Rusthall Medical Centre

Updated 31 May 2017

Rusthall Medical Centre is a GP practice based in Rusthall, Tunbridge Wells, Kent with approximately 6200 patients registered with the practice.

35% of patients are 65 years and over, 64% are in paid work or full time education and 1% are unemployed.

The practice has a General Medical Services contract with NHS England for delivering primary care services to the local community. There are four GP partners (two male and two female). The GP partners are supported by a salaried GP (female), a practice manager, two part-time practice nurses and two part-time health care assistants (all female) and an administrative team. A wide range of services and clinics are offered by the practice including asthma and diabetes.

The practice is a training practice, currently providing training for two part-time GP registrars (female). (Training practices have GP trainees and F2 doctors).

There is full access for wheelchair users and car-parking facilities are available on site. The practice registers patients who live in the Rusthall and Langdon Green areas of Tunbridge Wells, Kent.

The practice is open between the hours of 8am to 6.30pm Monday the Friday. Appointment times are as follows:-

• Monday 9.10am to 11.30am and 2.30pm to 5.30pm

• Tuesday 8.30am to 11.30am and 3pm to 5pm

• Wednesday 8am to 11.30am and 2.30pm to 5pm

• Thursday 8am to 11.30am and 2.30pm to 5pm

• Friday 8.30am to 11.30am and 2pm to 5pm

Extended hours and pre-bookable appointments are offered on a flexible basis for those patients who are unable to attend during the usual opening hours. They are between 7.30am and 8am on Tuesdays, Wednesdays and Thursdays. 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:

• Rusthall Medical Centre, Nellington Road, Tunbridge Wells, Kent, TN4 8UW

Updated 31 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rusthall Medical Centre on 7 July 2016. The overall rating for the practice was requires improvement (rated as Requires improvement for providing safe and well-led service and Good for providing effective, caring and responsive services). The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Rusthall Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 May 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 7 July 2016. 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:

• Since our inspection in July 2016 the practice had improved its systems and processes for the monitoring and recording of investigations into significant events.

• Staff had received relevant training for safeguarding children and adults, infection control and Health and Safety.

• A system for the recording, secure storage of and auditing of prescription pads and printer compatible prescription forms had been implemented.

• Recruitment procedures had been updated to help ensure that all appropriate recruitment checks were undertaken prior to employment of staff.

• The practice had improved its governance processes in order to help ensure that all governance documents including policies, protocols and minutes of meetings were up to date and accessible to all staff.

• The provider was able to fully demonstrate compliance with the requirements of the duty of candour.

The practice had also taken appropriate action to address areas where they should make improvements:

• Appropriate action had been taken to ensure staff were aware of the vision and strategy and their responsibilities in relation to them.

• The staff induction programme had been updated to incorporate a record and audit trail of the training received by newly employed staff.

• The communication of information and change to all staff had been improved in order to ensure it was effective and auditable.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 May 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 7 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 94% compared to the clinical commissioning group (CCG) average of 88% and the national average of 88%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and each GP conducted structured annual reviews on their own patients to check that 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 31 May 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 7 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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 recorded that a cervical screening test had been performed in the preceding five years was 86% compared to the clinical commissioning Group (CCG) average of 84% and the national average of 81%.

• Appointments were available outside of school hours.

• Baby changing facilities were available.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The practice was proactive in its efforts to encourage eligible patients to receive the Meningitis ACWY vaccine

• The practice offered child flu vaccination clinics.

Updated 31 May 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 7 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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 cared for approximately 67 patients residing in an adjacent nursing home. Weekly visits were conducted with additional visits as required. Staff from the care home attended the practice’s multidisciplinary team meetings. The practice was proactive in ensuring relevant vaccinations were offered. Staff at the care home told us that they were well supported by the practice.

Updated 31 May 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 7 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• The needs of the working age population, those recently retired and students had been identified and the practice offered pre-bookable extended hour appointments on three mornings per week between 7.30am and 8am and telephone consultations at pre-arranged times.

• The practice was proactive in offering online services, electronic prescribing services as well as health promotion and screening as appropriate for this age group.

Updated 31 May 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 7 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 88% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the clinical commissioning group (CCG) average of 85% and the national average of 84%.

  The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 97% compared to the CCG average of 89% and the national average of 90%

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 97% compared to the CCG average of 88% and the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice had a system to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

• 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 provided accommodation for consultations with the Community Psychiatric Nurse where this best met the needs of individual patients.

• We saw evidence that the GPs worked closely with patients and their families to provide a holistic approach to care.

Updated 31 May 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 7 July 2016 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 with a learning disability. There were 25 patients on the register.

• The practice offered longer appointments for vulnerable patients as required

• 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 that concerns should be reported and all staff were aware of the formal process for doing this and had access to relevant policies. Staff had received specific training in relation to both child and adult safeguarding.