Archived: Cressex Health Centre

Updated 3 May 2018

Cressex Health Centre is situated in High Wycombe; Buckinghamshire within a purpose built premises at the main practice and converted premises at the branch practice (known in the report as Lynton House).

Services are provided from:

• Cressex Health Centre, Hanover House, Coronation Road, Cressex Business Park, High Wycombe Buckinghamshire HP12 3PP

• Lynton House (the branch practice), 43 London Road, High Wycombe, Buckinghamshire, HP11 1BP

The practice website is:

• www.cressexhealthcentre.co.uk

The practice provides services via an Alternative Provider Medical Services (APMS) contract. APMS contracts are provided under Directions of the Secretary of State for Health. APMS contracts can be used to commission primary medical services from traditional GP practices). The APMS contract was awarded to Chiltern Vale Health (2012) LLP (current provider also known as CV Health) in July 2015.

The practice has a patient population of approximately 8,200 registered patients. The practice population of patients aged between 0 to 9 and 20 to 44 years old is significantly higher than the national average and there are a lower number of patients aged above 45 years old compared to the national average. The practice has a highly transient and unique mix within the patient population; patients are often outside of the country for long periods and patients registering at the practice are often only in the area for short, temporary amount of time. This has an impact on screening and recall programmes. Patients registered at the practice are from a number of different ethnic backgrounds, approximately 67% of patients have an Asian or Black background and there are a growing number of Eastern European patients. This ethnic mix is consistent with the variety of cultures in High Wycombe. A large proportion of practice patients speak English as a second language.

Updated 3 May 2018

At our previous comprehensive inspection at Cressex Health Centre in Buckinghamshire on 26 April 2017 we found a breach of regulations relating to the premises, specifically the premises at the branch practice. Although the overall rating for the practice was good, the practice was rated requires improvement for the provision of safe services. The practice was rated good for the provision of effective, caring, responsive and well-led services. In addition, all population groups were also rated good.

The full comprehensive report on the April 2017 inspection can be found by selecting the ‘all reports’ link for Cressex Health Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 April 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection in April 2017. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. At our inspection on the 10 April 2018 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. The overall rating remains good.

Our key findings were as follows:

• Systems had been implemented and embedded which ensured care and treatment was provided in safe premises.

• Until the full refurbishment was completed, the practice had continued to assess, manage and monitor the environmental risks at the branch practice. The refurbishment was completed in March 2018 and all the previous risks to patient safety had been minimised through defined and embedded systems.

• There was an improved system to effectively monitor and improve patient outcomes for patients on the learning disabilities register. For example, there were two designated leads who managed the learning disability register, an administrative lead and a clinical lead. We saw all the patients on the learning disability register had been contacted and invited to attend or have a home visit for a learning disability health check. We saw the improved system and invites and in some cases a series of invites had significantly increased the uptake rate.

• The practice had continued to review the existing arrangements with regards to the number of patients completing the bowel cancer screening programme, with a view to increase uptake rates. For example, the practice had worked with the national bowel cancer screening programme team and consented to the practice name being added to the bowel cancer screening kits. Evidence based research has shown that endorsement by a patient’s own GP practice on invitation letters leads to an increase in screening uptake.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 8 June 2017

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

• The number of patients registered at the practice with a long-standing health condition was higher when compared to local and national averages. Specifically, there was a significantly higher prevalence of registered patients with diabetes. This had led to focused diabetes clinical audits, additional diabetes training and ongoing discussions with national diabetes groups with a view of future project work.

• Performance for diabetes related indicators showed the practice had achieved 90% of targets which was similar when compared to the CCG average (90%) and lower when compared to the national average (95%).

• Longer appointments and home visits were available when needed.
• 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 8 June 2017

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 patients who had a high number of A&E attendances

• The emergency care practitioner and one of the nurses had completed additional paediatric training to increase the number of appointments for children.

• Immunisation rates were high for all standard childhood immunisations.

• The practice’s uptake for the cervical screening programme was 82%. This was an increase of 4% on the previous year’s uptake and was comparable with the CCG average of 84% and the national average of 81%.

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

• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals.
• We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 8 June 2017

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. Older people at risk of isolation within the community were identified and discussed at meetings including multi-disciplinary meetings to address any additional support required.

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

• There was a register to effectively support patients requiring end of life care.

• The practice provided GP services to a local care home; a designated GP provided services which included twice weekly ward round. Feedback from the care home praised the service and said the service they received was professional and empathic and they were very happy with the GP service they receive.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older patients were higher when compared with local and national averages.
• The premises were accessible to those with limited mobility. However, we noted access at the branch practice (Lynton House) required improvement.

Updated 8 June 2017

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.

• Services were flexible, provided choice and ensured continuity of care for example, telephone consultations was available for patients that chose to use this service.

• There was a range of appointments which now included telephone consultations and early morning appointments every weekday. These appointments were specifically for patients not able to attend outside normal working hours but there were no restrictions to other patients accessing these appointments.

• On-line booking for appointments was available for patients’ convenience and the number of registered users was increasing. The practice website was well designed, clear and simple to use featuring regularly updated information.

Updated 8 June 2017

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

• The practice offered flexible longer appointments for patients with complex mental health needs.

• Nationally reported data showed that outcomes for patients experiencing poor mental health and patients diagnosed with dementia were higher when compared with local and national averages.

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. Several members of staff had additional training in recognising and supporting people with dementia.

Updated 8 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 homeless people, those with learning disabilities and those with caring commitments.

• It offered annual health checks for patients with learning disabilities. Health checks were completed for three patients out of 57 patients on the learning disability register. Care plans had been completed for six of those 57 patients on the learning disability register. The practice had implemented an action plan to improve the care of patients with learning disabilities which included appointing a learning disability GP Lead, sharing local and national learning disability guidance including case studies in the health inequalities commonly experienced by people with learning disabilities and learning disability awareness training for all practice staff.

• The practice offered longer appointments for patients whose circumstances may make them vulnerable.

• In April 2017, the practice patient population list was 8,160. The practice had identified 97 patients, who were also a carer; this amounted to 1.2% of the practice list.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.