Archived: Summerhill Surgery

Updated 1 March 2017

Summerhill Surgery delivers services from purpose built premises in Ramsgate, Kent. The practice has a car park and patient areas are accessible to patients with mobility issues, as well as parents with children and babies. There are approximately 6,000 patients on the practice list. The surrounding area has a high prevalence of people living in deprived circumstances. For example, there are more children affected by income deprivation in the practice patient population than local and national averages (practice average 30%, local average 27% and national average 20%). The practice also has more patients registered with a long-standing health condition than local and national averages (practice average 68%, local average 60% and national average 54%).

The practice holds a General Medical Service contract and consists of two GP partners (one male and one female). One of the GP partners has been absent from the practice since November 2015; the practice employs two regular locum GPs (male) to help cover GP appointments. There are three practice nurses (female) and one healthcare assistant (female). The GPs, nurses and healthcare assistant are supported by a practice manager and a team of administration and reception staff. A wide range of services and clinics are offered by the practice including: asthma, diabetes, minor surgery and antenatal clinics.

The practice is open from 8am to 6.30pm Monday to Friday. There are extended hours 7am to 8am on Thursdays. Morning appointments are from 8am to 11.40am and afternoon appointments are from 2pm to 3.50pm. There are daily ‘sit and wait clinics’ from 12noon to 12.20pm.

An out of hour’s service is provided by Primecare, outside of the practices opening hours. There is information available to patients on how to access this at the practice, in the practice information leaflet and on the website.

Services are delivered from:

243 Margate Road, Ramsgate, Kent, CT12 6SU.

Updated 1 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Summerhill Surgery on 1 November 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach for reporting and recording significant events. However, not all significant events contained sufficient detail and the practice was unable to demonstrate that outcomes and learning were consistently shared throughout the practice.
• Not all risks to patients were assessed and well managed. For example infection prevention and control, legionella risk assessments and medicines management.
• Blank prescription pads and forms were stored securely. However, the practice was unable to demonstrate that they had a system to track and monitor their use.
• 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.
• Information needed to plan and deliver care and treatment was not always available to relevant staff in a timely manner and accessible way through the practice’s patient record system and their intranet system.
• The practice was unable to demonstrate they had a consistently systematic approach to care planning.
• 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.
• Urgent appointments were available on the same day. However, patients said they sometimes found it difficult to book appointments with a GP when they needed them.
• Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was below local and national averages.
• 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 sought feedback from staff and patients, which it acted on.
• There were a range of mechanisms to manage the governance of the practice; however, governance arrangements were not always effectively implemented.
• The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems for notifiable safety incidents. However, the practice was unable to demonstrate a systematic approach for sharing this information with staff to help ensure appropriate action was taken

The areas where the provider must make improvement are:

• Develop an effective system for sharing significant events and incidents to ensure lessons are learned.
• Ensure the practice has regard for national guidance on the prevention and control of infection.
• Ensure the practice has regard for national guidance on the management of medicines and develop systems to monitor blank prescription forms and pads, vaccine storage and ensure that there is a process for managing and acting on medicine alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).
• Ensure risk assessment and management activities include all potential and actual risks to patients, staff and visitors.
• Review the process for care planning for frail and elderly patients and medicine management reviews for patients on multiple medicines to help ensure the safety and individual needs of these patients are being met.
• Review and improve patients’ experience of the service, including areas such as telephone access to services and access to GP appointments.

The areas where the provider should make improvement are:

• Review clinical staffing levels to help ensure patients have access to routine GP appointments.
• Review staff training to help ensure that all staff receive appropriate training such as Mental Capacity Act training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 March 2017

The practice is rated as requires improvement for the care of people with long-term conditions. The provider was rated as inadequate for providing safe and well-led services, requires improvement for providing effective and responsive services and good for providing caring services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable with local and national averages (QOF data used in this report was obtained from http://qof.digital.nhs.uk ).
• Longer appointments and home visits were available when needed.
• These patients had a named GP and 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, the practice was unable to demonstrate they had a consistent approach to annual medicine reviews for patients on multiple medicines.

Updated 1 March 2017

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as inadequate for providing safe services, requires improvement for providing effective, responsive and well-led services and good for providing caring services. The resulting overall rating applies to everyone using the practice, including this patient population group. There were, however, examples of good practice:

• 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 practice’s uptake for the cervical screening programme was comparable with local and national averages.
• 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 1 March 2017

The practice is rated as requires improvement for the care of older people. The provider was rated as inadequate for providing safe services, requires improvement for providing effective, responsive and well-led services and good for providing caring services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• The practice was unable to demonstrate they had a consistent approach to care planning, especially for frail and elderly patients aged over 75 years.
• 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 access to two beds in a nursing home for patients requiring extra support or respite care.

Updated 1 March 2017

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The provider was rated as inadequate for providing safe services, requires improvement for providing effective, responsive and well-led services and good for providing caring services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• 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.
• 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 1 March 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider was rated as inadequate for providing safe services, requires improvement for providing effective, responsive and well-led services and good for providing caring services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• 82% of patients diagnosed with dementia had received a face to face care review meeting in the last 12 months, which was comparable to the local average of 81% and the national average of 84%. (This data was obtained from http://qof.digital.nhs.uk)
• Performance for mental health related indicators were comparable with local and national averages.
• 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 1 March 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider was rated as inadequate for providing safe services, requires improvement for providing effective, responsive and well-led services and good for providing caring services. The resulting overall rating applies to everyone using the practice, including this patient population group.

• The practice held a register of patients living in vulnerable circumstances including 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.
• 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.