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Crossfell Health Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 1 May 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crossfell Health Centre on 4 October 2017. The overall rating for the practice was good. The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for Crossfell Health Centre on our website at .

This inspection was a desk-based review carried out on 6 April 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the ‘should’ that we identified in our previous inspection on 4 October 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At our inspection on 4 October 2017 we reported that: The provider should ensure action is taken to improve telephone access to the Practice. Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was below local and national averages. We rated the location as requires improvement for providing responsive services.

The practice is now rated as good for providing responsive services.

Our key findings were as follows:

  • The provider has made changes to the appointment system which has improved access for patients.
  • Did not attend (DNA) rates for the month of March 2018, in comparison to October 2017 had reduced by almost 50%
  • The provider has introduced a nine months closure to the patient list to reduce the pressure around access to care.
  • Test results and prescriptions can now only be accessed via the telephone after 2pm (for results) and 4pm (for prescriptions) to reduce early morning pressure around telephone access.
  • Since October, each GP has additional telephone slots available for consultation
  • The provider has now reinstated GP pre-bookable appointments throughout the week. (Previously only offered on Saturdays).
  • The patient participation group carried out a survey which asked patients views about telephone access to the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Effective

Good

Caring

Good

Responsive

Good

Updated 1 May 2018

At our previous inspection on 4 October 2017, we rated the practice as requires improvement for providing responsive services as the arrangements in respect of patients’ access to appointments needed improving.

These arrangements had significantly improved when we undertook a follow up inspection on 6 April 2018. The practice is now rated as good for providing responsive services.

Responding to and meeting people’s needs

  • The provider increased nurse practitioner appointments over a two-month trial period and intends to continue this in the future.
  • The patient participation group carried out a survey which asked patients views about telephone access to the practice. 51 out of 55 patients surveyed felt that access to the telephones had improved since October 2017.

Access to the service

  • The provider reinstated GP pre-bookable appointments throughout the week. Pre-bookable appointments had previously only been available on Saturdays or with locum GPs.
  • Did not attend (DNA) rates for the month of March 2018, in comparison to October 2017 had reduced by almost 50%. In October 2017 there were 407 DNAs compared to 246 in March 2018.
  • The provider has introduced a nine months closure to the patient list to reduce the pressure around access to care.
  • Test results and prescriptions can now only be accessed via the telephone after 2pm (for results) and 4pm (for prescriptions) to reduce early morning pressure around telephone access.
  • Since October, each GP has additional telephone slots available for consultation

The provider has increased receptionist resources. By providing cover earlier in the morning to help meet the high demand in answering the telephones, patients are better able to access services.

Well-led

Good
Checks on specific services

People with long term conditions

Good

Updated 16 November 2017

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

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 77%. The local Clinical Commissioning Group (CCG) average was 83%,and the national average was 80%.

  • 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.

Families, children and young people

Good

Updated 16 November 2017

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

  • From the sample of documented examples we reviewed we found 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.

  • Immunisation rates were relatively high for all standard childhood immunisations.

  • We were told 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, in the provision of ante-natal, post-natal and child health surveillance clinics. The health visiting team visited the practice regularly to liaise.

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

Older people

Good

Updated 16 November 2017

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

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

  • 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.

Working age people (including those recently retired and students)

Good

Updated 16 November 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, for example, extended opening hours on Saturdays.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 November 2017

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

  • The practice carried out advance care planning for patients living with dementia.

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 100% (local CCG average 93%, national average 89%)

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

  • Patients at risk of dementia were identified and offered an assessment.

  • 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 poor mental health.

  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 16 November 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 with a learning disability.

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

  • 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.