Borough Green Medical Practice

Updated 1 December 2017

Borough Green Medical Practice is a GP practice based in rural Borough Green, Kent with a catchment area of approximately 13,700 patients.

The practice is similar across the board to the national averages for each population group. For example, 18% of patients are aged 0 -14 years of age compared to the CCG national average of 17%. Scores were similar for patients aged under 18 years of age and those aged 65, 75 and 85

years and over. The practice is in one of the least deprived areas of Kent and has a majority white British population.

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

Borough Green Medical Practice is arranged over two storeys, with all the patient accessible areas being located on the ground floor. The practices are accessible to patients with mobility issues, as well as parents with children and babies.

Borough Green Medical Practice is open 7.30am to 1.00pm and 2.00pm to 7.30pm on Monday and Tuesday, 8.00am to 1.00pm and 2.00pm to 6.30pm on Wednesday, Thursday and Friday.

The practice 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 a dispensary manager, two senior dispensers, four dispensers and a dispensary receptionist.

The practice is a training practice which takes foundation year two GPs (ST2 GP Registrars) and has one ST2 GP Registrar working at the practice, as well as two GP Registrars. Two of the GP partners are GP trainers and one partner provides training for Foundation Year doctors.

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:

Borough Green Medical Practice, Quarry Hill Road, Sevenoaks, Kent, TN15 8RQ.

Updated 1 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Borough Green Medical Practice on 17 August 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 August 2016 inspection can be found by selecting the ‘all reports’ link for Borough Green Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 2 November 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 17 August 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:

• The practice had received approval for funding to replace the clinical hand wash basins in all rooms to comply with Department of Health guidance. There was a programme of work to complete all clinical rooms by March 2018.
• All carpets in the practice were deep cleaned every six months, and ad hoc deep cleaning was available if required. All privacy curtains at the practice were disposable and were replaced every six months, or sooner if required.
• A standard operating procedure had been developed to ensure that the dosage, type and batch number of local anaesthetics were recorded in the notes of patients undergoing minor surgery at the practice.
• The practice had adequate supplies of emergency medicines and equipment and had a process to ensure these were in date and fit for use.
• The practice had undertaken a review of their practice of leaving non-urgent correspondence for patients’ usual doctors to deal with on their return from periods of absence. They looked at 387 non-urgent items for one of the doctors over a two week period and found none that required urgent action. They had concluded that, as the practice had not led to any urgent matters being overlooked, it would remain in place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

​ Chief Inspector of General Practice

Updated 10 November 2016

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 comparable to the local and national average. For example, 80% 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 compared to the local average 79% and the national average 78%).

• 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 10 November 2016

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 82%, which was comparable to the national average.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice has close links with a local secondary school and provided presentations to year eleven students (children aged 15 or 16 years old) on coping with anxiety both before and during their exams.

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

• The practice held two midwife sessions per week, in order to ensure pregnant patients had access to pre and post-natal care.

Updated 10 November 2016

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 two residential care homes. This involved registering all the patients (with their consent) with one of two lead GPs who looked after that home. As required visits to nursing 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 10 November 2016

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 10 November 2016

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 71%, which was comparable to the national average.

• 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%,

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice worked closely with the Admiral Nurses (specialist dementia trained nurses) in order to offer support to patients with dementia, as well as their carers.

• 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 10 November 2016

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.

• 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.