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Inspection Summary


Overall summary & rating

Good

Updated 20 May 2016

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Crayford Town Surgery on 11 February 2016. 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; however, the system for learning from significant events needed to be more robust.
  • Risks to patients were assessed and mostly well managed. Some mandatory training had not been completed by one non-clinical member of staff; however, this training was booked shortly after our inspection. Annual infection control audits had not been conducted since 2013, but the practice conducted a new audit shortly after our inspection.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Nationally published data showed patient outcomes were mostly above or in line with the locality and nationally. Although some audits had been conducted which led to quality improvements, there was no evidence of a continuous cycle of audits.

  • The provider was aware of and complied with the requirements of the Duty of Candour.

  • Information about services and how to complain was available and easy to understand, and there was an effective system in place for managing complaints.

  • The majority of patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment; however, results from the national GP patient survey showed the practice was rated below average for consultations with GPs.
  • Most patients said they found it easy to make an appointment and urgent appointments were available the same day, but continuity of care was not always available and they had experienced continuing difficulties accessing the practice via telephone. The practice had discussed plans to make improvements.
  • 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. The practice proactively sought feedback from staff and patients, which it acted on, and they provided positive examples of how staff had been involved in their vision.

The areas where the provider should make improvement are:

  • Ensure all staff are up to date with any outstanding training.

  • Review the systems in place for learning from significant events, the completion of annual infection control audits and a second cycle is completed on all clinical audits.

  • Continually monitor patient feedback regarding consultations with GPs and telephone access and make any necessary improvements to improve patient experience.

  • Consider displaying/providing information on the different avenues of support available to carers, and formalise a system for identifying carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 May 2016

The practice is rated as good for providing safe services.

  • There was a system in place for reporting and recording significant events. Lessons were shared to make sure action was taken to improve safety in the practice but in some instances, learning or action points from significant events were not thorough enough.

  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed in most instances. A non-clinical member of staff had not completed some up-to-date mandatory training but the practice manager told us they had been booked to receive this training in March 2016. Annual infection control audits had not been conducted; an infection control audit was last conducted in 2013, and was repeated in February 2016 after our inspection.

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 in line with or above average local and national averages.

  • Staff assessed needs and delivered care in line with current evidence based guidance. A nurse had completed mental capacity training.

  • Although some audits had been conducted, only one was a two cycle completed audit and we saw limited evidence that clinical audits were driving quality improvements at the practice.

  • 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 below others for several aspects of consultations with GPs.

  • The majority of patients told us 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; however there was no formal system in place to identify or support patients who had caring responsibilities.

  • 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 was one of six surgeries selected to pilot a Health Champion scheme where trained volunteers based at the surgery could signpost any patient to one of over 500 charitable organisations within Bexley.

  • Patients said they did not always find it easy to make an appointment with a named GP and continuity of care was not always available, but urgent appointments available the same day.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • The practice offered drug rehabilitation counselling every Thursday.

  • The practice participated in a pilot for the Hurley Web GP programme which allowed patients to check symptoms and possible management options for simple illnesses online and leave enquiries for a GP via email which would be answered by the end of the next working day.

  • 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, and we saw positive examples of where they had been involved in the development of the practice’s motto and practice information leaflet.

  • 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 which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • 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 but they told us they did not feel listened to by the practice. The GP partners told us they had not always been able to achieve the expectations of the PPG and we saw that some of their suggestions had been implemented by the practice.

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.

  • Performance for diabetes related indicators was mostly in line with local Clinical Commissioning Group (CCG) and national averages. 81% of patients with diabetes had well-controlled blood pressure (CCG average 81%, national average 78%). 87% of patients with diabetes had well-controlled blood sugar levels (CCG average 82%, national average 78%).

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and they were offered annual reviews in their birthday month to check their health and medicines needs were being met.

  • 95% of patients with asthma had an annual review in the previous 12 months, which was above the CCG average of 73% and the national average of 75%. 

  • 91% of patients with chronic obstructive pulmonary disease had a review in the previous 12 months, which was above the CCG average of 89% and the national average of 90%.

  • 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. A young patient told us of an occasion where a receptionist had encouraged them to attend the practice to receive a vaccine.

  • The practice’s uptake for the cervical screening programme was 84%, which was slightly above the CCG average of 81% and the national average of 82%.

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

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

Older people

Good

Updated 20 May 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.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were mixed. For example, 100% of patients aged over 75 years with a fragility fracture were being treated with an appropriate bone sparing agent. This was above the local Clinical Commissioning Group average of 98% and the national average of 93%.

  • The practice was responsive to the needs of older people. They offered home visits by the GP and nurse practitioner and urgent appointments for those with enhanced needs, and this was acknowledged positively in feedback from patients.

  • One of the practice’s nurse practitioners was the palliative care lead for patients on end of life care and several patients gave positive feedback about the level of service they had received.

  • The practice had improved on it’s out of hospital deaths by eight percent since the previous year.

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 offered extended hours opening on Thursday evenings from 6.30pm until 8.00pm.

  • 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 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. 81% of patients with dementia had a face-to-face review of their care in the previous 12 months (CCG average 81%, national average 78%).

  • Performance for mental health related indicators was above average. 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive agreed care plan in their records (CCG average 94%, 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. They had received training in dementia awareness from a dementia support group.

People whose circumstances may make them vulnerable

Good

Updated 20 May 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 and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

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

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Four patients had successfully completed the methadone rehabilitation programme at the practice in its first year of service.

  • 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.