Cross Deep Surgery

Updated 21 April 2016

Cross Deep Surgery provides primary medical services in Twickenham to approximately 10,500 patients and is one of 29 practices in Richmond Clinical Commissioning Group (CCG).

The practice population is in the least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 8%, which is lower than the CCG average of 10%, and for older people the practice value is 10%, which is comparable to the CCG average of 11%. The age distribution of the practice population is in line with local averages. Of patients registered with the practice, the largest group by ethnicity are White (88%), followed by asian (6%), mixed (4%), black (1%) and other non-white ethnic groups (1%).

The practice operates from a large converted residential premises, which had been extended. All patient facilities are split over the ground floor and first floor and there is a lift available for patients and staff to use. The practice has access to six doctors’ consultation rooms, two nurse consultation rooms and a treatment room. The practice team at the surgery is made up of three part time female GPs who are partners, two part time female salaried GPs and two part time male salaried GPs; in totoal there are 38 GP sessions available per week. In additional, the practice also has one full time and one part time female registrars, one full time and one part time female nurses and a full time female healthcare assistant. The practice team also consists of a practice manager, secretary, and nine members of reception/administrative staff.

The practice operates under a General Medical Services (GMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8:30am to 11:40am every morning apart from Wednesday when appointments start at 9am, and 3pm to 5:30pm every afternoon. Extended hours surgeries are offered between 7:30am and 8am and between 6:30pm and 7pm on Tuesdays, Wednesdays and Thursdays. Patients can also access appointments via the CCG seven-day opening Hub, based at the practice, which offers appointments from 8am until 8pm every day, including weekends.

When the practice is closed patients are directed to contact the local out of hours service.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease, disorder or injury; surgical procedures; and family planning.

Updated 21 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cross Deep Surgery on 4 February 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.

• Patients said they found it easy to make an appointment with a named GP and that 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.

However there were areas of practice where the provider should make improvements:

• They should ensure that all staff receive annual Basic Life Support training, in line with national guidance.

• They should advertise to patients that translation services are available.

• They should ensure that they follow their recruitment policy and that they keep complete personnel files for all staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 21 April 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’s overall performance in relation to long-term conditions was comparable to CCG and national averages. For example, QOF achievement for the percentage of patients with hypertension who had well controlled blood pressure was 83%, the CCG average was the same and the national average was 84%.

• For asthma the practice achieved 100% of the overall QOF points available, compared with a CCGand national average of 97%, and the practice had recorded having carried-out a review in the preceding 12 months of 92% of patients with chronic obstructive pulmonary disorder (COPD), which was the same as the CCG average, the national average was 90%.

• The practice’s overall performance in relation to diabetes indicators was comparable to CCG and national averages at 92% of the total QOF points available, compared with an average of 90% locally and 89% nationally. In particular, the number of diabetic patients who had well controlled blood pressure was 90% (CCG average was 79% and national average was 78%); and the proportion with a record of a foot examination and risk classification in the preceding 12 months was 94% (CCG average 90%, national average 88%). The percentage of diabetic patients who had received influenza immunisation was 96% (CCG average 90% and national average 94%).

• 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 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.

• The practice had an in-house pharmacist who ensured that those patients on long-term medicines received the appropriate monitoring.

Updated 21 April 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.

• The practice had recorded having carried-out an asthma review in the last 12 months for 72% of asthmatic patients, which was comparable to the CCG average of 72% and national average of 75%.

• 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 had been carried-out for 83% of women registered at the practice aged 25-64, which was comparable to the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives and health visitors.

• In-house sonography was available, including vaginal scans for early pregnancy detection.

Updated 21 April 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.

• All patients aged 75 and over had a named GP.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were better than local and national averages. For example, of patients with hypertension who had a record of blood pressure reading in the past 12 months, 93% had blood pressure that was well controlled, compared to a CCG average of 83% and national average of 84%. One hundred percent of patients aged over 75 with a record of a fragility fracture and a diagnosis of osteoporosis were treated with an appropriate bone-sparing agent, compared to a CCG average of 96% and a national average of 93%.

Updated 21 April 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 as well as a full range of health promotion and screening that reflects the needs for this age group.

• Early morning and evening appointments were available, and additional appointments, including weekend appointments were available via the CCG’s seven-day opening hub based at the practice.

Updated 21 April 2016

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

• Forty-five patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which represented 89% of eligible patients. This was comparable to the CCG and national average of 84%.

• The practice had recorded a care plan in the past 12 months for 55 patients with schizophrenia, bipolar affective disorder and other psychoses, which represented 90% of eligible patients. This was comparable to the CCG average of 92% and national average of 89%.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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.

• 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.

Updated 21 April 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 homeless people, carers, and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

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

• 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.