Archived: Cranbrook Medical Centre

Updated 6 June 2017

Cranbrook Medical Centre is a GP practice for approximately 1900 patients of the newly formed town. The specification for the new service was produced with the help of local residents.

The new service had been commissioned by NHS England and included an Alternative Provider Medical Services (APMS) contract for the first two years of operation.

The numbers of patients has increased since opening. There were 600 patients registered in the first two months and now average 10 new patients per week.

The practice is operated by Access Health Care, a social enterprise organisation owned by Exeter based Devon Doctors.

The practice has three part time GPs who in total equal just over one whole time equivalent. They are supported by two practice nurses, a practice manager and four administration staff. Practice staff are supported by central board members, medical directors, a governance team and human resources department.

The practice is open Monday to Friday between 8.30pm until 12pm and between 2pm until 6pm. Patients are encouraged to access the local walk in centre and out of hours service when the practice is not open. There is a contracted agreement that the out of hours provider responded to calls between 12pm and 2pm and between 6pm and 8.30am.

There was no information regarding the demographics of the practice. However we were told that the majority of patients were white British with a very small number of European, Chinese and African patients. The practice had a lower than national average age group. For example, of the 1900 patients 713 were between the ages of birth and 18, 1013 were between the ages of 19 and 49 and only 87 were between the ages of 60 and 90.

The practice is registered to provide regulated activities which include:

Treatment of disease, disorder or injury, surgical procedures, maternity and midwifery services and Diagnostic and screening procedures and operate from:

Cranbrook Medical Centre

Younghayes Centre

169 Younghayes Road

Cranbrook

Exeter

EX5 7DR

Updated 6 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cranbrook Medical Centre on 11 May 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 in place for recording, reporting and learning from serious significant events. Lessons were shared across the organisation and with other practices within the organisation. The process for managing near misses or minor events was under review.

• The practice had clearly defined and embedded local and organisational systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• An extensive range of clinical templates were used by clinical staff to ensure patients received evidence based practice and had all health checks and reviews performed.

• There was positive feedback from the Friends and Family Test and patients told us they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The majority of patients we spoke with said they found it easy to make an appointment with a 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.
• There was a clear leadership structure and staff felt supported by management and the organisation.
• The practice proactively sought feedback from staff and patients, which it acted on. For example, in response to feedback changes had been made to the appointment system.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw one area of outstanding practice:

There was a higher than average number of children and babies at the practice and staff had a proactive approach to understanding and caring for the needs of those patients. The GPs and nurses all had experience, skills and additional training in the care of paediatric patients. Staff were also consistent in supporting people to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill-health. For example developing an information leaflet and providing an app giving advice, support and guidance for common childhood illnesses including sepsis giving patients greater control and information of when to seek advice.

The areas where the provider should make improvement are:

• Ensure all prescribers at the practice are aware of the systems and processes used in the management of high risk medicines.

• Review processes, systems and records both at practice level and organisational level to ensure comprehensive records and audit trails are in place to reflect the actions and decision making process fully for minor events and near misses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 June 2017

The practice is rated as good for the care of people with long-term conditions.

• The practice provided regular specialist diabetic clinics with a specialist nurse who worked alongside the practice nursing team.
• The practice completed an annual virtual diabetic clinic with a consultant from the Royal Devon and Exeter Hospital (RD&E).
• The practice offered regular asthmatic reviews with the asthma nurse.
• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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.
• Staff referred patients with long term conditions and depression and anxiety (DAS) to a partnering GP practice who hosted a specific DAS service.

Updated 6 June 2017

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

• There was a higher than average number of younger patients. For example, 700 of the 1900 patients were under the age of 18. The GPs and nurses all had experience, skills and additional training in the care of paediatric patients. For example, paediatric dermatology.

• 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 accident and emergency (A&E) attendances.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, there were clinics with the Midwives on Tuesday and Fridays and Health Visitor clinics were held every Tuesday, Wednesday, Thursday and Friday.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• The organisation had developed a leaflet and provided an app called HANDi which provided advice, support and guidance for common childhood illnesses. For example, what to do if a child has a temperature and guidance of when to contact a GP, call NHS 111 or 999.

Updated 6 June 2017

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

• The practice supported a smaller than national average of older patients due to the demographic of the new town it was located in. For example, approximately 40 patients were aged between 55 and 75 years and 12 patients were 76 years and over.

• The practice provided new patient checks and the lead GP carried out regular medication reviews for older people and worked closely with the complex care team and community nursing teams assigned to the practice.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

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

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 6 June 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• Patients were able to book appointments online and could access appointments from 8am and the practice were in the process of commencing monthly Saturday morning clinics.

• 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 6 June 2017

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

• There was a lower than average older patient population at the practice.
• The practice carried out advance care planning for patients living with dementia.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health.
• Patients with depression and anxiety (DAS) were referred to the local DAS service.
• The practice had information available for patients experiencing poor mental health about how they could 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 mental health crises.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 6 June 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 those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients who needed them.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example health visitors and safeguarding teams.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.