Hildenborough & Tonbridge Medical Group

Updated 28 September 2017

Hildenborough and Tonbridge Medical Group is a GP practice based in Hildenborough, Kent. There are approximately 16,000 patients registered with the practice.

The demographics of the patient population shows that 22% of patients are under the age of 18 (compared to the England average of 21%) and 22% are aged 65 years and over (compared to the England average of 17%). The practice is situated in a popular and more affluent commuter area. The number of patients between the ages of 40 to 54 years is slightly above the England average and the number of patients between the ages of 20 to 39 years is below the England average.

Hildenborough and Tonbridge Medical Group consists of four practices:

• Hildenborough Medical Centre, Westwood, Tonbridge Road, Hildenborough, Kent TN11 9HL.

• Trenchwood Medical Centre, 264 Shipbourne Road, Tonbridge, Kent TN10 3ET.

• Leigh Surgery, Rear of Leigh village hall, High Street, Leigh, Kent TN11 9RL.

• Weald Surgery, Morleys Road, Weald, Kent TN14 6QX.

All four practices are staffed and managed from Hildenborough Medical Centre, Westwood, Tonbridge Road, Hildenborough, Kent TN11 9HL.

Hildenborough Medical Centre is able to provide dispensary services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy premises. This service is delivered by a dispensary team of two dispensers.

The practice operates under a General Medical Service contract. There are 10 GP partners (six male and four female). The practice manager is also a partner. The GP partners are supported by a female salaried GP, the practice manager, six female practice nurses, one female practice nurse assistant and one female health care assistant, two dispensers and a team of administrators, secretaries and receptionists.

The practice is a training/teaching practice. At the time of our inspection, there were two female GP trainees and two foundation year 2 doctors (one female and one male) working at the practice. The practice also offered placements of three to eight weeks for medical students.

Hildenborough Medical Centre is open between 8am and 6.30pm Monday to Friday. Appointments are offered from 8am to 11.30am and 4pm to 6.30pm on Mondays, 8am to 11.30am and 12.40pm to 6.30pm on Tuesdays, 8am to 11am and 3.30pm to 6.30pm on Wednesdays, 8am to 2pm and 4pm to 6.30pm on Thursdays and from 8am to 11.30am and 3.30pm to 5.30pm on Fridays.

Trenchwood Medical Centre is open between 8am and 6.30pm Monday to Friday. Appointments are offered from 8am to11.30am and 3pm to 6.30pm on Mondays, 8am to11.30am and 2.30pm to 6.30pm on Tuesdays, 8am to 11.30am and 1.45pm to 6.30pm on Wednesdays, 8am to12pm and 4pm to 6.30pm on Thursdays and 8am to 11.30am and 3.30pm to 5.30pm on Fridays.

Appointments are offered at Leigh surgery between 2pm to 3pm on Mondays, 12pm to 1pm on Tuesdays, 1pm to 2pm on Wednesdays, 8am to 9am on Thursdays and 1pm to 2pm on Fridays.

Appointments are offered at Weald Surgery 12pm to 1pm on Mondays, 2.30pm to 3.30pm on Tuesdays, 12pm to 1pm on Wednesdays, 1pm to 2pm on Thursdays and 2pm to 3pm on Fridays.

Extended hours appointments are offered on Monday evenings from 6.30pm to 8pm at Trenchwood Medical Centre and 8am to 12pm on Saturdays at Hildenborough Medical Centre.

Patients requiring a GP outside of normal working hours are advised to contact the NHS GP out of hour’s service on telephone number 111.

We visited and inspected Hildenborough Medical Centre. The practices at Trenchwood, Leigh and Weald were not visited during the inspection.

Updated 28 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hildenborough & Tonbridge Medical Group on 21 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 Hildenborough & Tonbridge Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection conducted on 7 September 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 21 November 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:

• The practice had ensured that the system for reporting and recording significant events was implemented effectively.

• Risks to patients who used services were assessed and the systems and processes to address these risks ensured patients were kept safe. In particular, the risks associated with medicines management, as well as infection prevention and control.

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

• Dispensing Standard Operating Procedures (SOPs) had been signed by all relevant staff.

• Action had been taken to ensure that cold chain storage and medicine safety alerts were appropriately recorded.

• Dispensing errors and near misses were being recorded by dispensary staff in order to enable learning.

• Processes had been revised in order to ensure that minutes of meetings were detailed and demonstrated accountability.

• The programme of clinical audits had been further developed and was being monitored.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 March 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 and patients at risk of hospital admission were identified as a priority.
• The percentage of patients with diabetes, on the register, who had had influenza immunisation in the preceding 1 August to 31 March was 99% compared to the clinical commissioning group(CCG) average of 93% and the national average of 94%.
• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 90% compared to the 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 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 8 March 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.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 86% compared to the clinical commissioning group(CCG) average of 84% and the national average of 82%
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered a drop-in clinic at a branch site for young people.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice held quarterly children and families multi-disciplinary team meetings to discuss vulnerable patients, safeguarding and child protection issues.
• Family planning services were offered.
• The practice hosted Genito-Urinary Medicine and Sexual Health Clinics.

Updated 8 March 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 offered a dosette box service to supply medicines to older people in a more convenient manner.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice attended meetings in relevant residential care homes and a nursing home for the elderly and mentally infirm.

Updated 8 March 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 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 offered telephone and email consultations. It also offered extended hours on Monday evenings and Saturday mornings.

Updated 8 March 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 who had had their care reviewed in a face to face meeting in the last 12 months, was 90% 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 100% 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 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 8 March 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 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.
• 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 had arrangements to deliver medicines to vulnerable patients when necessary.