Crosslands Surgery

Updated 15 November 2016

Crosslands Surgery provides NHS primary medical services to around 7500 patients in the Norwood Green and Heston areas of Southall, West London through a 'personal medical services' contract. The service is run from one surgery.

The current practice clinical team comprises five GP partners (male and female), three salaried GPs (male and female) and two practice nurses. The practice employs a phlebotomist and a health care assistant who also take on reception duties. The practice employs a practice manager, administrative and reception staff. The GPs provide around 37 sessions a week in total.

The practice is a training practice providing fixed-term posts for trainee GPs with appropriate supervision and support.

The practice telephone lines are open from 8.00am until 6.30pm Monday to Friday. The practice offers appointments starting at 7.00am on Monday, Tuesday and Thursday and from 9.00am on Wednesday and Friday. The latest appointments are generally available until 6.00pm although there are also late evening surgeries until 8.00pm every Monday and Wednesday. The practice is closed over the weekend.

The practice offers telephone triage and consultations, online appointment booking and an electronic prescription service. The GPs make home visits to see patients who are housebound or are too ill to visit the practice.

When the practice is closed, patients are advised to use a contracted out-of-hours primary care service if they need urgent primary medical care. The practice provides information about its opening times and how to access urgent and out-of-hours services in the practice leaflet, on the NHS Choices website and on a recorded telephone message.

The practice population profile is broadly similar to the English national average. The population is characterised by average levels of income deprivation, disability, employment rates and life expectancy. The local population is ethnically diverse with a large local Indian community by cultural background. 

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; family planning; maternity and midwifery services; and treatment of disease, disorder and injury.

CQC has not previously inspected this practice.

Updated 15 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crosslands Surgery on 21 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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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, 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 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:

• The practice should monitor and reduce the frequency of long waits in reception and provide information to patients about likely delays.
• The practice should consider developing a website to provide patients with more detailed information about the service and practice news.
• The practice had only identified 14 carers at the time of the inspection. The practice should aim to ensure that patients who are carers are identified and their needs assessed.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 15 November 2016

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

• The practice kept registers of patients with long term conditions. These patients had a named GP and a structured annual review to check their health and medicines needs were being met. The practice operated a call-recall system to encourage patients to attend for their review.
• The prevalence of diabetes was high locally. The practice had implemented a dual appointment system for diabetic reviews - with patients seeing the health care assistant for preliminary tests before their review with the GP. The practice also offered insulin initiation.
• Even so, practice performance for diabetes related indicators tended to be significantly lower than the CCG and national averages. For example, 59% of practice diabetic patients had blood sugar levels that were adequately controlled compared to the CCG average of 69% and the national average of 78%.
• The practice participated in a local scheme to avoid unplanned admissions which included patients with multiple long term conditions. Patients identified as at risk were reviewed and had a personalised care plan. Cases were discussed at regular multidisciplinary meetings.
• The practice was carried out in-house spirometry testing to identify cases of COPD.
• The practice had a designated member of staff whose role included liaising with the local pharmacies to ensure any prescription changes, for example when requested by specialist teams, were actioned safely and effectively.

Updated 15 November 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 relatively high for all standard childhood immunisations.
• 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 ran a weekly walk-in clinic for pre-school children and babies which was staffed by a health care assistant, practice nurse and GP. Families were welcome to attend with questions, queries, for routine checks as well as any health problems. 
• We saw positive examples of timely communication and referral to health visitors and other community health services.

Updated 15 November 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 provided the seasonal flu vaccination for patients over 65 and the shingles and pneumococcal vaccinations for eligible older patients.

• The practice had assigned a member of staff as lead for liaison with local pharmacies about patients who required medicines compliance aids.

Updated 15 November 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 and flexible.
• The practice was open for extended hours both during the early morning and evening. Nurse and GP appointments were available at these times. The practice offered daily telephone consultations with a GP.
• The practice was proactive in offering online services as well as a full range of health promotion and screening reflecting the needs for this age group.  Patients could also sign up to the practice text messaging service.
• 75% of eligible women registered with the practice had a recorded cervical smear result in the last five years compared to the CCG average of 78% and the national average of 82%.

Updated 15 November 2016

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

• Clinical staff had attended dementia case-finding training in 2015. The practice provided a shared care service for patients with dementia, working alongside the specialist dementia service in the area, for example, co-prescribing medicines. 
• 79% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
• For patients with a diagnosis of psychosis, 16 of 34 (47%) had attended a face to face review of their care in the last 12 months. This was significantly lower than the CCG and national averages, both 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health and participated in the 'Shifting the setting of care' scheme. This meant for example, that patients could regularly access a specialist mental health worker or nurse at the practice.
• 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.

Updated 15 November 2016

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

• The practice offered longer appointments for patients with a learning disability. Patients with learning disability were offered a comprehensive check covering medical, physical, psychological and social wellbeing and care.
• The practice informed 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.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. One of the practice GPs was the safeguarding lead for the clinical commissioning group acting as a contact and source of advice to other practices in the area.