Archived: East Cliff Medical Practice

Updated 29 October 2015

East Cliff Medical Practice is a GP practice located in the centre of Ramsgate Kent and provides care for approximately 15000 patients. The practice has approximately 17% of patients between the ages of 65-75. They also have 25% more patients aged 85 years and over compared to the national average. It is an area of slightly higher income deprivation than practices nationally.

There are nine GP partners, five female and four male, as well as one female salaried GP. There are five female practice nurses and two female healthcare assistants. The practice has a personal medical services (PMS) contract with NHS England for delivering primary care services to local communities and also offers enhanced services for example, extended hours. The practice is an approved GP training practice training undergraduates. During each year there are normally three speciality registrars. A registrar is a qualified doctor who is training to become a GP through a period of working and training in a practice.

The practice is open between 8am and 7pm Monday to Friday. Appointments are from 9am to 12.30 pm and 3pm to 5.30pm each day. Extended hours surgeries are from 8am to 10.30am each Saturday.

Services are delivered from;

The Montefiore Medical Centre,

Dumpton Park Drive,

Ramsgate,

Kent,

CT11 8AD.

The practice has opted out of providing out-of-hours services to their own patients. Care is provided by Integrated Care 24 (IC24). There is information available to patients on how to access out of hours care.

Updated 29 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at East Cliff Medical Practice on 25 August 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Significant events were discussed by working groups comprising a staff member from each department that is a GP, a nurse, a receptionist and an administrator. The whole range of practice staff were involved in identifying safe solutions.

• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• The practice’s uptake for the cervical screening programme was excellent. It had bettered the national performance each year over the last nine years by between 11% and 20%.

• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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 practice had significantly lowered prescribing costs, by as much as 12% compared with some other practices in the clinical commissioning group (CCG), through the development of a local formulary (a list of medicines which have been approved for prescribing).

We saw several areas of outstanding practice namely:

• The practice had piloted a scheme which provides two beds in a local care home to support practice patients and help avoid hospital admissions. The learning from this was shared with others and the CCG now commissions beds in a number of homes for other practices.

• There was a drop in clinic for mothers and babies each week

• The practice is the holder of the Royal College of General Practitioners (RCGP) Quality Practice Award. To obtain the award, which is highest attainable from the college, the practice submitted a portfolio of evidence and was subject to an assessment visit. The award is for a five year period and the practice has held the award for the last 15 years.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 October 2015

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. Longer appointments and home visits were available when needed. These patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 29 October 2015

The practice is rated as outstanding for the care of families, children and young people. There were systems in place, involving health visitors, 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. Childhood immunisation rates for the vaccinations given to under twos ranged from 89% to 97% and for five year olds from 89% to 96%. All of these were better than local and national averages, some by small margins but others by up to six percentage points. Appointments were available outside of school hours and the premises were suitable for children and babies.

We saw good examples of joint working with midwives, health visitors and school nurses, this included a drop in clinic for mothers and babies each week which we saw was well attended and well appreciated by mothers who attended and to whom we spoke. There were GPs who held qualifications in obstetrics and gynaecology. One GP had a special interest in breastfeeding. The practice’s uptake for the cervical screening programme was excellent. It had bettered the national performance every year over the last nine years by between 11% and 20%.

Updated 29 October 2015

The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

The practice provided equipment, and training in its use to a local care home. Care staff could therefore provide more accurate information so that the practice could make better judgements on, for example, whether and when a patient needed to be seen or go to hospital. The practice piloted a scheme, commissioned by the Clinical Commissioning Group (CCG), which provides two beds in a local care home. This supported practice patients and helped avoid hospital admissions. Patients who needed supported care, for example between leaving hospital and returning to their own homes, could receive it. These facilities were almost exclusively used by older patients.

Updated 29 October 2015

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.

Updated 29 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Ninety two per cent of patients experiencing poor mental health had had an annual physical check of aspects of their health. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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. It had a system to follow up patients who had attended A&E where they may have been experiencing poor mental health. Many staff had received training on how to care for people with mental health needs and dementia.

Updated 29 October 2015

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 such as those with a learning disability.The practice had carried out annual health checks for virtually all patients with a learning disability in the nearby school. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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