Orchard End Surgery

Updated 9 June 2017

Orchard End Surgery is situated in Cranbrook, Kent and has a registered patient population of 3,250.

The practice patient population includes a larger than average proportion of people aged 5-15 and 40-59 and a smaller than average proportion of people aged 20-40. The practice is located in an area with a lower than average deprivation score.

The practice staff consists of two GP partners (one male and one female) who are supported by a practice manager, a practice nurse (female), a phlebotomist/trainee health care assistant (female), two dispensary staff and an administrative team.

Most patient areas are on the ground floor and are accessible to patients with mobility issues, as well as parents with children and babies. One of the consulting rooms is located on the first floor. Staff told us they arrange for patients who are unable to use the stairs to be seen in one of the rooms on the ground floor. There is a small car park and on-street parking for patients at the practice.

The practice has a general medical services contract with NHS England for delivering primary care services to the local community. The practice is not a training practice.

The practice is open between the hours of 8.30am and 6pm on Monday, Tuesday, Wednesday and Friday, and on Thursday from 8.30am to 12 midday. An extended hours surgery is available on Tuesday evenings from 6.30pm to 8pm. Between 8am and 8.30am and between 6pm and 6.30pm, services are provided by South East Health Limited. On Thursday between 12 midday and 6pm, services are provided by a neighbouring practice, The Crane Surgery. The practice’s telephones are closed between 1pm and 3pm daily. During this time, patients can call the duty doctor at the practice.

There is a range of clinics for all age groups. There are arrangements with other providers (South East Health Limited) to deliver services to patients outside of the practice’s working hours.

Services are provided from:

• Orchard End Surgery, Dorothy Avenue, Cranbrook, Kent, TN17 3AY.

Updated 9 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orchard End Surgery on 15 September 2016. The overall rating for the practice was requires improvement. The practice was rated as requires improvement for providing safe, effective and well-led services and rated as good for providing caring and responsive services. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Orchard End Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 23 May 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 15 September 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:

• Since our inspection in September 2016 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.

• The practice had ensured that staff had received relevant training, annual appraisals and were supported to keep up to date with all relevant mandatory training. For example, safeguarding, information governance and basic life support.

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

• The security arrangements for the dispensary had been improved in order to ensure it was accessible to authorised staff only.

• Regular audits of infection prevention and control had been implemented and conducted.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 June 2017

The provider had resolved the concerns for safety, effective and well-led identified at our inspection on 15 September 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.

• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 93% compared to the Clinical Commissioning Group (CCG) and national average of 88%.

• 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 9 June 2017

The provider had resolved the concerns for safety, effective and well-led identified at our inspection on 15 September 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 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, and we saw evidence to confirm this.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 85% compared to the Clinical Commissioning Group (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 had produced a leaflet to encourage teenagers to feel more at ease in seeing a GP and this was available in the waiting room.

Updated 9 June 2017

The provider had resolved the concerns for safety, effective and well-led identified at our inspection on 15 September 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.

• GP services were provided to the residents of a local nursing home and the practice carried out regular visits there.

Updated 9 June 2017

The provider had resolved the concerns for safety, effective and well-led identified at our inspection on 15 September 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 help ensure these were accessible, flexible and offered continuity of care.

• Late appointments were offered and the practice also offered telephone consultations.

• 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 9 June 2017

The provider had resolved the concerns for safety, effective and well-led identified at our inspection on 15 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 77% of patients diagnosed with dementia had 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 their record in the preceding 12 months was 100% compared to the Clinical Commissioning Group (CCG) and national average of 88%.

• 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.

• Patients experiencing poor mental health were told about how to access various support groups and voluntary organisations.

• There was 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. For example, they supported the work of a local “memory lane café” for patients living with dementia.

Updated 9 June 2017

The provider had resolved the concerns for safety, effective and well-led identified at our inspection on 15 September 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 homeless people, travellers and those with a learning disability.

• Longer appointments were offered to patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• Vulnerable patients were informed about how to access various support groups and voluntary organisations.

• Staff were trained to the appropriate level in safeguarding adults and children.