St Andrews Medical Centre

Updated 21 February 2017

St Andrews Medical Centre is a GP practice based in Southborough, Kent with a patient population of 8067.

The practice is similar across the board to the national averages for some population groups. For example, 20% of patients are aged 0 -14 years of age compared to the CCG national average of 17%. Figures were similar for patients aged under 18 years of age, 65 years, 75 years, 85 years and over. The practice is on the ninth centile deprivation indices, meaning this practice in one of the least deprived areas of Kent.

The practice holds a General Medical Service contract and consists of three GP partners (female). The GPs are supported by two salaried GPs (female), a locum GP (male), a practice manager, a business manager, four practice nurses (female) and an administrative team. A wide range of services and clinics are offered by the practice including asthma and diabetes.

The practice is arranged over one floor, with all the patient accessible areas being located on the ground floor. The practice is accessible to patients with mobility issues, as well as parents with children and babies.

The practice is open between 8am to 6.30pm Monday, to Friday. Extended hours appointments were offered from 7am to 11am on Saturday. In addition, appointments could be booked up to eight weeks in advance; urgent appointments were also available for people that needed them. There is a duty doctor system for patients to access the practice between 6pm to 6.30pm. 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:

• St Andrews Medical Centre, St Andrews Court, Pinewood Gardens, Southborough, Tunbridge Wells, Kent, TN4 0LZ

Updated 21 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Andrews Medical Centre on 12 January 2017. 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.
• 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 and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and 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.
• Translation services were available to patients whose first language was not English.
• The practice had developed a wide range of other services for patients. The practice objective was to place the patients at the heart of the services, rather than the patients being sent through the health care system to access the services.
• There was a clear leadership structure and staff felt supported by management. The practice 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 February 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.

• Performance for diabetes related indicators were in line with the local and national averages. For example, 74% of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol (a blood test to check blood sugar levels) or less in the preceding 12 months (local average 77% and national average 78%).

• There was a specialist diabetic nurse led course held once a month on Sundays; for the purpose of all newly diagnosed Type 2 diabetic patients, to attend the Diabetes Education and Self-Management for Ongoing and Diagnosed (DESMOND) patient education course.

• 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 21 February 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 83%, which was comparable to the CCG and national average of 81%.

• 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 and health visitors.

Updated 21 February 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. It had a scheme for patients, who lived in one of the three local nursing and/or residential care homes. This involved registering all the patients (with their consent) with one of GP partners who looked after that home. As required visits to nursing/residential care homes were conducted.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 21 February 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.

Updated 21 February 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 their care reviewed in a face to face meeting in the last 12 months was 74%, which was comparable to the local and national averages 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 91%,local average of 92% and national averages 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.

• There was a scheme for 74 patients, who lived in a local dementia nursing/residential care home. This involved registering all the patients (with their consent) with one of the GP partners who looked after that home. As required visits to the care home were conducted.

• 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 21 February 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 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.

• 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.