Archived: Crawcrook Medical Centre

Updated 12 September 2017

Crawcrook Medical Practice is located in the Ryton area of Gateshead, Tyne and Wear and provides care and treatment to approximately 7,276 patients from Crawcrook, Greenside and the surrounding areas. The practice provides services from the following address which we visited during this inspection:

• Crawcrook Medical Centre, Pattinson Drive, Crawcrook, Ryton, Tyne and Wear, NE40 4US.

The practice did have a branch surgery, known as Greenside Surgery but this closed in May 2017 following a period of public consultation.

The practice is located in purpose built accommodation which opened in 2012. All reception and consultation rooms are fully accessible for patients with mobility issues. Dedicated parking spaces are available to the side and rear of the building and there is car park an on street parking available nearby.

The practice is open on a Monday to Friday from 8am to 6pm but practice doors are opened at 7.50am. Appointment times run from 8am to 5.30pm.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and GatDoc.

The practice currently consists of:

• Three GP partners (two of whom do not carry out consultations)
• Two salaried GPs
• One Advanced Nurse Practitioner
• One Nurse Practitioner
• Two Practice Nurses
• One health care assistant
• One temporary health care assistant apprentice
• 14 non-clinical members of staff including a practice manager, reception supervisor, medical secretary, secretary, receptionists (including two apprentice receptionists) and finance assistant

The nurse practitioner and apprentice receptionists are not employed directly by the practice but by Community Based Care (CBC) Health Ltd. CBC Health Ltd is a not for profit healthcare support organisation who represent 31 GP practices across the Gateshead area and were working with the practice to aid improvement and development. A CBC Health Ltd practice manager has also been seconded to the practice to support this development. The two GP partners who do not carry out consultations are also employed by CBC Health Ltd and are involved in assisting with the development of governance arrangements.

The area in which the practice is located is in the eighth (out of ten) most deprived decile. In general people living in more deprived areas tend to have a greater need for health services.

The practices age distribution profile showed fewer patients under the age of 40 than the national average and a higher number of patients in the over 40 age groups. Average life expectancy for the male practice population was 79 years and for the female population 83 which were both the same as the national averages.

57% of the practice population were recorded as having a long standing health condition (CCG average 55% ad national average 53%) Higher percentages may result in an increased demand for primary health services. 64% of the practice population were recorded as being in paid work or full time education (CCG average 60% and national average 63%).

Updated 12 September 2017

Letter from the Chief Inspector of General Practice

On 3 March 2016 we carried out an announced comprehensive inspection at Crawcrook Medical Centre which included an inspection of the branch surgery, known as Greenside Surgery. The overall rating for the practice was requires improvement, having being judged as requires improvement for Safe, Effective and Responsive. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Crawcrook Medical Centre on our website at www.cqc.org.uk.

After the comprehensive inspection the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment.

• Regulation 18 Health & Social Care Act 2008 (Regulated Activities) 2014 Staffing

This announced comprehensive inspection was carried out on the 20 July 2017 in order to review the action taken by the practice to be compliant with the regulations. Overall the practice is now rated as good.

• The practice had taken steps to address the concerns we had identified during out previous inspection in relation to the provision of safe, effective and responsive services.

• The provider had entered into a partnership arrangement with a not for profit healthcare support organisation who represent 31 local GP practices to aid and support improvement within the practice. Improvements had included employing additional clinical and non-clinical staff, reviewing the appointment system and the centralisation of some medicines management and back office functions.

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.

• Risks to patients were assessed and well managed.
• There was evidence of quality improvement and clinical audit activity leading to improvements in patient care and outcomes.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff were consistent and proactive in supporting patients to live healthier lives through health promotion and signposting to relevant support services. The practice hosted counsellors from mental health and drug and alcohol support services on a weekly basis.
• Information was provided to patients to help them understand the care and treatment available.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had a system in place for handling complaints and concerns and responded quickly to any complaints.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.
• The practice was aware of and complied with the requirements of the Duty of Candour regulation.

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

• Continue to monitor and improve access to services and appointment availability.

• Assure themselves that clinical staff have undertaken appropriate training in relation to the Mental Capacity Act 2005 and Deprivation of Liberty standards (DoLS).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 September 2017

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

Nationally reported Quality and Outcomes Framework (QOF) data (2015/16) showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. For example,

• The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma compared to the CCG average of 97.9% and national average of 97.4%).
• They had obtained 100% in respect of hypertension (CCG average 99.1% and national average 97.3%)

Longer appointments and home visits were available when needed. A system was in place to ensure patients with long term conditions were recalled and offered a structured annual review to ensure their health and medicine needs were being met. Written care plans were in place for patients with chronic obstructive pulmonary disease and asthma. 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.

Updated 12 September 2017

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

There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors. Appointments were available outside of school hours and the premises were suitable for children and babies. A number of appointments were blocked for emergency use throughout the day to accommodate young and school age children requiring an urgent appointment.

There were arrangements for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given were in line with CCG/national averages. For example, the practice had obtained a score of 9.2 out of 10 for the delivery of childhood immunisations compared to the national average of 9.1 out of 10. However, they had scored slightly under the expected target of 90% for three of the four immunisation indicators which contribute to the overall score. Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Updated 12 September 2017

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. All patients over the age of 75 had an allocated named GP and were offered immunisations against influenza, pneumonia and shingles. The practice maintained a palliative care register and end of life care plans were in place for those patients they were appropriate for. They regularly referred older patients to the local falls clinic and other support organisations such as the community rehabilitation for older people (CROP) team. They also worked with local health care navigators to ensure older people received coordinated care and treatment to enable them to stay in their own home or care home and avoid non-elective admission to hospital. The practice had adopted a weekly ward round approach to visiting and caring for patients resident in two local care homes and provided home visits for long term housebound patients.

Updated 12 September 2017

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. Patients could order repeat prescriptions and routine healthcare appointments online. Telephone and same day appointments were available. A text message reminder service was available.

The practice offered a full range of health promotion and screening which reflected the needs for this age group. They also offered contraception services, sexual health screening, smoking cessation clinics and alcohol dependency identification and brief intervention.

The practice had temporarily withdrawn their extended opening hours to concentrate on improving access to appointments during core hours. It was envisaged that the extended hours provision would recommence in September 2017 when patients would be able to access extended hours appointments at two other local GP practices ran by CBC Health Ltd. However, patients registered with the practice were also able to access appointments with a GP at one of three local extended access care facilities from 8am to 8pm on a Monday to Friday and from 9am to 2pm on a Saturday and Sunday.

Updated 12 September 2017

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

Nationally reported Quality and Outcomes Framework (QOF) data (2015/16) showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. For example,

• The practice had obtained 100% of the points available to them for providing recommended care and treatment to patients with dementia (CCG average 95.6% and national average 96.6%)
• They had obtained 100% in relation to depression (CCG average 93.7% and CCG average 92.2%)

Staff had undertaken dementia awareness training and clinicians were proactively involved in dementia screening and identification.

The practice hosted counsellors from mental health support organisations and the local drug and alcohol services on a weekly basis and encouraged patients with mental health issues to access psychological wellbeing services.

Updated 12 September 2017

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

The practice regularly worked with multi-disciplinary teams (MDT) in the case management of vulnerable people. They had told vulnerable patients 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. Where appropriate, patients with complex conditions were discussed amongst the clinicians at their regular MDT meetings.

Patients with a learning disability were invited to attend an annual health check and were routinely offered longer appointments. A member of staff had been identified as a learning disability lead. The practice was registered with the safe place scheme. This scheme provides vulnerable people with a place to go for help and support in dealing with any incident that should occur whilst they are out in the community regardless of whether they are registered with the practice.

The practice was proactive in their identification of carers, including young carers. A member of staff acted as a carers champion whose role involved signposting carers to appropriate help and support services. The practice had identified 246 of their patients as being a carer. This represented approximately 3.4% of the practice patient population.