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Archived: Cross Hall Surgery Good

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Inspection Summary


Overall summary & rating

Good

Updated 6 December 2016

Letter from the Chief Inspector of General Practice

We undertook an announced focused inspection of Cross Hall Surgery on 6 September 2016. We found the practice to be good for providing safe care, and it is rated as good overall.

We had previously conducted an announced comprehensive inspection of Cross Hall Surgery on 18 February 2016. As a result of our findings during that visit, the practice was rated as good for being effective, caring, responsive and well-led, and as requires improvement for being safe and for providing good care for vulnerable patients. We found that the provider had breached Regulation 12 (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; safe care and treatment.

The practice wrote to us to tell us what they would do to make improvements and meet the legal requirements. We undertook this focused inspection to check that the practice had followed their plan, and to confirm that they had met the legal requirements.

This report only covers our findings in relation to those areas where requirements had not been met. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Cross Hall Surgery on our website at http://www.cqc.org.uk/location/1-1738880838.

Our key findings across all the areas we inspected were that the practice had met the legal requirements by having:

  • Purchased and installed oxygen and a defibrillator to ensure that they were suitably equipped to manage medical emergencies.

The practice had made additional improvements as follows:

  • Conducted regular fire drills to ensure that staff were updated on the fire evacuation procedure.
  • Provided information on the avenues of support available to patients that were carers.
  • Advertised translation services for patients that did not speak or understand English.
  • Created a register for homeless people so that they could register as patients to receive on-going care at the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 December 2016

The practice is rated as good for providing safe services.

  • The practice purchased and installed oxygen and a defibrillator to ensure that they were suitably equipped to manage medical emergencies.

  • They conducted regular fire drills to ensure that staff were updated on the fire evacuation procedure.

Effective

Good

Updated 20 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were mostly similar to or above average in comparison to local and national averages.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 20 May 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice similar to than others for some aspects of care, and below average in others. For example, 95% said they had confidence and trust in the last GP they saw (CCG average 95%, national average 95%), and 75% said the GP gave them enough time (CCG average 84%, national average 87%).

  • The majority of patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 20 May 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice participated in a local scheme to identify and improve the management of patients with atrial fibrillation, and another to relieve winter pressures on local A&E services.

  • The majority of 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, with the exception of the absence of a defibrillator and oxygen for use in emergencies.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 20 May 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • There was an overarching governance framework. In most cases this supported the delivery of the strategy and good quality care; however, arrangements to monitor and improve quality and identify risk were not robust in relation to infrequent fire drills and the lack of emergency equipment.

  • The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

Checks on specific services

People with long term conditions

Good

Updated 20 May 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.

  • There was a dedicated diabetes clinic every Thursday afternoon.

  • Performance for diabetes related indicators was above the local Clinical Commissioning Group (CCG) and national average in some areas and below in others. For example, 86% of patients with diabetes had well-controlled blood pressure in the previous 12 months (CCG average 74%, national average 78%), and 88% of patients with diabetes had received the annual flu vaccine in the previous nine months (CCG average 91%, national average 94%).

  • Longer appointments and home visits were available when needed.

  • All of these patients had a named GP and most of them had received a structured annual review to check their health and medicines needs were being met.

  • 91% of patients with chronic obstructive pulmonary disease had a review in the previous 12 months. This was in line with the local Clinical Commissioning Group (CCG) average of 91% and the national average of 90%.

  • 81% of patients with asthma had a review in the previous 12 months. This was above the CCG average of 74% and the national average of 75%.

  • 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.

Families, children and young people

Good

Updated 20 May 2016

The practice is rated as good for the care of families, children and young people.

  • There were systems in place 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 has a cervical screening rate of 84%, which was in line with the national average of 82%. The practice had increased its chlamydia screening rate from none in 2012/2013 to 33 in 2014/2015 and they received an award in recognition of this achievement from the local CCG.

  • Appointments were available outside of school hours and the premises were suitable for children and babies but there were no baby changing facilities.

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

Older people

Good

Updated 20 May 2016

The practice is rated as good for the care of older people.

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

  • The practice did not have a register for patients aged over 75 years but all of these patients had a named GP.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were good. For example, 100% of patients aged over 75 with a record of a bone fragility fracture on or after April 2014 were being treated with an appropriate bone sparing agent. This was above the local Clinical Commissioning Group average of 96% and the national average of 93%.

  • Longer appointments and home visits were available for older people when needed, and this was acknowledged positively in feedback from patients.

Working age people (including those recently retired and students)

Good

Updated 20 May 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.

  • Health promotion advice was offered and there was a wide variety of accessible health promotion material available throughout the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • Performance for dementia related indicators was average. 85% of patients with dementia had a face-to-face review of their care in the previous 12 months (CCG average 84%, national average 84%).

  • Performance for mental health related indicators was above average. 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan in the previous 12 months (CCG average 84%, national average 88%).

  • The practice regularly worked with multi-disciplinary teams in the case management of people 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 in place 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.

People whose circumstances may make them vulnerable

Good

Updated 6 December 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

During our previous inspection on 18 February 2016, some vulnerable people were not able to access on-going care at the practice; the GP told us that homeless people would not be registered as patients.

During this inspection on 6 September 2016, we found that the practice had created a registration policy stating that homeless patients would be allowed to register as patients, and they had created a register for homeless patients on their computer system.