Tonbridge Medical Group

Updated 27 July 2017

Tonbridge Medical Group is situated in Tonbridge, Kent. The practice has a general medical services contract with NHS England for delivering primary care services to the local community. Services are provided from two sites: Pembury Road and Higham Lane.

The practice has a patient population of 15,070. The proportion of patients who are aged 20 to 34 years is lower than national averages and the proportion of patients aged 40 to 54 years is higher than the national average. The practice is in an area with a low deprivation score and lower than average levels of unemployment.

Consultation and treatment rooms are located on the ground and first floors at both sites. The ground floors are fully accessible to patients with mobility issues, as well as parents with children and babies. There is no lift access to the first floor at either site. Staff told us that they arrange for patients who had difficulty using the stairs to be seen in one of the ground floor consulting rooms. There is a small car park with dedicated disabled parking spaces at Pembury Road. There is on street parking at Higham Lane as well as a disabled parking space.

There are six GP partners (three male and three female), who are supported by seven salaried GPs (one male and six female). There are two paramedic practitioners (one male and one female), four practice nurses and three health care assistants (all female). In addition, there is a practice manager, an assistant practice manager and a team of reception and administrative staff.

The practice is a training practice (training practices have GP trainees and Foundation Year Two trainee doctors).

The practice is open between 8am and 6.30pm Monday to Thursday. On Tuesday, the Pembury Road site is open from 8am to 8pm. On Friday, the Higham Lane site is open from 8am to 4.30pm. The Pembury Road site is open from 8am to midday on Saturday.

There are arrangements with other providers (Integrated Care 24) to deliver services to patients outside of the practice’s working hours.

Services are provided from:

• Tonbridge Medical Group: 64 Pembury Road, Tonbridge, Kent, TN9 2JG
• 9 Higham Lane, Tonbridge, Kent, TN10 4JB.

Updated 27 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tonbridge Medical Group on 24 November 2016. The overall rating for the practice was good. The practice was rated as requires improvement for providing safe services and rated as good for providing effective, caring, responsive and well-led services. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Tonbridge Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 28 June 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 24 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good.

Our key findings were as follows:

• Records showed that all staff were trained to the appropriate level in safeguarding and basic life support, and that relevant staff were up to date with infection prevention and control training.
• Cleaning equipment, including hazardous cleaning fluids were appropriately stored.
• The practice was able to demonstrate that risks to patients, staff and visitors from fire were being assessed and well managed.
• Records showed a legionella maintenance visit had been carried out by an external company in February 2017. (Legionella is a germ found in the environment which can contaminate water systems in buildings). However, the practice had yet to implement actions to minimise the risk of legionella infection.
• The practice ensured that all confidential waste was appropriately disposed of.
• The practice had recruited members of staff to fill the vacancies in the reception and administrative teams.
• The practice manager held a record of staff training which showed that staff received mandatory and other training appropriate to their roles.
• There was a system that ensured that patients’ test results were reviewed promptly, including when their usual GP was away.
• The practice had made some changes to the arrangements for patients wishing to telephone the practice in order to improve access and this was under ongoing review.
• Information about how to complain was displayed in the practice entrance hall and on the website.
• The practice had recruited additional members of the patient participation group (PPG) and had involved the PPG in relevant practice meetings.

The area where the provider should make improvements is:

• Implement plans to ensure that action is taken to minimise the risk of the spread of legionella.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 January 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, such as asthma and diabetes, and patients at risk of hospital admission were identified as a priority.
• The percentage of patients on the diabetes register with a record of a foot examination and risk classification within the preceding 12 months was 96% compared to the CCG and national average of 89%.
• 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 co-ordinated reviews for patients with complex needs to minimise the number of times they needed to visit the practice.
• The practice used innovative informatics to alert doctors when patients were at risk of developing long term conditions, such as diabetes and dementia.

Updated 25 January 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. Immunisation rates were relatively high for all standard childhood immunisations.
• 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 80%, which was comparable to the CCG and national average of 83%.
• 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.

Updated 25 January 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 employed two paramedic practitioners who undertook home visits for older people.

Updated 25 January 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 offered late night appointments on Fridays and Saturday morning appointments for working people and students.
• 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.

Updated 25 January 2017

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

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 76% compared to the CCG and national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record in the preceding 12 months was 93% compared to the CCG average of 91% and 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 practice had told patients experiencing poor mental health about how to 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 had a good understanding of how to support patients with mental health needs and dementia.

Updated 25 January 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.
• 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 informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice provided care for patients who had been excluded from other practices in the area because of unacceptable or violent behaviour.
• 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.