Clanricarde Medical Centre

Updated 23 February 2018

Clanricarde Medical Centre is a GP practice located in the centre of Tunbridge Wells, Kent and provides care for approximately 14,481 patients. The age of the patients on the practice list is very similar to the national average. There are marginally more patients under 18 years of age than nationally and fewer patients over 65 years of age than nationally. The practice is in one of the least deprived areas of Kent.

There are seven GP partners, four female and three male, who are supported by four salaried GPs (female). There are five practice nurses, a nurse practitioner, a travel nurse and two healthcare assistants (all female). The clinicians are supported by two practice managers and an administrative team. The practice has a general medical services contract with NHS England for delivering primary care services to local communities and also offers enhanced services. For example, extended hours and minor surgery. The practice participates in the national programme of post-graduate training for doctors by offering a placement in a GP practice to doctors who have graduated and completed at least one year as a hospital doctor.

Services are delivered from:

• Clanricarde Medical Centre, Abbey Court, 7-15 St Johns Road, Tunbridge Wells, Kent, TN4 9TF
• Rowan Tree Surgery, Rowan Tree Road, Tunbridge Wells, Kent, TN2 5PX

The practices are open as follows:

Clanricarde Medical Centre between 8.30am and 6.30pm Monday to Thursday and 8.30am to 6pm on Friday. Extended hours surgeries are from 6.15am to 8am Thursdays, Tuesdays 6.15am to 8am and 6.30pm to 7pm Wednesdays and Thursdays.

Rowan Tree Surgery between 8am to 1pm and 2pm to 6.30pm Monday to Friday.

The practice operates a duty doctor system to ensure there is GP cover for urgent and emergency cases. The Practice has an arrangement with Integrated Care 24 (IC24) between 8.00 am to 8.30am Monday to Friday, 6.15pm to 6.30 pm Monday to Thursday & 6.00 pm to 6.30 pm on Fridays. Additionally, the practice has opted out of providing out-of-hours services to their own patients. Care is provided by IC24 and there is information available to patients on how to access out of hours care.

We inspected both practices as part of this inspection.

Updated 23 February 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection September 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Clanricarde Medical Centre on 9 January 2018, under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved patients in their care and treated them with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Continue to ensure that fridge temperatures are routinely monitored and recorded.

• Continue with their plan to help ensure health checks for patients with learning disabilities are offered.

• Continue to ensure that minutes of multi-disciplinary meetings are maintained.

• Continue with their plan to help ensure that one set of policies and procedures are implemented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 November 2015

The practice is rated as outstanding for providing services to patients with long-term conditions. Data showed that the practice’s performance in monitoring and maintaining the health of patients with long-term conditions, in line with current best practice guidelines, was significantly better than that achieved nationally or locally. Where national and local performance had fallen slightly in the management of long-term conditions, such as asthma, diabetes and chronic obstructive pulmonary disease, the practice had maintained or improved its performance. This had been consistent over the period of registration with the Care Quality Commission.

Nursing staff had lead roles in chronic disease management. Patients at risk of hospital admission were identified as a priority and were followed up when they were discharged from hospital. Longer appointments and home visits were available when needed. All 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 19 November 2015

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 in line with national averages for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies.

We saw examples of joint working with midwives, health visitors and school nurses, this included midwife led ante-natal clinics. The practice’s uptake for the cervical screening programme was 95.66%, which was markedly better than the national average of 81.7% and put the practice in the top 2% in the country. The practice’s uptake for the cervical screening programme had bettered the national performance each year over the last nine years by between 14% and 17%.

Updated 19 November 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were often better 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 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.

Updated 19 November 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. This included chlamydia testing kits which were available without having to ask at reception.

Updated 19 November 2015

The practice is rated as outstanding 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 people experiencing poor mental health, including those with dementia. Ninety three per cent of patients diagnosed with dementia had a care plans and had received a face to face review in the last twelve months, this was 10 percentage points above the local average.

In 2013 and 2014 94% of mental health patients had a care plan, agreed between them, their family and/or carers and their GP. Between 2009 and 2013 100% of patients had had such a care plan.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. There was a monthly psychiatric community nurse clinic and a monthly memory clinic at the practice.

Updated 19 November 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. It had recently signed up to provide an enhanced service for patients with learning disability and was planning how to provide out annual health checks for all these patients. It offered longer appointments for people with a learning disability. The practice had a system of registering homeless patients using the details of a local homelessness charity.

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.