White House Surgery

Updated 11 July 2017

Dr Jedrzejewski and partners is a GP practice in an urban area of Folkestone. The demographics of the practice population are very similar to the national average, with the exception that about a fifth of the practice’s patients are of Nepali origin. This arises from the areas traditional links with the Ghurkha servicemen who are barracked nearby.

The practice has approximately 10,000 patients. There are three partner GPs, two of whom are practising (one male and one female) and one of whom is retired. There is one salaried GP (male) and the practice employs regular locum GPs. There are male and female GPs available. The practice employs six nurses and a healthcare assistant (all female). The practice is open 8.30am – 6.30pm Monday to Friday. There are extended surgery hours until 8.15pm on Mondays and Tuesdays.

The practice has a GMS (General Medical Services) contract. The practice is not a training practice for doctors but does carry out training for students of nursing.

Patients requiring a GP outside of normal working hours are advised to contact an external out of hour’s service that is provided by Nestor Primecare. The number of this service is clearly displayed in the reception area and on the practice website.

We last inspected this practice on 28 July 2015. We rated the practice as requires improvement overall. We found that it required improvement for providing safe and well led services. These related to the management of significant events and to the over governance arrangements. At this inspection we found that the practice had addressed the issues of concern.

Regulated activities are provided from:

Dr Jedrzejewski and partners

The White House Surgery,

1 Cheriton High Street,

Folkestone,

Kent,

CT19 4PU.

Updated 11 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Jedrzejewski and partners on 28 July 2015. The overall rating for the practice was requires improvement. Specifically it was good for providing effective, responsive and caring services but required improvement for providing safe and well led.

The full comprehensive report on the 28 July 2015 inspection can be found by selecting the ‘all reports’ link for Dr Jedrzejewski and partners on our website at www.cqc.org.uk.

The areas where the provider must make improvement were:

• Ensure a systematic approach to reporting, recording and monitoring significant events, incidents and accidents.

• Ensure there are formal governance arrangements and staff are aware how these operate, including maintaining the cleanliness and fabric of the building.

The areas where the provider should make improvement were:

• Review staff training to link this to personal development plans and practice’s needs.

• Review staff files to ensure that all contain the required.

This inspection was an announced comprehensive inspection carried out on 30 May 2017 to confirm that the provider 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 28 July 2015. This report covers our findings in relation to those requirements. We found that the concerns identified at the previous inspection had been rectified. Overall the practice is rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system for reporting and recording significant events.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

• 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 the requirements of the duty of candour.

The area where the provider should make improvements is:

• The practice should review the provision of health checks for learning disability patients to help ensure that these are offered annually.

• Review the new protocol for managing medicines alerts to ensure it is effective.

• Should continue to develop systems for support patients who are caring for others.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 July 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators were above the local and national average. For example, 100% of patients with diabetes, on the register, had an IFCCHbA1c of 64 mmol/mol (a blood test to check blood sugar levels) or less in the preceding 12 months compared to the clinical commissioning group (CCG) average of 92% and national average of 90%.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP. There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. The practice employed a clinical administrator to support the chronic disease nurse to maintain this function.
• 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. Additionally these patients were offered a single longer appointment to cover multiple conditions to help avoid patients having to re-attend, to reduce potential patient DNAs (Did Not Attends) and better utilise clinical time.

Updated 11 July 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 Accident and Emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• The practice participated in the C-Card Scheme providing free condoms to young people and helping to provide integrated contraception and sexual health services.

Updated 11 July 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• The practice was coordinating efforts with the Age UK Personalised Care Programme particularly for older patients with the greatest need.
• The practice employed a home visiting nurse who proactively engaged with patients over 75 years to support and review patients to improve and better manage their health for example in relation to falls, stroke and other health conditions.

Updated 11 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations 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, extended opening hours and “catch up” immunisation programmes for those unable to attend during the working week
• 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.
• The practice cooperated with other local practices in providing a shared GP appointment clinic from 8am to 8pm at the local hospital. Staff working there had access to the patients’ notes.

Updated 11 July 2017

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

• The practice carried out advance care planning for patients living with dementia.
• Eighty eight percent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• In overall mental health indicators the practice was below the CCG and national averages, by 30 percentage points. However some indicators were in line with national and CCG performance. Mental health data were difficult to reconcile. The practice was aware of the discrepancies and had discussed them, but could identify no single comprehensive explanation. The practice felt that it was related to the patient demographics.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could 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 interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 11 July 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. For example patients who were “sofa surfers” (a homeless person in the habit of staying temporarily with various friends and relatives) were not asked to re-register if their current address fell outside the practice boundary.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability. However it had not proactively offered learning disability patients an annual health check during the last year (to 31 March 2017). During the previous year it had carried out annual health checks for all its patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• The practice had identified a number of patients who were at risk because of acquired controlled drug dependency. The practice was working with the clinical commissioning group in delivering planned reduction regimes for them.