This practice is rated as Outstanding overall. (Previous rating 27/06/2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

We carried out an announced comprehensive inspection at The Ivy Court Surgery on 26 June 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• The practice used information about care and treatment to make .improvements
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• There was a clear leadership structure and staff felt supported by management.

We saw areas of outstanding practice:

• There was a community ‘virtual’ ward which met every fortnight to discuss the most complex patients. The virtual ward operates in the same way as a normal hospital ward, the difference is the patient stays comfortably and safely in their own home. The practice ensured a community geriatrician attended their community virtual ward meetings, providing an additional level of clinical input to those complex patients.
• The community ward and weekend urgent care service had significantly reduced hospital admissions for patients over 75.
• Ivy Court Surgery was the first practice in Ashford to host an in-house ultrasound service over eight years ago. This year they had improved this service by now offering this service across Ashford, to all local practices, and hosted the service in various sites across the rural cluster.
• Patients who had been diagnosed with breast, prostate or bowel cancer within the last five years were invited in to the practice for a 45 minute review with a GP who was a fellow in cancer care, for a more holistic review.
• The practice recognised that mental health problems were not limited solely to patients, and this could also affect their staff. One of their GP partners was heavily involved in running Mindfulness Based Cognitive Therapy (MBCT).

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Ivy Court Surgery on 13 April 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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment for patients.
• The practice provided training and mentorship for future healthcare professionals including trainee GPs and student nurses.
• 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 that 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 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.

We saw several areas of outstanding practice:

• The practice offered a community ‘virtual’ ward which met once a fortnight. Team members included GPs, an elderly care consultant, social care staff, community nurses and representatives from the voluntary sector. The aim of the virtual ward was to help to ensure that patients’ emotional and social needs were met and given equal importance.
• The practice had recognised their patient list contained a higher than average amount of elderly patients and had chosen to focus on dementia as a particular issue for their population. There was an aim to raise the profile of dementia locally and one of the GP partners collaborated with other healthcare professionals and the Alzheimer’s Society to give a series of talks in the local church. Two members of staff had attended dementia awareness training courses and were being released once a fortnight to support patients and their carers at the local Dementia Café.
• The practice provided access to services seven days a week through a collaboration with two neighbouring surgeries. This service provided access to urgent appointments at the weekend from 9am to 12pm on Saturday at The Ivy Court Surgery and Sunday at The Hamstreet Surgery for over 25,000 patients. This meant patients did not have to travel to Hospital Accident and Emergency Departments and could access services locally. GPs and staff providing this service had access to patients’ notes providing continuity of care for patients attending urgent care clinics.
• There were regular consultant led frailty clinics undertaken at the practice. This service was provided through collaboration with neighbouring practices. Sixty seven patients at The Ivy Court Surgery had accessed this service.

The areas where the provider should make improvements are:

• Continue to identify patients who are also carers and build on the current carers register to help ensure that all patients on the practice list who are carers are offered relevant support if required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice