High Street Surgery

Updated 11 December 2017

High Street Surgery is situated in Dover High Street. It has a branch surgery, Whitfield Surgery located in Whitfield approximately 3.5 miles from their main surgery and a ten minute drive. They provide services to approximately 7947 patients. The practice population has a higher than average amount of people living in deprived circumstances.

The practice holds a General Medical Services contract. The practice team consists of three GP partners all male and one female salaried GP. The practice also employs three locum GPs all male. There is one nurse practitioner, four practice nurses and two healthcare assistants.

High Street Surgery is open from 8am to 6.30pm Monday to Friday. They operate extended hours appointments on Monday or Wednesday from 6.30pm to 7.30pm.

Whitfield Surgery is open from 8am to 1pm Monday and Friday, Tuesday and Wednesday 8am to 2pm and Thursday 8am to 4.45pm. Outside of these hours patients are transferred to High Street Surgery, Dover. Whitfield Surgery provides a dispensary service to patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy premises

When the practices are closed, an out of hours service is provided by IC24.

The practice was first inspected on 26 August 2015 and rated as requires improvement overall. The practice was reinspected on 28 February 2017. The practice had responded to the risks identified at the earlier inspection but additional breaches of the regulations were found. The practice was rated as requires improvement overall.

Services are delivered from:

• High Street Surgery, Dover, Kent CT16 1EQ, and
• Whitfield Surgery, 43 Sandwich Road, Whitfield, CT16 3LT

The branch surgery at Whitfield was not visited as part of this inspection.

Updated 11 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at High Street Surgery on 28 February 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the February 2017 inspection can be found by selecting the ‘all reports’ link for High Street Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 November 2017 to confirm that the practice 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 February 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had improved patients access to information regarding their complaints system. Posters were displayed within the reception area.

• The practice had systems to support patients with limited mobility, including wheelchair users, to access the building and their services.
• The practice had strengthened systems, processes and practices to minimise risks to patient safety.
• Staff had received training on safeguarding children and vulnerable adults relevant to their role.
• The practice had arrangements to respond to emergencies and major incidents.
• Staff had access to appropriate training and had the skills and knowledge to deliver effective care.
• Data from the national GP patient survey, published in July 2017 showed improvements in some aspects of care from July 2016.
• The practice had identified 1.6% of their patient list as carers and provided information and support for them to access services.
• The practice had introduced and were embedding systems to support the delivery of good quality care. This included arrangements to monitor and improve quality and identify risk.
• Staff attended meetings and were supported to undertake training opportunities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 December 2017

The provider had resolved the concerns for safety, effectiveness, caring and well-led identified at our inspection on 28 February 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Data from the Quality and Outcome Framework (QOF) showed performance for diabetes related indicators were comparable with local and national averages.
• 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.

Updated 11 December 2017

The provider had resolved the concerns for safety, effectiveness, caring and well-led identified at our inspection on 28 February 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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.
• Immunisation rates were relatively high for all standard childhood immunisations.
• 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.

Updated 11 December 2017

The provider had resolved the concerns for safety, effectiveness, caring and well-led identified at our inspection on 28 February 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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.

Updated 11 December 2017

The provider had resolved the concerns for safety, effectiveness, caring and well-led identified at our inspection on 28 February 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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 on Monday from 6.30pm to 7.30pm.
• 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, such as chlamydia screening.

Updated 11 December 2017

The provider had resolved the concerns for safety, effectiveness, caring and well-led identified at our inspection on 28 February 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• The practice carried out advance care planning for patients living with dementia.
• 94% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average.
• 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.

Updated 11 December 2017

The provider had resolved the concerns for safety, effectiveness, caring and well-led identified at our inspection on 28 February 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• 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.
• 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.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.