The Lonsdale Medical Centre Partnership

Updated 24 February 2017

The Lonsdale Medical Centre Partnership is located in the town of Tunbridge Wells, Kent. The practice serves a population of approximately 6,600 patients from an area with low levels of social deprivation. The practice population has higher than average numbers of patients between the ages of nought to four and 25 to 44. The town has a high number of patients who commute into London. The practice has lower numbers than average of patients between the ages of 10 to 24 and 54 to 84. The practice profile for patients over the age of 85 is similar to the national average.

The practice is located in a converted building with level access and an automatic door at the rear of the building. The practice has three floors, and has clinical and consulting rooms on the ground floor and first floor; the first floor can be accessed via a stair lift if required. The practice moved into the current premises in 2000.The practice is led by seven GP partners (four female, three male), four of which are part time, and supported by a nursing team of five (all female) including a nurse practitioner, two practice nurses and two health care assistants, a practice manager, a patient services manager and a team of administration and reception staff. The practice is not currently a teaching or training practice.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments were from 8:30am to 5:30pm daily. The practice offered staggered appointment times throughout the day. Extended hours appointments were offered at the following times from 6:30pm to 7:30pm on Wednesday and Thursdays. When the practice is closed the out of hours cover is provided by IC24 accessed via NHS 111.

Services are provided from:

Lonsdale Medical Centre

1 Clarincarde Gardens

Tunbridge Wells

Kent

TN1 1PE

Updated 24 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Lonsdale Medical Centre Partnership on 18 January 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system for reporting and recording significant events. We saw a number of examples of significant events used to identify any opportunity for learning.
• Risks to patients were assessed and well managed.
• 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. Opportunities for staff development were valued.
• The practice was proactive about staff development and encouraging staff to achieve their potential, which were regularly reviewed. We saw a number of examples of positive development opportunities.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Many of the comment cards we received reported an excellent service, friendly helpful staff and good access to appointments.
• The practice was aware a number of patients commuted to London and offered an electronic prescription service, including access to prescription collections at pharmacies in London.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

• The practice had a mission to continually improve the quality, range and way they delivered care in consultation with their patients, their staff and other health care professionals within the local community.

• On a monthly basis patients with multiple chronic diseases were checked so that the patients’ health and care reviews could be combined into one session. The records were also checked to make sure that the correct blood tests had been done

• The practice proactively sought feedback from staff and patients, which it acted on.
• The patient participation group had organized local health awareness events. For example, a recent educational event had covered subjects such as fire safety awareness, Alzheimer’s and information on diabetes.
• The practice held a dementia clinic in conjunction with a dementia specialist from Carers First. Patients and their carers were invited to spend half an hour with Carers First, followed by a 10 minute GP appointment. The practice also held an education event for patient’s carers and families.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure patients with a learning disability are offered an annual review.

• Improve the number of clinical audits and re-audits undertaken to improve patient outcomes.

• Ensure the systems to monitor water temperature testing in relation to legionella are followed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 February 2017

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.

• Performance for diabetes related indicators were better when compared to the clinical commissioning group (CCG) averages and the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was in the target range was 80% which was comparable to the local average of 77% and the national average of 78%.

• 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% which was better than the local average of 89% and the national average of 88%.

• The practice offered insulin imitation service for patients, held joint clinics with the local diabetic consultants where appropriate and all newly identified diabetic patients were offered information packs including lifestyle advice.

• The practice uses risk stratification tools to help identify any new diagnosis of chronic obstructive pulmonary disease (a range of chronic lung conditions).Patients had a care plan and were referred to a local respiratory support group and pulmonary rehabilitation service.

• High risk patients (with impaired glucose levels) who may be at risk of developing diabetes were offered a diabetes prevention programme.

• All patients with a long term condition 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.

• On a monthly basis patients with multiple chronic diseases were checked so that the patients’ health and care reviews were combined into one session. The records were also checked to make sure that the correct blood tests had been done.

Updated 24 February 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 A&E attendances. The GPs reviewed any children of concern following any hospital attendance and during regular clinical meetings.

• 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 83%, which was comparable to the CCG average of 83% 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 and saw examples of referrals to health visitors. The practice hosts two midwife clinics each week. Newly pregnant mothers were able to self-refer to the midwife, as well as be referred by the GPs and nursing team.

• If vaccination appointments were missed, the practice followed these up with parents, in order to discuss the care options available. Referrals were made where relevant for follow up with a GP or other service if required.

Updated 24 February 2017

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

• 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.

• The practice held weekly ward rounds at the local care homes where they looked after patients. Any patients with complex care needs and those at risk of hospital admissions were identified and had regularly reviewed care and treatment plans.

• Following any hospital discharge patients on the priority register were highlighted to their GP for follow up consultations within three days.

• Care plans for patients were shared on the clinical commissioning group Care Plan Management System, for relevant other healthcare professionals to access. The Care Plans included a record of the patient’s preferred place of death, where appropriate.

• Older patients at risk of falls were referred to a local postural stability class. Referrals were made where relevant to Carers First, Crossroads and the Good Neighbour Network.

Updated 24 February 2017

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, including online prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group. The practice was aware a number of patients commuted to London and offered an electronic prescription service, including access to prescription collections at pharmacies in London.

• The practice offered extended hours appointments two evenings a week and conducted a high number of telephone appointments, for patients who could not access the practice during normal working hours.

The practice offered a text reminder service which also gave patients a text feedback option.

Updated 24 February 2017

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

• Performance for mental health related indicators were mostly better than the local and national averages. For example,

• The percentage of patients with a serious mental health problem who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 100% which was better than the local average of 91% and above the national average of 88%.

• The percentage of patients with a serious mental health problem whose alcohol consumption has been recorded in the preceding 12 months was 85% which was below the local average of 91% and the national average of 89%.

• 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 percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 97% which was higher than the local average of 83% and the national average of 83%.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Patients were able to self-refer to a talking therapies support group held at the practice. The practice had a number of support groups available which were promoted in the practice and through the practices website.

• The practice held a monthly clinic with the community psychiatric nurse, which the GPs could refer patients to.

• 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. The reception staff offered a reminder for appointments, where possible, for patients with memory problems or complex mental health needs.

The practice held a dementia clinic in conjunction with a dementia specialist from Carers First. Patients and their carers were invited to spend half an hour with Carers First, followed by a 10 minute GP appointment. The practice also held an education event for patient’s carers and families.

Updated 24 February 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 and those with a learning disability. The practice used the practice address where required to register homeless patients and offered opportunistic care and appointments where possible.

• The practice offered longer appointments for patients with a learning disability. The practice had recently highlighted the need to increase the number of patients with learning disabilities who had an annual review. The practice had set up a meeting with the local learning disability nurse to help them improve the service provided to these patients.

• 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.