Crown House Surgery

Updated 13 July 2017

Crown House Surgery is situated on the first floor within a purpose built primary care centre within the grounds of Retford Hospital in Retford Primary Care Centre, Retford, Nottinghamshire, DN22 7XF. Car parking and disabled access, via a lift, is provided.

The practice provides Personal Medical Services (PMS) for 11,949 patients in the NHS Bassetlaw Clinical Commissioning Group (CCG) area. Enhanced services are provided and include those for patients living with dementia and learning disability.

They have a patient population which is slightly higher than average for patients who are over 50 years of age and lower for patients less than 40 years of age. The practice is situated in a fifth least deprived area nationally.

There are five male and two female GP partners. There are five nurses including an advanced nurse practitioner (ANP) and two health care assistants (HCA). A pharmacist is also employed for eight hours per week. There is a practice manager and a large administration team.

This is a training practice for qualified doctors intending to become General Practitioners.

Opening times are Monday and Tuesday 8am to 6.30 pm Wednesday, Thursday and Friday, 7.30 am to 6.30pm.

When the practice is closed the patients are directed to call the NHS 111 service.

The CQC registration for the practice was not up to date in that one partner had retired and a new partner had joined the practice. The practice manager told us they would address this as soon as possible.

Updated 13 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crown House Surgery on 13 July 2016. The overall rating for the practice was Good but with a rating of Requires Improvement for safety. Although no breaches of regulations were found at the July 2016 inspection, areas for improvement were identified. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Crown House Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 20 June 2017 to confirm that the practice had made improvement in the areas we identified in our previous inspection on 13 July 2016. This report covers our findings in relation to those improvements.

Overall the practice is rated as Good.

Our key findings were as follows:

• A policy to manage safety alerts had been developed and implemented.

• Security of blank prescription forms and pads had been improved in line with national guidance.

• The recruitment policy and procedure had been reviewed and updated.

• Detailed records to enable analysis of complaints had been developed and implemented. The practice provided minutes of a meeting where trends over a 12 month period had been discussed, areas for improvement had been identified and action to improve had been agreed.

Area where the provider should make improvement are:

• Maintain records of immunisation status for all staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 5 October 2016

The practice is rated as outstanding 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.

• Performance for diabetes related indicators was 100% which was 3% above the CCG average and 11% above the national average. The practice had two GPs and two nurses who were trained and provided specialist care for patients with diabetes. The practice held quarterly meetings related to the care of patients with diabetes.

• The practice had also scored 100% in all other indicators related to 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 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 reviewed the effectiveness of their recall system for patients with long-term conditions. They had reviewed the needs of patients and developed a detailed protocol which identified the different types of appointments patients should have depending on their needs. This enabled the patients to have all tests on the same day and the appropriate length of appointment with their GP. This was further enhanced by writing to patients on different coloured paper depending on their needs so staff could easily identify which appointment the patient required when the patient contacted the practice.

Updated 5 October 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.

• The practice held weekly “Think Family” meetings where any concerns about children or families were discussed. The practice had developed a tool kit to assist them to identify possible concerns with triggers such as attendances at accident and emergency, and out of hours services and wider family issues. The GPs attended safeguarding meetings when possible and always provided reports where necessary for other agencies. The practice had developed a detailed template to assist them to provide the relevant information for these reports.

• Immunisation rates were comparable to local and national rates 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.

• The practice’s uptake for the cervical screening programme was 83%, which was comparable to the CCG and 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.

• The practice hosted counselling services for young people.

Updated 5 October 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.

Updated 5 October 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 offered early morning appointments three mornings per week.

• 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.

Updated 5 October 2016

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

• 86% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

• Performance for mental health related indicators was 100% which was 5% higher than the CCG average and 7% above the national average.

• 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.

• The practice hosted counselling services for patients including separate services for young people.

• 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 5 October 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 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 held weekly “Think Family” meetings where any concerns about children or families were discussed. The practice had developed a tool kit to assist them to identify possible for concerns with triggers such as attendances at accident and emergency, and out of hours services and family issues.