Northdown Surgery

Updated 19 October 2016

Northdown Surgery provides services from purpose built premises to patients living in Cliftonville, Margate, Kent. The building is on one level and all patient areas are accessible to patients with mobility issues, as well as parents with children and babies. There are approximately 10,800 patients on the practice list. The practice’s age range population profile is close to national averages. However, the surrounding area has a high prevalence of people living in deprived circumstances. For example, the practice has more patients in their patient population who are lone parents claiming income support than national averages (practice average 1.7%, national average 1.2%) and more patients claiming out of work benefits (practice average 14%, national average, 9%).

The practice holds a General Medical Service contract and consists of four GP partners (three female and one male). Together the GP partners provide 30 sessions per week. Alongside the GPs there is one paramedic practitioner (female) who provides eight sessions and an advanced nurse practitioner (female) providing six sessions. The practice has successfully recruited another paramedic practitioner to join the team. There are two nurses (female), a primary care visitor (female) one nurse apprentice (female), two healthcare assistants (female) and a phlebotomist (phlebotomists take blood samples).

The practice has undergone significant changes to the management team in the last three years; including the retirement of three GP partners and a change of practice manager. The current GPs and nurses are supported by two practice managers (who have been in post six months) and a team of administration and reception staff. A wide range of services and clinics are offered by the practice including: diabetes, minor surgery and child health/baby clinics. Patients have access to physiotherapy and counselling services on site (these services are delivered by two local healthcare providers).

The practice is open from 8am to 6.30pm Monday to Friday and provides extended hours every Saturday from 8am to 12noon.

An out of hour’s service is provided by IC24, outside of the practices opening hours. Information is available to patients on how to access this service at the practice, in the practice information leaflet and on the website.

Services are delivered from: St Anthony's Way, Margate, Kent, CT9 2TR.

Updated 19 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northdown Surgery on 23 August 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 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.
• 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 it was sometimes difficult to get through to the practice by telephone and to make an appointment with a GP. The practice was aware of this and after consultation with the patient participation group (PPG) and patients, were taking action. Urgent appointments were available on the same day for patients that needed them.
• Data from the national GP patient survey showed patients showed the practice was below local and national averages in some aspects of care. The practice was aware of these results and through consultation with the patient participation group (PPG) and patients, had formulated an action plan. The practice was in the process of implementing some of these actions at the time of the inspection.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The management structure had been recently restructured, including two joint practice managers, to reflect the changing needs of the practice. New lead roles had been created and staff felt supported by the new management team.
• The practice was responsive to the needs of older patients and gave equal importance to patients’ emotional and social needs alongside their physical and health requirements. The practice had collaborated with the local clinical commissioning group (CCG) in two projects aimed at improving outcomes for this patient population group.
• The practice were proactive in identifying and supporting carers and had 330 patients recorded on the carers register (3% of the practice list).
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice team had recognised that it faced challenges linked with recruiting clinical staff and delivering services in an area that had a high prevalence of patients living in deprived circumstances. In response the practice was forward thinking and part of several local and national pilot schemes to improve services and outcomes for patients in the area.

The areas where the provider should make improvements are:

• Continue to improve systems and processes to monitor and recall patients with long-term conditions including diabetes, asthma and dementia.
• Continue to promote national screening programmes to help improve outcomes for patients.
• Continue, with the support of the patient participation group (PPG), to review and improve patients’ experience of the service, including in areas such as telephone access and access to GPs.
• Continue to review the staff appraisal systems to help ensure all staff receive regular support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 October 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.
• Performance for diabetes related indicators were slightly lower when compared to local and national averages. The practice had recognised the management of long-term conditions was an area that required improvement and at the time of the inspection the practice had begun to implement a program of improvements.
• 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 19 October 2016

The practice is rated as good 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.
• The practice’s uptake for the cervical screening programme was 78%, which was slightly below the CCG average of 83% and the national average of 82%. The nursing team had recognised this and had instigated several measures to promote the screening programme within the practice, including a designated notice board in the patient waiting room.
• 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.

Updated 19 October 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 patients and gave equal importance to patients’ emotional and social needs alongside their physical and health requirements. The practice had collaborated with the local clinical commissioning group (CCG) to run a Primary Care Visitor project to help support patients to remain in their own homes. Patients with enhanced needs were offered home visits and urgent appointments.
• The practice took part in a project in 2014/15, funded by the CCG to provide support and care to patients living in care homes. The practice used funding from this project to purchase equipment for five care homes and employ a paramedic practitioner who provided care for patients and training for care home staff aimed at improving outcomes for patients. A patient ‘deterioration tool’ was developed from this which was used by local care homes to help identify and monitor patients at risk of deteriorating health.

Updated 19 October 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 patient 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 reflects the needs for this age group.
• The practice provided a telephone triage clinic for patients who may not be able to attend the practice during working hours.
• The practice offered Saturday morning clinics from 8am to 12.30pm for patients who could not attend during normal working hours.

Updated 19 October 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 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 19 October 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 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.