Archived: Crusader Surgery

Updated 14 June 2017

Crusader Surgery is situated on the outskirts of Clacton-on-Sea, Essex. The practice is one of 39 practices in the North East Essex Clinical Commissioning Group. The practice holds a Personal Medical Services contract with the NHS. There are approximately 5200 patients registered at the practice. People living in this area tend to have greater need for health services due to the higher percentage of older and deprived people, living in the practice area.

Since our last inspection, there has been a change in the clinical leadership at the practice and this had led to a considerable number of improvements being made.

Crusader Surgery is a training practice, however currently there are no registrars receiving training. Since our previous inspection, the practice has changed from a two-partner GP practice to a single-handed GP provider who is a male GP. The GP is supported by two part-time regular locum GPs, a nurse prescriber, two practice nurses, three healthcare assistants, a practice manager, a secretary, and nine administrative and reception members of staff. Clinical and administrative staff members at the practice work a range of hours including full and part-time.

The practice was open between:

Monday        8.30am – 1pm, 2pm - 6.30pm

Tuesday       8.30am – 1pm, 2pm - 6.30pm

Wednesday  8.30am – 1pm, 2pm - 6.30pm

Thursday      8.30am – 1pm, 2pm - 6.30pm

Friday           8.30am – 1pm, 2pm - 6.30pm

GP appointments were available between:

Monday         9am - 11.30am, 2pm - 6.30pm

Tuesday        9am - 11.30am, 2pm - 6.30pm

Wednesday   9am - 11.30am, 2pm - 6.30pm       6.30pm - 7.30pm (Workers Clinic)

Thursday       9am - 11.30am, 4pm - 6.30pm

Friday            9am - 11.30am, 2pm - 6.30pm

During the hour between 1pm and 2pm when the practice was closed, patients had access to the GP on call using the practice telephone number.

They have opted out of providing GP ‘out of hour’s services’. Patients calling the practice outside normal practice working hours are advised by the answerphone message to contact the 111 non-emergency services. Patients requiring urgent treatment are advised to contact the out of hour’s service, which is provided by Care UK.

We carried out an announced comprehensive inspection at Crusader Surgery on 28 October 2015 returning five days later on 02 November 2015 to speak with a GP not available at the initial inspection. The practice was rated as inadequate overall, and placed in special measures for a period of six months. We issued enforcement action and a warning notice to be complied with by March 2016.

We carried out a follow-up inspection on 12 April 2016 to check for compliance with the warning notice.  This inspection showed we were satisfied that the practice had complied with the warning notice in relation to the three domains inspected.

Updated 14 June 2017

We carried out an announced comprehensive inspection at Crusader Surgery on 28 October 2015 returning five days later on 02 November 2015 to speak with a GP not available at the initial inspection. The practice was rated as inadequate overall and placed in special measures for a period of six months. We took enforcement action against the provider and issued a warning notice to be complied with by March 2016.

We then carried out a follow up inspection on 12 April 2016 to check for compliance with the warning notice. We found that that the practice had complied with the warning notice.

The comprehensive report for 28 October 2015 and 02 November 2015 inspection and the follow up report 12 April 2016 can be found by selecting the ‘all reports’ link for Crusader Surgery on our website at www.cqc.org.uk.

This comprehensive follow-up inspection was carried out on 03 March 2017 following the period of special measures. Overall, the practice is now rated good.

Our key findings were as follows:

• There was an effective system in place for reporting and recording safety incidents.
• Risks to patients were documented assessed and well managed.
• Staff members assessed patients’ needs and delivered care in line with current clinical guidance.
• Information about how to complain was available at the practice and on their website.
• We saw staff members had been trained with the skills, knowledge and experience to deliver effective quality care and treatment.
• Patients told us they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about how to complain was available and easy to understand.
• Patients 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 members felt supported by the GP and practice manager. Since the last inspection, there had been a change of leadership and improvements had been made.
• The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice asked the members of their virtual patient participation group to comment on proposed developments at the practice.

The areas where the provider should make improvement are:

• The areas where the provider should make improvement are:
• Promote and encourage a more active patient participation group. Improve cervical screening uptake.
• Review the accessibility to the practice by telephone and in person to ensure this meets patients needed.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice

Updated 14 June 2017

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

• Chronic disease management was managed by the nursing team with lead roles in chronic disease management. Patients at risk of hospital admission were identified and prioritised.
• Personalised care plans were used to ensure patients received care and treatment to meet theirneeds.
• Diabetic quality data from 2015 to 2016 showed they were comparable with the local CCG and national practice averages.

Other services provided by the practice for this population group were:

• Longer appointments and home visits when needed.
• A named GP and structured annual review.
• Working with other relevant health and social care professionals to deliver a package of care, aimed at reducing the need for hospital visits. 

Updated 14 June 2017

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

• Children living in disadvantaged circumstances or at risk were followed up, for example, those who had a high number of A&E attendances.
• Immunisation rates were higher than local CCG and national practice averages for standard childhood immunisations.
• There was a GP designated safeguarding lead. Staff told us they would speak to the lead if they recognised any signs of abuse.
• Cervical screening data showed the practice was comparable with other local CCG and national practice data.
• Appointments were available outside of school hours and college hours, and the premises were suitable for children and babies.
• On-line appointments were available in advance and on the day.

Updated 14 June 2017

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

• Personalised care was offered to meet older people’s needs for example urgent appointments or home visits for those with enhanced needs.
• All older people had a named GP.
• Patients identified as frail or at risk of deteriorating health, were discussed during multidisciplinary/palliative care meetings quarterly.
• Senior health checks were offered, on an ad hoc basis to maximise their uptake.
• Uptake for shingles and flu vaccinations was higher than local and national averages. The practice actively campaigned across a variety of media, for example; prescription repeat forms, posters and information on the television screen in the waiting room, on their website, and opportunistically during routine appointments.
• A GP care advisor visited the practice weekly to assist patients seeking support to access benefits or equipment.

Updated 14 June 2017

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

• Services offered had been adjusted for the needs of the working age population, those recently retired and students.
• Online to access practice services were provided.
• A full range of health promotion and screening services were offered that reflected the needs of this population group.
• Appointments were available for working between 6.30pm and 7.30pm on Wednesday evenings.

Updated 14 June 2017

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

• The practice regularly worked with mental health professionals in the case management of patients experiencing poor mental health, including those with dementia.
• Patients with dementia had care plans designed to help clinicians support their needs.
• The practice told patients experiencing poor mental health how to access various support groups and voluntary organisations.
• The practice followed up patients who had attended accident and emergency, for those experiencing poor mental health.
• Staff members understood how to support patients with mental health needs and dementia.

Updated 14 June 2017

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

• The practice had identified people living in vulnerable circumstances including homeless people, travellers and those with a learning disability. This ensured staff members could offer service to support their needs.
• 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 displayed information in the practice and on their website and told vulnerable patients how to access various support and voluntary organisations.
• Staff members knew how to recognise signs of abuse of vulnerable adults and children. Staff members 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.