Archived: Crawley Down Health Centre

Updated 6 April 2017

Crawley Down Health Centre is located in a residential area of Crawley Down and provides primary medical services and a dispensing service to approximately 8,100 patients.

The practice also provides care and treatment for the residents of a nearby care home, which serves individuals with dementia or nursing needs.

There are two GP partners and four salaried GPs (three male, three female). Collectively they cover 43 sessions. The practice is registered as a GP training practice, supporting medical students and providing training opportunities for doctors seeking to become fully qualified GPs.

There are five female members of the nursing team; three practice nurses and two health care assistants. GPs and nurses are supported by the practice manager, a deputy practice manager, and a team of reception/administration staff. The dispensary service had a dispensary manager and three staff members.

Data available to the Care Quality Commission (CQC) shows the practice serves a higher than average number of patients who are aged over 65 when compared to the national average. The number of patients under 4 years of age is slightly below the national average. The number of registered patients suffering income deprivation is below the national average.

The practice is open from 8am to 1:00pm and 2:00pm to 6:30pm Monday to Friday. An emergency telephone service is provided between 1pm and 2pm. Extended hours appointments are offered Monday and Thursday mornings from 7.40am to 8.30am and Saturday mornings 9am to 12pm.

Appointments can be booked over the telephone, online or in person at the surgery. Patients are provided information on how to access an out of hour’s service by calling the surgery or viewing the practice website.

The practice runs a number of services for its patients including; family planning, minor surgery, health checks, smoking cessation, and travel vaccines (including yellow fever).

The practice has a General Medical Services (GMS) contract with NHS England. (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice is part of the NHS Horsham and Mid Sussex Clinical Commissioning Group.

Updated 6 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crawley Down Health Centre on 12 April 2016. During this inspection we found breaches of legal requirement and the provider was rated as requires improvement under the safe domain. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Crawley Down Health Centre on our website at www.cqc.org.uk. The practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that all significant events are fully recorded centrally at the practice to enable the on-going monitoring of trends and to ensure actions have been completed.

• Ensuring the practice maintains robust medicines management processes following national guidance, to include the correct storage of medicines.

• Ensuring that access to controlled drugs is restricted and improve the security arrangements for their storage.

• Ensuring risk assessments are completed including for fire and legionella, and that recommended actions are completed as appropriate.

• Ensuring that local and national performance indicators are monitored and that shortfalls are addressed, particularly for people experiencing poor mental health, to improve patient care and treatment.

Additionally we found that:

• The practice needed to ensure that all lessons learnt from complaints are communicated to the appropriate staff to support improvement at all levels.

• The practice needed to carry out an on-going audit programme to show that continuous improvements have been made to patient care in a range of clinical areas as a result of clinical audit.

• The practice needed to continue to improve the pathways for the obtaining and dissemination of relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines.

• The practice needed to ensure patients who are carers and who are cared for are pro-actively identified and supported.

This inspection was an announced focused inspection carried out on 14 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 12 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection..

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice was now maintaining a central log recording all significant events. These were discussed at clinical meetings and the minutes of these were disseminated to all appropriate staff.

• The practice now restricted access to controlled drugs (medicines that require extra checks and special storage because of their potential misuse) and increased their security arrangements.

• The practice had ensured that medicines were stored between the required temperature range of 2 to 8 degrees centigrade.

• Risk assessments had been undertaken for fire safety and legionella as required and had their recommendations acted upon.

• The practice had monitored the local and national performance indicators and evidence was seen of improvements. For example the percentage of patients, using data from 2014/15, diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months was 28%, which was worse than the national average of 84%. However, data from 2015/16 showed that this had risen to 93% which was better than both the local Clinical Commissioning Group (CCG) average of 85% and the national average of 84%.

• The practice discussed complaints at meetings which were minuted and subsequently disseminated to all staff.

• The practice was in the process of undertaking an audit in relation to the management of osteoporosis.

• The practice had a system in place that monitored evidence based guidance and standards and informed appropriate staff of any changes in guidelines.

• The practice had increased the number of carers recognised on their patient list from 24 carers to 86 carers, an increase of over 200%.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 August 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 percentage of patients with diabetes who had a record of a foot examination and risk classification within the preceding 12 months was 90% compared with a national average of 88%.
• 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 offered a range of services to people with long term conditions. This included clinics for diabetes, asthma and hypertension.

Updated 8 August 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.
• Immunisation rates were relatively high for all standard childhood immunisations. The practice had a policy to notify the child health services if a child repeatedly missed their immunisation appointment.
• 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.
• 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, health visitors and school nurses.

Updated 8 August 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 over 75 had a named accountable GP.

Updated 8 August 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 a full range of health promotion and screening that reflects the needs for this age group.
• The practice was proactive in offering online services including booking/cancelling appointments and an electronic repeat prescription service.

Updated 8 August 2016

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

• Data from the Quality and Outcomes Framework (QOF) showed results were considerably worse than national averages for this population group. For example the percentage of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months was 28%, which was worse than the national average of 84%. The exception reporting was below the national average (5% compared to the national average 8%). However we have seen evidence that the results have significantly improved to above averages in all areas of mental health for 2015/16.
• 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 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 8 August 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.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• Appointments were offered to patients with no fixed address. Staff told us that they would support those patients by registering them with a temporary address.

• 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.