Crawcrook Medical Centre

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that the service met people’s needs, and that staff treated people equally and without discrimination.

At our last inspection we rated this key question as requires improvement. At this assessment the rating remains the same.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff and leaders had an understanding of the local population and complied with accessible information standards. They had arrangements in place to identify people’s communication needs and preferences and offered interpretation services for those patients whose first language was not English.

Staff were able to refer patients to social prescribers to support their well being and social issues. For example, staff took opportunities to identify carers by coding them on the practice’s clinical system to ensure they were appropriately signposted to link workers within the primary care network. The provider had 1,631 recorded carers as patients and regularly audited data to monitor activity.

The practice recently recruited a new Advanced Clinical Practitioner (ACP) who was also a veteran champion who will work with the local veterans.

Staff had received training in equality and diversity.

We spoke with 3 of the 4 care homes linked to the practice, and they all said they had a specific doctor and nurse aligned to the care home who visits each week. They reported that the system worked well, and the visiting staff were pleasant, caring, easy to talk to and explained things well to patients, families and staff.

Data from the 2024 National GP Patient survey showed that 88.9% of people felt that they were involved as much as they wanted to be in decisions about their care and treatment, which was just lower than national average at 90.9%. However, as part of this survey the percentage of respondents who stated that during their last appointment, the healthcare professional was very good or fairly good at treating them with care and concern was 91.2%, which was above the national average of 85.3%.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

We saw the practice worked in partnership with other services to meet the needs of its patient population. Leaders explained they had tailored services to meet the varying demographic profile and diverse needs of its community at each practice.

Positive relationships were held with aligned care homes. They reported there were scheduled weekly visits from dedicated staff who worked well with staff, patients and families.

The Patient Participation Group (PPG) had not met since August 2024, although the next meeting was planned for March 2025. The PPG had put together an action plan for improvements as a result of the CQC inspection in 2023 and an inspection by Healthwatch in 2024 however there was no evidence of progress with this at the time of the inspection.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Leaders told us information was available to patients in different formats, and they would highlight on a patients’ record if they had any communication or accessibility needs. This was usually gathered at registration but would be done opportunistically where possible, for example, if circumstances changed and a patient required a certain font in correspondence such as a test result sent by text.

The practice had access to interpreter services, including British Sign Language. There was also a staff member proficient in sign language available for patients at two practices. If a patient required an interpreter a flag was placed on the patient record to ensure a double, face to face appointment was booked each time by the administrators.

Information provided by the service met the Accessible Information Standard.

Patients were informed as to how to access their care records.

The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. However, they involved people in decisions about their care and told them what had changed as a result.

At this assessment we found the practice had a complaints policy and kept a log of all formal complaints, which were used to look for themes and trends. The practice had a complaints leaflet which included details of where to escalate patient concerns if they were not happy with the practice’s response to their complaint. Patients could also log feedback online on the practice website.

The complaints we looked at were managed in line with the practice’s policy and were responded to effectively. However, the CQC received 2 complaints in the last year about the practice’s complaints process. We also received a complaint in which the patient told us they had raised as a formal complaint with the practice, however there was no record of this within the practice formal complaints log.

The provider told us staff were informed of incidents, complaints and learning from these at clinical and non-clinical staff meetings and weekly briefings. Clinical and non-clinical staff meeting minutes documented complaints and lessons learned were discussed with staff. However, the structure of the non-clinical staff minutes meant it was more difficult to identify if the agenda item was the result of a complaint as they were not clearly separated.

Clinical staff surveyed were clear complaints and learning was discussed with examples provided. However, non-clinical staff feedback was mixed with a lack of certainty around the occurrence of non-clinical meetings, staff attendance and learning from complaints being shared. The non-clinical staff meeting minutes did not document staff attendance or apologies for audit purposes to know which staff were there when an issue was discussed.

The PPG told us it had been a while since the last meeting in August 2024 and the minutes were not yet agreed and signed off. They also understood meetings would become less regular over the next two years with just 3 to take place in 2025, reducing to 2 meetings for 2026. There was a PPG proposed action plan which at the time of the inspection remained at discussion stage.

According to the NHS England GP Patient Survey 2024, 90.2% of patients who responded felt that they were listened to by the healthcare professional at their last appointment. This was above the National average of 86.7%.

We saw the practice sought and responded to patient feedback through patient surveys. For example, patients felt Rowlands Gills waiting area was poor. As a result, the practice have had lights repaired, colourful wall stickers put in place, gardening magazines provided together with a "children’s box" full of books and colouring in pages. This has been well received by the patients.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

The percentage of respondents to the GP National Patient Survey who responded positively to how easy it was to contact their GP practice on the phone was 28.7% compared to the national average of 49.7%. The percentage of respondents to the same survey who responded positively to the overall experience of contacting their GP practice was 55.1% compared to the national average of 67.3%.

In response to the National GP Patient Survey the service sought further feedback from members of the community through their own patient surveys. As a result of the surveys the provider identified changes to improve access to the service by managing the demand and supporting the workforce. For example, they had introduced a care navigation tool to support reception services identify the type of appointment needed and created a dedicated Advanced Nurse Practitioner team to support the responses and completions of eConsult’s. In January 2025 the service started trialing a chat function on the website as a further avenue for patient queries to reduce the call traffic. The usage for this was currently being monitored.

However, we noted the practice survey questions differed from those used in the GP National Patient survey therefore it was difficult to measure the more recent patient views on access and how this had changed as a result of the changes implemented.

Completed CQC staff questionnaires mentioned that more GP appointments were needed to improve access for patients.

The commission had received 15 complaints in the 12 months prior to our assessment. The themes from these included the attitude of the staff and issues with obtaining an appointment.

Two care home managers we spoke with whose care homes were aligned with the practice told us that staff were often waiting in the practice queue for the telephone to be answered. They confirmed staff were often kept waiting for a considerable period of time, taking staff away from patient care. We reported this to the provider at the time of the inspection and understand an alternative direct telephone number was provided in an attempt to reduce the wait times.

The practice sent us evidence of call data for the 20 working days during the month of February 2025. This data was unverified and may also include call data from outside of the working hours of the practice as well as calls to the out of hours service. The total number of incoming calls was 13,412 with 5,373 or 40% of those recorded as abandoned by callers. The average wait time varied considerably with the shortest wait at 6.6 minutes and the longest 25.7 minutes. The overall average time for a call to be answered during February 2025 was 13.6 minutes. This was a cloud-based system, however at the time of the assessment there was no option for patients to be called back when they reached the front of the queue. The call data was monitored by staff and management on an ongoing basis.

Staff and leaders listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Leaders explained they participated in the safe surgeries initiative which included a flexible registration procedure to accommodate individuals who faced barriers to accessing healthcare services, such as those who have no fixed address or asylum seekers. This comprises of accepting alternative forms of identification or proof of address, waiving administrative or ID requirements, and helping people complete registration forms.

The practice recognised that carers often pursued their role without being identified and as such staff were keen to identify and flag those patients with caring responsibilities to ensure they are correctly signposted to groups and help in the area.

Two dedicated staff members had been involved in the annual learning disability reviews for the last 3 years to establish a rapport with patients and encourage them to attend their annual review. This included a reminder call for patients the day before a review and if necessary, providing a home visit to ensure annual reviews were completed.

The practice recently recruited a new Advanced Clinical Practitioner (ACP) who was also a veteran champion. After the assessment, the provider told us this role was designed in response to feedback about access and experience challenges unique to veterans.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The practice had a Palliative care lead. Managers and care home staff told us people were supported to consider their wishes for their end-of-life care, including cardiopulmonary resuscitation. This information was shared with other services when necessary.