Archived: Crossways Practice

Updated 6 August 2015

Crossways Practice is located in a residential area of Crosby, Merseyside. There were 2674 patients registered at the practice at the time of our inspection on 19 May 2015.

The practice has one female salaried GP, a Healthcare Assistant, and reception and administration staff. The practice also employs locum GPs and agency practice nurses. The practice had recruited a permanent nurse and a GP since our inspection in February 2015. The practice is in the process of recruiting a practice manager.

The practice is open 8.00am to 6.30pm Monday to Friday. The practice does not offer extended hours opening. Patients requiring a GP appointment outside of normal working hours are advised to contact an external out of hours service provider (Urgent Care 24). Crossways Practice is an Alternative Provider Medical Services general practice (APMS).

We previously undertook a focused inspection in February 2015 in response to concerns we received. We issued three Requirement Notices as a result of our findings and requested an action plan. Requirement Notices were issued in relation to: governance (Regulation 17); supporting staff (Regulation 18); and failing to notify us of a police incident (Regulation 18 (CQC Registration Regulations 2009).

A comprehensive inspection was then undertaken on 19 May 2015 when we could see that some improvements had been made. At the 19 May inspection the practice had not reached the final date for compliance against their action plan from the February inspection we therefore carried out a further visit on 3 July 2016 to ensure the provider had met the Requirement Notices from February 2015.

Updated 6 August 2015

Letter from the Chief Inspector of General Practice

This is the report from our announced comprehensive inspection of Crossways Practice on the 19 May and 3 July 2015.

We previously undertook a focused inspection at the practice in February 2015 in response to an issue of concern. We issued three Requirement Notices as a result of our findings and requested an action plan. A comprehensive inspection was then undertaken on 19 May 2015 when we could see that some improvements had been made. At the 19 May inspection the practice had not reached the final date for compliance against their action plan from the February inspection. We therefore carried out a further visit on 3 July 2016 to ensure the provider had met the Requirement Notices from February 2015. We are therefore reporting on both inspections within this one report.

Overall the practice is rated as good.

Our key findings were as follows:

• The provider had met the Requirement Notices and made improvements in quality assurance processes and supporting staff.

• Following a period of instability in staffing arrangements, the practice had recruited a permanent nurse and a GP who started work in June 2015. The practice was in the process of recruiting a practice manager.

• There were systems in place to mitigate safety risks including analysing significant events and safeguarding. Systems were in place to ensure medication including vaccines were appropriately stored and in date. The practice used a pharmacy advisor to ensure the practice was prescribing in line with current guidelines.

• A Local Medical Director had been recently appointed to oversee the clinical governance of the practice and was proactively encouraging the use of clinical audits to ensure patients received treatment in line with best practice standards.

• Patients had their needs assessed in line with current guidance and the practice had a holistic approach to patient care.

• Feedback from patients and observations throughout our inspection highlighted the staff were kind, caring and helpful.

• The practice was responsive and acted on patient written formal complaints.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Carry out a risk assessment to ascertain the need for a defibrillator for the practice.
• Consider staff feedback, and then communicate to staff what actions will be taken and when, to address concerns raised.
• Formulate a maintenance plan to improve the overall décor and fixtures and fittings within the practice identified in the external risk assessment carried out in March 2014.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 August 2015

The practice continuously contacted these patients to attend annual reviews to check that their health and medication needs were being met. The practice had adopted a holistic approach to patient care rather than making separate appointments for each medical condition. The practice offered appointments up to 45 minutes to ensure patients with multiple needs were seen.

Updated 6 August 2015

One GP was the safeguarding lead for the practice. There were systems in place to identify and follow up children living in disadvantaged circumstances.

The midwife visited the practice once a week and there were immunisation clinics. The practice had an ‘early years’ fact sheet to provide information for example on immunisations. The practice had developed an ‘Access for Children’ policy to ensure that all children under five could be seen on the same day if required.

Updated 6 August 2015

The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, the avoidance of unplanned admissions scheme. All patients who were identified on this service had completed care plans in place. The practice had a designated named GP for patients who are 75 and over. The practice carried out home visits and also visited care homes in the area.

Updated 6 August 2015

The needs of this group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example the practice offered telephone consultations instead of patients having to attend the practice. The practice offered online prescription ordering and online appointment services.

Updated 6 August 2015

The practice referred patients to the appropriate services. The practice maintained a register of patients with mental health problems in order to regularly review their needs or care plans.

Mental Capacity Act training was available to all staff and SSP Health Ltd had also disseminated information regarding Deprivation of Liberty Safeguards to all its practices.

Updated 6 August 2015

A benefit of being a small practice was that staff knew patients and their families well and arranged appointments to suit patients’ needs. The practice used a system of placing alerts on patients’ records to highlight if they were carers. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.