Speldhurst and Greggswood Medical Group

Updated 17 March 2017

Speldhurst and Greggswood Medical Group is situated in Tunbridge Wells, Kent. The practice has a general medical services contract with NHS England for delivering primary care services to the local community.

The practice has a patient population of approximately 7,303. The proportion of patients who are aged under 4 years old, and from 20 to 39 is lower than the national average. The practice is in an area with a low deprivation score and lower than average levels of unemployment. Services are provided from two sites: The Medical Centre, Tunbridge Wells and The Old Bakery, Speldhurst.

The Medical Centre is a purpose built, single storey facility with its own car park and a dedicated disabled parking space. It is located close to the town centre with access to public transport services.

The Old Bakery is located in the village of Speldhurst. Consultation and treatment rooms are located on the ground and first floors. There is no patient lift. Staff told us that they would arrange for patients who had difficulty using the stairs to be seen in one of the consulting rooms on the same level as the waiting room. There is no patient parking, including disabled parking, at the practice.

There are two GP partners (one male and one female). Both of the partners work part time (1.6 whole time equivalents (WTE) in total). There are three part-time (1.7 WTE), salaried GPs, all of whom are female. There are two practice nurses and one health care assistant (all female). In addition, there is a practice manager as well as a team of reception and administrative staff. There is a dispensary at The Old Bakery with three dispensary staff, providing dispensing services to approximately 2,000 patients.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available between 8.20am and 11.10am and between 3.00pm and 5.00pm.

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:

• The Medical Centre, Greggs Wood Road, Tunbridge Wells, TN2 3JL, and
• The Old Bakery, Penshurst Road, Speldhurst, Kent, TN3 0PQ.

Updated 17 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Speldhurst and Greggswood Medical Group on 19 January 2017. 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.

The areas where the provider should make improvements are:

• Ensure cleaning equipment is appropriately stored and that infection control audits are regularly carried out.
• Ensure ‘near misses’ in the dispensary are recorded and analysed to identify learning and shared with staff.
• Ensure clinical rooms are locked at all times when unoccupied.
• Ensure minutes of meetings include details of actions agreed and demonstrate that these are followed up.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 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 percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 86% compared to the 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.
• However, patients with learning difficulties or long term conditions did not routinely receive a copy of their written care plan.

Updated 17 March 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 uptake for the cervical screening programme was 90%, which was better than 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.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 17 March 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.
• The practice had two portable hearing loops for use at reception and during consultations.

Updated 17 March 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. For example, the practice offered early or late appointments to patients who were unable to attend during the practice’s core working hours.
• 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.

Updated 17 March 2017

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

• 88% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate was 98% compared to the CCG average of 92% and the national average of 89%.
• 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 17 March 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 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.
• Representatives from the local Citizens’ Advice Bureau held clinics at the practice every two weeks for people to discuss issues with them.
• 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.