Lowfield Medical Centre Also known as Lowfield Medical Centre

Updated 11 July 2016

Dr Lawrence and partners is also known as Lowfield Medical Centre. It is located in a town centre urban area of Dartford, Kent and provides primary medical services to approximately 5,900 patients. The practice is based in a non-purpose built building which has been converted to improve accessibility for patients.

The practice patient population is similar to national averages but there are less working age males on the practice list than the national average and more female children between five and nine years and fifteen and nineteen years. There are also slightly more working age females than the national average (from 30 - 54 years). It is in an area where the population are mixed in terms of levels of deprivation. The area has a broad socio-economic mix and a broad ethnic mix. There are people who live in the area who do not have English as their first language and there is some transient population.

There are five GP partners at the practice, one male and four female. The practice is registered as a GP training practice, for doctors seeking to become fully qualified GP’s.

There are four female members of the nursing team; three practice nurses and one health care assistant/phlebotomist. GP’s and nurses are supported by a practice management team and reception/administration staff.

The practice is open from Monday to Friday between 8.30am and 6.30pm except for Wednesday when the practice closes at 1pm. Between 8am and 8.30am reception staff and a GP are in the practice and there is an emergency number for patients to call. Appointments are from 8.30am to 12.00 noon and from 3pm to 6.30pm. On Wednesday afternoons the telephones at the practice are answered and there is a GP on call for emergencies. Extended hours appointments are available one Saturday morning each month, every Thursday and alternate Wednesday evenings from 6.30pm to 8.30pm as required. Appointments’ can be booked over the telephone, online or in person at the practice. Patients are provided with information on how to access an ‘out of hours’ provider by calling the surgery and in the practice leaflet.

The practice runs a number of services for its patients including; chronic disease management, anti-coagulation clinics, new patient checks, minor surgery, family planning, counselling and travel vaccines and advice.

Services are provided from 65-67 Lowfield Street, Dartford, Kent, DA1 1HP.

Updated 11 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Lawrence and partners on 10 May 2016. 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.
• Risks to patients were assessed and well managed.
• Emergency medicine was checked regularly, however, the hypodermic needles in the emergency kit were out of date. These were replaced during the inspection and included in the list of checks to be carried out.
• 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.
• 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. Improvements were made to the quality of care as a result of complaints and concerns, however, verbal complaints were not recorded at the practice.
• Patients said there were appointments available, but that getting through to the practice on the telephone could be difficult. 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review how patients access appointments by telephone.
• Review the process to record verbal complaints.
• Continue to build their Carers register and to increase awareness of support available wherever possible.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 11 July 2016

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

• GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 79% compared to 78% within the Clinical Commissioning Group (CCG) and 81% at national average.

• Longer appointments and home visits were available when needed.

• All these patients 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.

• The practice provided a dedicated respiratory disease nurse who held a clinic once each week for patients with chronic breathing problems.

• The practice provided a GP led insulin initiation and monitoring clinic for patients newly diagnosed with diabetes.

Updated 11 July 2016

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.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 82% compared to 87% within the clinical commissioning group (CCG) and 82% as a national average.

• 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.

• Staff told us that the practice sent a letter congratulating families on their new baby/babies and attached a post-natal and a first immunisation appointment with this.

• Ante-natal whooping cough vaccine was offered to women who were 28 weeks plus into their pregnancy to help protect their unborn child/children.

Updated 11 July 2016

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 patient 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 a list of patients unable to leave the house and ensured they had access to repeat prescriptions over the telephone.

• Polypharmacy reviews were carried out for older patients between three and twelve monthly.

Updated 11 July 2016

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 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.

• The practice provided travel vaccinations and was a Yellow Fever designated centre.

• University students who returned during holiday periods were seen as temporary patients.

Updated 11 July 2016

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

• 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is the same as the national average.
• 97% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months which is better than the national average of 90%.
• 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 in place 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.
• Staff had a good understanding of the Mental Capacity Act and best interests’ decision making.

Updated 11 July 2016

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.
• The practice offered longer appointments for patients with a learning disability or complex needs.
• 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.
• The practice visited residential homes for people living with dementia and those with a learning disability. Medication for these patients was reviewed on admission to the care home and then on a six monthly basis.