Archived: Orchard House Surgery

Updated 11 May 2018

Orchard House Surgery serves a rural population in and around the village of Lydd in Kent. Services are delivered from purpose built premises. All patient areas are on the ground floor and are accessible to patients with reduced mobility, as well as parents with children and babies. There is parking available for patients attending the practice. There are approximately 4200 patients on the practice list. The practice age range population profile is close to national averages. However, the practice has more patients registered aged over 64 years and the surrounding area has a slightly higher prevalence of people living in deprived circumstances than national averages.

The practice holds a General Medical Service contract and consists of one principal GP (female). There is one nurse practitioner (female), two practice nurses (female) and three healthcare assistants (female). The GP and nurses are supported by a practice manager and reception and administration staff.

There are a range of clinics for all age groups as well as the availability of specialist nursing treatment and support. Patients have access to a counselling service every Friday. The practice is open from 8am to 6pm Monday to Friday, with appointments offered from 9am. There is an extended hour’s clinic on Wednesday evenings from 6.30pm to 7.15pm. Appointments for this service are bookable. The practice offers book on the day and some pre-bookable appointments and patients can be seen by the GP for all concerns or nurse practitioner for minor illness and injury.

The practice collaborated with other practices in the area to help develop new services and share resources. For example, a paramedic practitioner to help undertake home visits. The group had formed a company called the Channel Health Alliance.

An out of hour’s service is provided by Integrated Care 24 (IC24), outside of the practices normal opening hours and there is information available to patients on how to access this in the practice information leaflet and on the website.

Services are delivered from: Bleak Road, Lydd, Kent, TN29 9AE.

Updated 11 May 2018

We carried out an announced comprehensive inspection at Orchard House Surgery on 14 March 2017. We found the practice was good in safe, caring, responsive and well-led and requires improvement in effective. The overall rating for the practice was Good. The full comprehensive report on the March 2017 inspection can be found by selecting the ‘all reports’ link for Orchard House Surgery on our website at www.cqc.org.uk.

After the inspection in March 2017 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

This inspection was an announced focussed inspection carried out on 29 March 2018 to confirm that the practice had carried out their plan to meet the improvements we recommended after our inspection on 14 March 2017. This report covers findings in relation to those recommendations. At the March 2017 inspection, we told the practice they should:

• Continue to embed systems to recall and review patients as required.

• Continue to embed the process for on-going updates to staff training.

• Continue to develop the process for identifying and supporting those patients who wish to identify themselves as carers.

The inspection carried out on 28 March 2018 found that the practice had responded to the concerns raised at the March 2017 inspection and were in the process of embedding the changes made. The practice is now rated good for effective with an overall rating of good.

The key question inspected is rated as:

Are services effective? – Good

As part of our inspection process we also look at the quality of care for specific patient population groups. The patient population group inspected is rated as:

People whose circumstances may make them vulnerable – Good

Our key findings were as follows:

• The practice had improved its system to identify and support patients who are also carers.
• The practice was continuing to embed systems to recall and review patients. They had implemented new systems and processes which had resulted in improved Quality Outcome Framework (QOF) results.

• The practice had continued to develop and monitor the process for managing on-going updates for staff training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 June 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.
• The GP at the practice was in the process of completing diabetes training where the accreditation would enable insulin initiation.
• 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 and there was a system to recall patients for 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.
• Patients from the population group had access to a stop smoking and counselling service at the practice.

Updated 27 June 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found 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.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice provided support for premature babies and their families following discharge from hospital.
• 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 held regular multidisciplinary staff meetings that included other professionals who specialised in the care of families, children and young people.
• The practice was able to demonstrate that staff had access to up to date safeguarding policies for children and vulnerable adults and safeguarding training had been carried out at the appropriate level.

Updated 27 June 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 and held monthly gold standard framework meetings with a palliative care nurse.
• 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. For example, the practice had engaged with Personal Independence Coordinators to signpost patients to support services.

Updated 27 June 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 each week on a Wednesday evening.
• 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.
• Appointments and repeat prescriptions could be accessed on-line and the patient participation group was working with the practice to promote these services.

Updated 27 June 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.
• 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.
• 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.
• Longer appointments and home visits were available when needed.
• The practice was able to demonstrate they held regular multidisciplinary staff meetings that included other professionals who specialised in the care of people experiencing poor mental health (including patients with dementia).

Updated 11 May 2018