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Dr T Crawford & Partners Good Also known as Greenview Surgery

Inspection Summary


Overall summary & rating

Good

Updated 22 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Crawford and partners on 14 June 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 and an effective system in place for reporting and recording significant events and staff demonstrated an awareness and involvement in the process.
  • Risks to patients were assessed and well managed.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care and patients could access urgent appointments on the same day without difficulty.
  • 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.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • To carry out regular formal audits to demonstrate monitoring of infection control.

  • To introduce a formal induction checklist to clearly show all topics undertaken at induction including training.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 July 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events and staff were aware of this and participated in the process.
  • Lessons learnt were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support and a 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. Staff were able to demonstrate how they would recognise signs of abuse and the system in place to deal with it.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 22 July 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable with the local and national averages.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement and we saw evidence of how this had impacted on patient care.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. GPs and nurses had additional training in specific clinical areas and utilised these skills to provide a comprehensive service and prevent unnecessary attendance to the local hospital.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 22 July 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for all aspects of care.
  • Patients said 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.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality and patients we spoke with confirmed this.

Responsive

Good

Updated 22 July 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. They were working with the CCG to explore development and delivery of services in the practice for all patients in the locality to prevent the need to attend hospital.
  • 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. Patients we spoke with during inspection confirmed they had been provided with an appointment that day.
  • Appointments with the GPs were all 15 minutes in duration.
  • The practice had good facilities and was well equipped to treat patients and meet their needs which included staff with additional skills in areas such as family planning and contraceptive device fitting.
  • 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 22 July 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 it.
  • 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 weekly meetings where governance was discussed.
  • 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 partners were aware of and complied with the requirements of the duty of candour. They encouraged a culture of openness and honesty and staff we spoke with confirmed this. The practice had systems in place for 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 established and engaged well with the practice. They reported that the practice worked well with the group and responded to their views and feedback.
  • There was a focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 22 July 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. The practice monitored these patients closely offering support and had demonstrated a reduction in admissions as a result.
  • Diabetes indicators from the QOF were comparable with the national and CCG averages, for example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 79% which was comparable with the national average of 78%.
  • Longer appointments were provided for long term condition reviews and home visits were undertaken when needed.
  • The practice had an allocated member of staff responsible for ensuring the call and recall system operated efficiently and effectively.
  • All these patients had 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 22 July 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 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.
  • Cervical screening rates were at 80% and comparable with the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice offered a range of services for this group including eight week baby medical checks prior to immunisation and family planning services and post-natal depression screening.
  • We saw positive examples of joint working with midwives and health visitors.

Older people

Good

Updated 22 July 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice had identified a specific member of staff to co-ordinate daily liaison with staff involved in delivery of care of older patients and organisation of weekly ward rounds to the local care homes they provided services to.
  • The practice see all new patients, including those in care homes, within a month of registering with the practice and develop shared care plans during this process including end of life.
  • The practice signpost to a variety of support organisations such as Age UK.

Working age people (including those recently retired and students)

Good

Updated 22 July 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 was proactive in offering online services including electronic prescribing as well as a full range of health promotion and screening that reflects the needs for this age group.
  • The practice offered NHS health checks and new patient checks and reported a good uptake of this service.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 July 2016

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

  • 89% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
  • 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had had a comprehensive, agreed care plan documented in the record, in the preceding 12 months which was comparable to the national average of 89%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients 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 and engaged with ‘First for Wellbeing’, a service that provided social support and addressed social isolation and emotional wellbeing who attended the practice regularly.
  • The community mental health lead was based at the practice and they met weekly with them for advice regarding mental health issues.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 22 July 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 those with a learning disability.
  • 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 informed vulnerable patients; such as carers, about how to access various support groups and voluntary organisations.
  • 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.
  • The practice accommodated the Community Law Service which provided advice and advocacy for financial, housing and social needs.
  • The practice had identified 246 patients as carers which represented 3.2% of the practice list
  • The First for Well-Being Service also attends the practice, which provides support for patients experiencing social isolation and helps address emotional wellbeing.