Crown Medical Centre

Updated 23 June 2016

Crown Medical Centre is located close to the centre of Taunton. The practice serves a local and rural population of approximately 9400 patients from Taunton and the surrounding villages. The practice was purpose built in 2002, has parking on site including spaces for patients with a disability. The practice has a number of rooms which it makes available to other services, these include; a dietician, a counsellor, a physiotherapist as well as a chiropractor. The Somerset Local Medical Council is located on the premises as well as a pharmacy.

Crown Medical Centre has eight GPs, seven of whom are partners. Between them they provide 40 GP sessions each week and are equivalent to five whole time employees. Six GPs are female and two are male. There are three practice nurses including two non-medical prescribers whose working hours are equivalent to 2.37 whole time employees (WTE). A health care assistant and phlebotomist are also employed by the practice with combined hours of 1.36 WTE. The GPs and nurses are supported by 11 management and administrative staff including a practice manager and operations assistant.

The practices patient population is expanding and has slightly more patients between the age of 40 and 64 years than the national average. Approximately 2.3% of the patients are over the age of 85 years compared to a national average of 2.2%. Approximately 53% of patients have a long standing health condition compared to a national average of 54% which can result in a higher demand for GP and nurse appointments. These figures indicate there may well be competing demands for GP appointments however patient satisfaction scores are high with over 92.9% of patients describing their overall experience at the practice as good.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the fourth least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). Average male and female life expectancy for the area is the same as the national average of 79 and 83 years respectively and one year less than the Clinical Commissioning Group average.

The practice is open between 8am and 6:30pm Monday to Friday. Appointments are available from 8:30am and emergency telephone access is available from 8am. The practice operates a mixed appointment system with some appointments available to pre-book and others available to book on the day. GP appointments are 15 minutes each in length and appointment sessions are typically 8:30am to 11:30am and 3pm to 6pm. Each consultation session has 12 appointment slots. The practice offers online booking facilities for non-urgent appointments and an online repeat prescription service. Patients need to contact the practice first to arrange for access to these services.

The practice has a General Medical Services (GMS) contract to deliver health care services; the contract includes enhanced services such as childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor surgery services. An influenza and pneumococcal immunisations enhanced service is also provided. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

The practice has opted out of providing out-of-hours services to their own patients. Patients are directed to this service by the practice outside of normal practice hours or via NHS 111.

Updated 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 17 December 2015. During this inspection an overall rating of good was made, with the effective, caring, responsive and well led areas all being rating as good. However, a breach of Regulation 12 of The Health and Social Care Act (Regulated Activities) Act 2014 was found. This related to the safe delivery of services.

The practice required improvement for the provision of safe services to ensure all Patient Group Directions and Patient Specific Directions are appropriately authorised before vaccines were administered to patients. In addition we also recommended the practice should consider improvements in some other areas to improve the safe delivery of services.

After the comprehensive inspection, the practice sent us their action plan and recorded within this what they would do to meet legal requirements in relation to the Regulation 12 breach.

We undertook a desk-based focused inspection on 07 April 2016 to check that the practice had followed their action plan and to confirm that they now met legal requirements. We did not visit the practice.

We found the practice was meeting the regulation that had previously been breached in relation to safe care and treatment. The practice provided evidence to us that Patient Group Directions and Patient Specific Directions were authorised and signed by the authorising clinicians before vaccines were administered to patients.

During our previous inspection we recommended the practice should consider additional improvement and these had been improved as follows:

• The recruitment policy had been reviewed so relevant checks are now carried out and this was now recorded in staff records.
• The contract arrangements with the cleaning contractor had been reviewed and action taken, including increasing cleaning hours and more thorough cleaning.
• The complaint procedure had been amended so all patients received a satisfactory response, to both verbal and written concerns, in line with good practice.
• Governance arrangements had been reviewed and lead roles confirmed to ensure all checks, audits, complaints, significant events, policies and day to day management of the practice were carried out, reviewed and the information from these informed improvements in service quality and staff development.
• The clinical leadership of the nursing team had been reviewed and a GP confirmed to the staff as clinical lead. Their role was to provide support and guidance on clinical issues.

We have amended the rating for this practice to reflect these changes. The practice is now rated as good for the provision of safe services.

This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Crown Medical Centre on our website at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 January 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.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that 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 hosted a ‘wellbeing worker’ who worked with patients with long term conditions to identify the most effective ways of supporting them.
• The practice nurses carried out home visits for patients who were housebound with long term conditions, these visits were for checks on their conditions and included the administration of flu vaccinations.

Updated 28 January 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.
• 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 rates for the practice (80.49%) were comparable to the national average (81.83%).
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Families were registered with the same GP to aid continuity of patient care and increase awareness of wider family issues.
• We saw good examples of joint working with midwives, health visitors and school nurses.
• Through support, education and advice one of the nurses helped an isolated and withdrawn young patient lose a considerable amount of weight. Through the weight loss they had gained confidence, had become less withdrawn and had started to look for a job.
• The practices immunisation clinics had two trained nurses to ensure the process was safe (and as comfortable as possible) for patients. If patients did not attend immunisation appointments there was a system for chasing up these patients and alerting other professionals that they had not attended.

Updated 28 January 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.
• All older patients over the age of 75 years had a named GP, the reception team booked patients with the same GP even when presenting with an urgent problem.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Telephone consultations were offered to frail older patients who were unable to get to the practice to see to see their GP. Their usual GP was able to triage the call and decide the best way to support the patient.

Updated 28 January 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.
• Telephone appointments were available for working age patients and students to enable them to discuss their condition with their GP. As a result of the conversation the GP would book a face to face appointment with the patient if required.
• The nursing team had reviewed their working hours to identify ways to see patients earlier in the morning for blood tests, before patients went to work or school as well as during the lunchtime period.

Updated 28 January 2016

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

• Approximately 75% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
• 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 and provided access to training for its staff to improve care planning.
• 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 people with mental health needs and dementia.

Updated 28 January 2016

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

• The practice held registers of patients living in vulnerable circumstances including homeless people and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability where this was needed.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice 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.
• Patients with learning disabilities were invited to the practice for an annual health check. Where patients had complex needs these checks were done at the patients home.