Archived: The Crossroads Surgery

Updated 4 June 2015

The Crossroads Surgery is situated in the Rainhill area of St Helens which is a deprived area of the country. The practice is located in a small purpose built property. At the time of our inspection there were 3063 patients on the practice list.

The practice has two partner GPs and two salaried GPs in addition is a nurse, a healthcare assistant, two practice managers, reception and administration staff. The practice is open 8.30am to 6pm Monday to Friday. Patients requiring a GP outside of normal working hours are advised to contact an external out of hours service that is provided by local GPs. The number of this service is clearly displayed in the reception area and on the practice website. The practice has a PMS (Personal Medical Services) contract and also offers enhanced services for example; various immunisation and learning disabilities health check schemes.

Updated 4 June 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crossroads Surgery on 24 March 2015 Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe, and well led services. It also required improvement for providing services for the following population groups; older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable, people experiencing poor mental health (including people with dementia). It was good for providing a caring, effective and responsive service.

Our key findings across all the areas we inspected were as follows:

Our key findings were as follows:

• There were systems in place to mitigate safety risks including analysing significant events and safeguarding however they were not consistently applied. The premises were clean and tidy. Systems were in place to ensure medication including vaccines were appropriately stored and in date. The recruitment procedure was not consistently being followed.

• Patients had their needs assessed in line with current guidance and the practice had a holistic approach to patient care. The practice promoted health education to empower patients to live healthier lives.

• Feedback from patients and observations throughout our inspection showed the staff were kind, caring and helpful.

• The practice had systems in place to respond to and act on patient complaints and feedback however these were not consistently applied. There were limited governance systems in place to monitor the safety and the quality of the service provided.

• The staff worked well together as a team.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Review the systems for assessing and monitoring the quality and safety of service provision and take steps to ensure risks are managed appropriately. With particular regard to the process for formal clinical and non-clinical meetings to take place and serious events investigation and analysis.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

In addition the provider should:

• Review the system in place for complaints handling and investigation to ensure formal lessons learned and actions taken are clearly identified to practice staff and to the complainant.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 June 2015

There were aspects of care and treatment that required improvement that related to all population groups. All these patients had as a minimum a structured annual review to check that their health and medication needs were being met. The practice had adopted a holistic approach to patient care rather than making separate appointments for each medical condition. This included services such as spirometry, 24 our blood pressure monitoring, ECG, anti-coagulation monitoring (INR).

Updated 4 June 2015

There were aspects of care and treatment that required improvement that related to all population groups. A GP partner was the safeguarding lead for the practice. There were systems in place to identify and follow up children living in disadvantaged circumstances and also cases of domestic violence. Records showed the lead GP liaised and sought advice from other health and social care professionals when necessary.

The practice provided baby immunisations, weighing and six week checks. The midwife visited the practice once a week and there were immunisation clinics available.

There were appointments for children available outside core school hours.

Updated 4 June 2015

There were aspects of care and treatment that required improvement that related to all population groups. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example home visits to patients over 65 were made via the acute visiting scheme. The practice had a designated named GP for patients who are 75 and over and care plans were in place for these patients.

The practice had registered with the Dementia Friends website.

Updated 4 June 2015

There were aspects of care and treatment that required improvement that related to all population groups.The needs of this group 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 the practice offered early morning appointments with the practice nurse and telephone consultations were available instead of patients attending the practice. The practice offered online prescription ordering with a 24 hour turn around and online appointment services.

Updated 4 June 2015

There were aspects of care and treatment that required improvement that related to all population groups. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health and sign posted patients to the appropriate services. The practice participated in enhanced services for dementia and used screening tools to identify those patients at risk. The practice had encouraged its staff and patients to become dementia friends.

Updated 4 June 2015

There were aspects of care and treatment that required improvement that related to all population groups. Annual health checks for people with a learning disability were carried out and health action plans updated. The practice had a register of vulnerable patients. The practice was part of a multi – disciplinary group made up of health and social care services who met monthly to monitor the health and well-being of this group of patients.