and performance required improvement.

We found that:

  • Appropriate standards of cleanliness and hygiene were met.
  • Staff had the information they needed to deliver safe care and treatment.
  • The practice was able to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
  • Staff worked together and with other organisations to deliver effective care and treatment.
  • Staff helped patients to be involved in decisions about care and treatment.
  • Complaints were listened to as well as responded to and used to improve the quality of care.
  • There were clear responsibilities, roles and systems of accountability to support good governance and management.

We found two breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Review practice systems so that they always alert staff to family and other household members of children on the risk register.
  • Ensure that all staff take effective action to keep data secure.
  • Ensure that the practice’s cold chain policy is adhered to by practice staff.
  • Continue to ensure that actions identified in risk assessments are completed in a timely manner.
  • Ensure Patient Group Directions are completed fully.
  • Ensure that serial numbers of blank prescription forms and pads are recorded.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

22 February 2022

During an inspection looking at part of the service

We carried out an announced focused inspection The Thorndike Surgery in Rochester, Kent on 22 February 2022 in response to information of concern we received regarding access to the practice.

Overall, the practice remains rated as GOOD from the previous inspections in March 2018, however we have re-rated the responsive key question as REQUIRES IMPROVEMENT.

Our key findings

  • Patient feedback was mixed, some feedback indicated recent improvements had been made however many patients reported they were not able to access the practice, highlighting problems with the telephone system.
  • The issues with the telephone system resulted in people raising concerns about being able to book appointments and access care, treatment and GP services.
  • Throughout the inspection, we saw evidence that the practice had taken action to improve access to services and were continuing to review other areas of improvement to how patients accessed the practice. We saw complaints were received and listened to, themes were identified, and senior management meetings discussed the options for improvement identified. We also saw additional staff had been employed and the practice had changed the triage system to improve patient requests for advice and appointments
  • The practice was continuing to review other areas for improvement in patient access to its services.

We based our judgement of the quality of care at this service on a combination of:

  • What we found when we inspected
  • Information from our ongoing monitoring of data about services and
  • Information from the provider, patients, the public and other organisations.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Thorndike Surgery on our website at www.cqc.org.uk

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Interviews with members of staff
  • Reviewing the appointment system
  • Requesting evidence from the provider
  • A short site visit
  • Discussions with patients and external stakeholders who accessed services from the practice

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Kent and Medway. To understand the experience of GP Providers and people who use GP services, we asked a range of questions in relation to urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

We found a breach of regulations. The provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

6 March 2018

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at The Thorndike Surgery on 27 and 28 June 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for The Thorndike Surgery on our website at www.cqc.org.uk.

After the inspection in June 2017 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

This inspection was an announced focussed inspection carried out on 6 March 2018 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 27 and 28 June 2017. This report covers findings in relation to those requirements.

This practice is now rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Good

As part of our inspection process we also look at the quality of care for specific patient population groups. The patient 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

Our key findings were as follows:

  • The practice followed national guidance on the management of medicines and infection prevention and control.

  • Improvements to risk management had been made with health and safety risks now being assessed and well managed.

  • Incoming records that required the attention of clinical staff were now being processed in a timely manner.

  • The way the practice referred patients to other services had improved.

  • Results from the national GP patient survey published in July 2017 demonstrated improvements in patient satisfaction scores on consultations with GPs and nurses as well as on their involvement in planning and making decisions about their care.

  • Results from the national GP patient survey published in July 2017 also demonstrated a decline in all but one of the patient satisfaction scores with how they could access care and treatment at this practice.

  • The availability of the different types of appointments offered by the practice had improved. However, further improvement in the availability of routine appointments was still required.

  • Improvements to governance arrangements at the practice had taken place.

  • Plans to address the safety issues associated with the shortage of clinical staff had been enhanced and implemented resulting in improvements.

  • The practice was able to demonstrate that learning from complaints received was taking place with planned improvements being implemented more fully.

The areas where the provider must make improvements are:

  • Continue to implement plans to improve patient satisfaction scores.
  • Continue to implement plans to improve patient access to routine appointments.

The areas where the provider should make improvements are:

  • Continue to work with the contracted external company to manage and reduce the risks associated with legionella. (Legionella a germ found in the environment which can contaminate water systems in buildings).
  • Continue to manage all incoming records in a timely manner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

27 and 28 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thorndike Surgery on 27 and 28 June 2017. Overall the practice is rated as requires improvement.

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

  • There was an effective system for reporting and recording significant events.
  • There were systems, processes and practices to help keep patients safe and safeguarded from abuse.
  • The practice was unable to demonstrate they always followed national guidance on infection prevention and control.
  • The arrangements for managing medicines in the practice did not always keep patients safe.
  • Risks to patients, staff and visitors were not always assessed and managed in an effective and timely manner.
  • The practice had arrangements to respond to emergencies and major incidents.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • There was evidence of clinical audits driving quality improvement.
  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • The practice was unable to demonstrate they had an effective system that managed test results and other incoming correspondence in a timely manner.
  • The practice was unable to demonstrate they had a reliable system that followed up on patients who were referred to other services.
  • Patients said they were treated with compassion, dignity and respect. However, national GP patient survey results were poor for some satisfaction scores on consultations with GPs and nurses and for involvement in planning and making decisions about their care and treatment when seeing nurses.
  • There was limited access to routine appointments for patients, which was ongoing.
  • Information about services and how to complain was available and easy to understand. Some improvements were made to the quality of care as a result of complaints and concerns.
  • Governance arrangements were not always effectively implemented.
  • There was a clear leadership structure and most staff felt supported by management. The practice gathered feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are;

  • Ensure care and treatment is provided in a safe way to patients.

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are;

  • Include all clinical equipment in checking to help ensure it is working properly.

  • Ensure all staff receive an annual appraisal.

  • Continue to identify patients who are also carers to help ensure eligible patients are offered relevant support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

2 December 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thorndike Surgery on the 2 December 2014. During the inspection we gathered information from a variety of sources. For example, we spoke with patients, interviewed staff of all levels and checked that the right systems and processes were in place.

Overall the practice is rated as good. This is because we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for all patient population groups.

Our key findings were as follows:

  • Patients’ said they felt safely cared for and had no concerns about their care or treatment.
  • Staff were helpful, caring and considerate to patients’ needs.
  • Patients felt listened to and their opinions about care and treatment were acted upon.
  • The environment was safe and always cleaned to a high standard.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
  • Patients said they were treated with dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand.
  • The practice had a clear vision which had quality and safety as its top priority.
  • A business plan was in place, was monitored and regularly reviewed and discussed with all staff.

However, there were also areas of practice where the provider should make improvements:

  • Staff meetings that include attendance of the whole staff team.
  • Ensure that clinical audits are complete audit cycles.
  • Improve processes for making appointments and reducing waiting times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice