Crosland Moor Surgery

Updated 22 June 2017

Crosland Moor Surgery, 11 Park Rd West, Crosland Moor, Huddersfield, HD4 5RX provides services for 4136 patients. The surgery is situated within the Greater Huddersfield Clinical Commissioning Group and provides primary medical services under the terms of a personal medical services (PMS) contract. The area is more deprived than average and the population is mainly White British. There are a small number of Black African-Caribbean or South Asian ethnicity patients. There are several asylum seekers and families with refugee status being supported by the provider.

Crosland Moor surgery is registered as a single handed practice managed by Dr Chandrakala Sodagam Rao. Dr Rao has recently taken on a partner and we have advised the practice to make the necessary application to us to reflect this change without delay.

Services are provided within a purpose built and accessible building. The premises are currently leased from NHS Property Services. There are two full time GPs (male and female) and two regular locum GPs offering two further sessions each week. The provider employs two part time practice nurses who work a combined total of 46 hours a week. The practice has a practice manager and five part time reception staff. The practice employs a cleaner who attends daily.

The practice is open Monday to Friday from 8.30am to 6pm. The practice closes for lunch each day between 12.30-1.30pm however urgent calls can be made to practice staff during this time. Out of hours treatment is provided by Local Care Direct.

Updated 22 June 2017

Letter from the Chief Inspector of General Practice

This inspection was an announced comprehensive inspection that took place on 26 April 2017 and reviewed the provision of safe, effective, caring, responsive and well led services. We also reviewed evidence to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulation that we identified in our previous inspection on 29 June 2016. On that occasion, we rated the practice as good for providing effective, caring and responsive services. However, a breach of the legal requirements was found which resulted in the practice being rated as requires improvement for providing safe and well led services. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Crosland Moor Surgery on our website at www.cqc.org.uk.

The practice had made the required improvements to meet the legal requirements in the key question of safe and well led and is rated as good in all of the service areas we inspected.

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.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. However, some patients told us that it was sometimes more difficult to book a routine appointment in advance.
• The practice had good facilities and was well equipped, to treat patients and meet their needs. The building was accessible and a hearing loop was available for patients that would benefit from this.
• There was a clear and visible 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.

The area where the provider should make improvement is:

• Review the level of exception reporting in the area of cervical screening to be assured that eligible women are being encouraged to attend for screening.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 22 June 2017

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.

• 84% of diabetic patients on the register had achieved a blood sugar result of 59 mmol or less in the preceding 12 months. This demonstrated that their diabetes was being well controlled. This was 13% higher than the local average and 14% higher than the national average. In addition, 96% of diabetic patients had received a foot examination to check for nerve or skin damage associated with their condition. This was 10% higher than the local average and 7% higher than the national average.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and were offered 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.

Updated 22 June 2017

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 accident and emergency (A&E) attendances. Immunisation rates were in line with or higher than local and national averages.

• 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.

• The practice’s uptake for the cervical screening programme was 93%, which was 8% higher than the CCG average of 85% and 12% higher than the national average of 81%. However, the clinical exception rate for screening was 20%, which was higher than the local and national average of 7%. Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.

• A full range of contraceptive services including implants and coils was provided by a female GP at the practice.

• 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.

Updated 22 June 2017

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.
• The practice identified older patients on multiple medications and reviewed their needs with the community pharmacy team.
• The practice worked closely with the Community Matron and hospital discharge coordinator to support older patients.

Updated 22 June 2017

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. Telephone appointments and morning appointments from 8.30am were available.

• The practice was proactive in offering online services such as appointment booking and medication requests as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 22 June 2017

• 78% of eligible patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was 6% lower than the national average

• 97% of patients experiencing a serious mental illness had an up to date care plan. This was 9% higher than 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.

• Patients with mental health issues were actively supported with same day appointments for patients in need.

• 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. This included telephoning and/or texting patients to remind them of upcoming appointments.

Updated 22 June 2017

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 people experiencing homelessness or temporary living arrangements and 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.