Archived: Crewkerne Health Centre

Updated 8 October 2015

We inspected the practice at the location of Crewkerne Health Centre, Middle Path, Crewkerne, Somerset, TA18 8BX, where all registered regulated activities were carried out. This focused inspection was undertaken to follow up a breach of regulation found at our previous comprehensive inspection undertaken on 12 November 2014.

The practice serves approximately 11,250 patients living in a five mile radius around Crewkerne in South Somerset including 1000 patients living within the Dorset area.

The national general practice profile showed the practice has a large demographic of patients over the age of 55 years. This was above the England and Somerset Clinical Commissioning Group (CCG) average, particularly between the ages of 65 to 69 years old. The practice population is below national and CCG averages for patients under 44 year olds. The practice is in the least deprived range for the area.

There are seven GP partners, five male and two female. Each week the GPs covered 49 sessions which is the equivalent to six and half full time GPs.

The nursing team consisted of a nurse practitioner, who worked four days per week, four female practice nurses who worked the equivalent to approximately three full time nurses. There were also three female health care assistants, equivalent to approximately two full time health care assistants.

The practice has a General Medical Service contract with NHS England. The practice is contracted for a number of enhanced services including extended hours access, facilitating timely diagnosis and support for patients with dementia, minor surgery, patient participation, immunisations and remote care monitoring.

The practice has core opening hours from 8am to 6:30pm to enable patients to contact the practice. Extended hours were provided on Monday evening until 8pm. The practice refers their patients to NHS 111 operated by Vocare, Somerset Doctors Urgent Care for out-of-hours services to deal with urgent needs when the practice is closed.

Updated 8 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crewkerne Health Centre on the 12 November 2014. During the inspection we gathered information from a variety of sources. For example, we spoke with patients, members of the patient forum, interviewed staff of all levels and checked that the right systems and processes were in place.

Overall the practice is rated as good. This was because we found the practice was good at providing caring, effective, responsive and well-led services. The practice were also good for providing services for all population groups. The practice required improvement for providing safe services.

Our key findings were as follows:

• The practice provided patients with a good triage system which enabled patients to see a GP within two days. Patients who wanted to see a preferred GP may have had to wait longer.
• Patients generally told us staff were respectful and compassionate towards them when they visited the practice.
• The practice had good communication with other services and health professionals to ensure patients received joined up care packages.

We saw several areas of outstanding practice including:

• The practice was involved in the programme called ‘Productive General Practice’ supported by NHS Improving Quality. This programme has now been completed and last year the practice had been voted the best practice to have gained the most from the projects set out of all 20 Somerset practices that had participated. They continue to use this approach in their practice. For example, prescription staff changed their working hours to increase the availability for patients to receive their prescriptions during busier times.

• The practice had established through the Joint Strategic Needs Assessment for Somerset that Somerset had a higher than national average adult obesity. The Clinical Innovations Group piloted a weight management project, which has now ended. The practice found this a successful pilot and has continued with weight management clinics. Approximately 95% of patients that attended these clinics lose the targeted weight.

• There was a proactive system for double checking all patients with chronic obstructive pulmonary disease had ‘just in case’ medicines prior to Christmas and New Year holidays.

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

Importantly, the provider must:

• Ensure actions are addressed promptly following audits and assessments, such as fire risk assessments and infection control audits, to ensure they protect patients from risks that could have been detected.
• Regularly carry out clinical audit cycles to evidence whether improvements had been made and the measure of patient impact since the previous audit and shared with the team and new protocols formed, where necessary.
• Ensure there is a formal process to ensure results and research from audits and incidents, such as medical emergencies are shared with the team for additional learning and where necessary form new practice protocols.

In addition the provider should:

• Ensure a risk assessment is completed so appropriate medicines to use on a home visit are contained within the home visit bag and consider where it is kept in the practice to ensure it is held securely.

• Ensure they have appropriate evidence to provide proof of identification when recruiting new staff.

• Inform patients of the confidentiality arrangements in the reception area to reduce them from being overheard when discussing personal information.

• Ensure information on complaints is easily available for patients to access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 March 2015

The practice is rated as good for the care of patients with long-term conditions. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check their health and medicine needs were met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multi-disciplinary package of care. There was also a proactive system for double checking all patients with chronic obstructive pulmonary disease had ‘just in case’ medicines prior to Christmas and new year holidays.

Updated 26 March 2015

The practice is rated as good for the care of families, children and young patients. 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 patients who had a high number of accident and emergency (A&E) attendances. Immunisation rates were just below Somerset Clinical Commissioning Group average for most standard childhood immunisations. Patients told us children and young patients 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. We saw the waiting area had a children’s play area to entertain children whilst they were waiting for their appointment. We saw good examples of joint working with midwives and health visitors and regular meetings were held to discuss any children or families ‘at risk’.

Updated 26 March 2015

The practice is rated as good for the care of older patients. The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, avoiding unplanned admissions. The top 2% of patients who had been identified were at risk of emergency admission at hospital had been visited or received face to face consultations. This was in order to set a care plan to reduce admissions. The practice was responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs. Monthly meetings were held with the community team to discuss patients who required end of life care and their needs were discussed when required.

Updated 26 March 2015

The practice is rated as good for the care of working-age patients (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. For example, extended hours were provided on Monday evenings where GP and nurse appointments were available. The practice was proactive in offering online services for repeat prescriptions and had a future plan to implement an online booking system for appointments. There was a full range of health promotion and screening which reflected the needs for this age group.

Updated 26 March 2015

The practice is rated as good for the care of patients experiencing poor mental health (including patients with a form of dementia). The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. They 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. They had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. All GPs were aware of the need to respond quickly to a mental health crisis and the local support available. GPs carried out regular reviews of patients with severe mental health problems. The practice had a counsellor attend the practice regularly to provide talking therapies work and they had regular contact with the GPs.

Updated 26 March 2015

The practice is rated as good for the care of patients whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. They had carried out annual health checks for patients with a learning disability and offered longer appointments for patients with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. They 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.