Kingswood Surgery

Updated 24 April 2017

Drs.Bowes,Gillam,Roome,Stone,Welch & Roome also known as Kingswood Surgery is situated in Tunbridge Wells, West Kent and is within walking distance of the town centre. The practice operates out of two-storey premises and clinical services are delivered on both floors. The facilities are accessible for patients with a disability. However there is no lift, so for those patients who are unable to climb the stairs, the doctors will see them in a ground floor clinical room and this is arranged by the receptionists when booking the appointment. There is limited on-site parking and street parking is available around the practice. 22% of the practice population were older people and 23% were in the younger age group. 95% of the registered patients were white and 2.5% were Asian.

The staffing team consists of six GPs who are partners in the practice and two salaried GPs. Two of the GPs are male who work 8 sessions and 6.4 sessions respectively and there are six females working between 2 sessions and 6.4 sessions. There are also four part-time practice nurses, two part-time health care assistants and a part-time phlebotomist. There is a full-time practice manager, who is supported by a team of part-time receptionists, administrators and medical secretaries.

The practice is open between 7am and 6.30pm on Mondays and Wednesdays and between 8am and 6.30pm on Tuesdays, Thursdays and Fridays. It also opens between 8.30am and 12am on the first Saturday of each month. Appointments are available from 7.10am to 12.00pm and from 3.30pm to 6pm Mondays and Fridays, and between 2pm and 6pm on Tuesdays, Wednesdays and Thursdays. Appointments are also available on the first Saturday of each month between 8.30am and 12am.

When the practice is closed, patients are redirected to Integrated Care 24 (‘IC24’), the out of hours provider for the area.

There are 9,722 registered patients on the practice list.

The practice offers medical student training for final year students at the University College of London, as well as providing training for a GP Registrar.

Services are provided from

Kingswood Surgery, Kingswood Road, Tunbridge Wells, Kent, TN2 4UH

Updated 24 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr. Bowes, Gillam, Roome, Stone, Welch & Roome 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 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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:

• The practice was providing a service to a local women’s refuge, enabling these women and their children to receive treatment as permanent residents, rather than being registered as temporary residents. This allowed the practice to obtain past GP records which were summarised as a priority. Children’s Immunisation records were checked and any outstanding vaccines administered whilst at the refuge. The permanent resident status also allowed patients to be part of the routine immunisation recall system. The registration process had been adapted for these patients, recognising that some may have fled their homes and had therefore been unable to produce the necessary form of identification.

The areas where the provider should make improvement are:

• Ensure the staff training programme is completed.

• Complete the practice’s business development plan.

• The practice’s system of recalling patients who had not attended to discuss blood test results and follow-up’s from secondary care specialist referrals were not always being processed consistently and the system should therefore be reviewed.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 24 April 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’s performance for diabetes indicators showed that the last blood pressure reading taken of patients was 140/80mmHg or less (measured in the preceding 12 months), was 73%, compared to the Clinical Commissioning Group (CCG) average of 77% and the national average of 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.
• Where a patient had more than one long-term condition, the practice scheduled appointments suited to review all such conditions at the same time, in order to avoid repeat visits.
• Clinical support was provided for vulnerable groups, such as local residential care establishment, which provided care for adults with a learning disability and complex needs and another home which provided residential care and support for adults aged 18-65 with acute mental health issues.
• There was an in-house carer’s support service offering guidance and advice on services and health checks.
• Monthly multi-disciplinary team meetings were held with district nurses, social and community care specialists and palliative care nurses for patients with long-term conditions.

Updated 24 April 2017

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 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 performance for cervical screening was similar to CCG / national averages. For example, 83% of women aged less than 65 years were recorded as having a cervical screening test in the preceding 5 years. This compared to the CCG average of 83% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies and these were triaged before being referred to the GP where there was a clinical need. In such cases, a call back would be made within a maximum four hour period.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The practice was providing a service to a local women’s refuge, enabling these women and their children to receive treatment as permanent residents, rather than being registered as temporary residents. This allowed the practice to obtain past GP records which were summarised as a priority. Children’s Immunisation records were checked and any outstanding vaccines administered whilst at the refuge and they also. Became part of the routine immunisation recall system. The registration process had also been adapted for these patients, as it was acknowledged that they may have been unable to produce the necessary form of identification, so they were able to register without identification or proof of address. When a woman first registered, they were offered a new patient consultation with the lead GP, so that a relationship could be developed and sensitive issues shared. Women were also being offered counselling as well as being signposted to support in the voluntary sector.

Updated 24 April 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.
• There was a register and care plans in place for all patients identified as being at risk of having an unplanned hospital admission. Patients admitted to hospital were reviewed within three days of discharge.
• Space had been allocated in the surgery for district nurses and palliative care teams, to facilitate easier communication and collaboration. Monthly MDT meetings were attended by representatives from local care and nursing homes.
• GPs carried out scheduled weekly visits to a local care home.
• There was an in-house physiotherapy service.

Updated 24 April 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 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. Telephone appointments were offered as an alternative to a face-to-face appointment was not necessary.
• The practice offered extended surgery hours from 7.10am to 8am on Mondays and Wednesdays and a Saturday morning surgery between 8.30am and midday on the first Saturday of the month.
• Sexual health and family planning services were offered.
• Dedicated immunisation sessions were held for students about to go to university, including flu vaccinations.

Updated 24 April 2017

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

• 71% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG average of 84% and the national average of 84%.
• 78% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record in the preceding 12 months. This compared to a CCG average of 91% and a national average of 89%.We discussed this with the GP, who told us the practice had a strong relationship with the residential home offering care to those patients with acute mental health issues, who had carried out a high number of psychiatric reviews independent of the practice. This meant they did not feel able to claim for this work on ethical grounds.
• 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 in place 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. Their records were tagged to enable receptionists to identify them and offer them priority access to a GP.
• There was a named GP for this group of patients, including those at the residential home offering care to those patients with acute mental health issues.

Updated 24 April 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 homeless people, travellers and those with a learning disability.
• The practice offered longer, protected appointments for patients with a learning disability.
• There was a high prevalence of patients with a learning disability (76 patients), and all had been invited for health checks, 38 having been completed in the previous 12 months.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and the child safeguarding lead met every six weeks with the health visitor, school nurse and midwife, to discuss vulnerable families.
• 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.
• There was a named GP for all vulnerable patients, including those with a learning disability.
• Whilst mainly transient, the women at the local refuge centre had been registered as permanent patients, thereby ensuring continuity of care and safeguarding of their personal information.