Crouch Oak Family Practice Also known as The Crouch Oak Family Practice

Updated 27 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Crouch Oak Family Practice on 6 October 2015. Breaches of legal requirements were found during that inspection within the safe and well-led domains. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:

• Recruitment information being available for each person employed. This included completing Disclosure and Barring Service (DBS) checks for staff whose roles required them to have one, proof of identity and references.
• The on-going development and implementation of systems and processes in place for effective governance including assessing, monitoring, and driving improvement in the quality and safety of the services provided, as well as mitigating any risk.
• Ensure assessments for legionella and gas safety had taken place.

We undertook this focused inspection on 18 May 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and was rated as Good under the safe and well-led domains. This report only covers our findings in relation to those requirements.

• Recruitment files contained the required information which included evidence of Disclosure and Barring Service (DBS) checks for those staff who needed them, proof of identity and references.

Systems and processes were in place for effective governance. Including:

• staff recruitment files staffing levels and staffing structure
• development of a new employee handbook and new contracts for staff
• induction checklists and appraisal systems
• training requirements for staff and implementing new e-learning modules

Evidence was seen for building safety assessments including legionella, fire, electrical and gas safety.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 June 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 medicine needs were being met. For those people 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 trained nurses in diabetes and asthma care. It also ran dedicated respiratory clinics and diabetes clinics; with more complex patients having access to the Community Diabetic Nurse. The practice could provide in-house spirometry (this is a lung function test that can help diagnose various lung conditions, for example chronic obstructive pulmonary disease). The practice could also provide 24 hour BP monitoring for patients with conditions such as hypertension.

Updated 27 June 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 monthly meetings with health visitors to discuss vulnerable families. Immunisation rates were good 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. Appointments were available outside of school hours and the premises were suitable for children and babies. There was a practice policy to offer on the day urgent appointments for children. The practice had designated GPs who lead in sexual health and family planning, who could offer a wide range of services.

Updated 27 June 2016

The practice is rated as good for the care of older people.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered continuity of care with a named GP. Elderly patients with complex care needs and those at risk of hospital admission all had personalised care plans that were shared with local organisations to facilitate the continuity of care. For example, dementia and end of life care. It was responsive to the needs of older people, and could offer daily visits to elderly housebound patients where necessary and rapid access appointments for those with enhanced needs. The practice looked after three care homes and provided a named GP who conducted weekly visits to ensure continuity of care. We saw evidence the practice was working to the Gold Standards Framework for those patients with end of life care needs. The practice participated in the Dementia Enhanced Service that facilitates diagnosis and support for patients with dementia.

Updated 27 June 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

T he 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 ran a late evening surgery from 6:30pm to 8pm on a Tuesday and a Saturday clinic from 9am to 12pm. The practice was proactive in offering online services. For example, on line booking of appointments and Electronic Prescribing. This enabled patients to order their medicine on line and to collect it from a pharmacy of their choice, which could be closer to their place of work if required. There was a full range of health promotion and screening that reflected the needs for this age group. GPs and nurses offered advice by telephone each day for those patients who had difficulty in attending the practice. Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years.

Updated 27 June 2016

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

Patients with severe mental health needs had care plans and received annual physical health checks. The practice offered continuity of care with a named GP for this population group and had a GP who was the Mental Health Lead. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations, and liaised closely with the Community Health Team in relation to the availability of counselling services. A consultant psychiatrist visited the practice on a weekly basis which patients could be referred to, and the practice worked closely with the psychiatrist and the community pharmacist for advice on individual medicine regimes.

Updated 27 June 2016

The practice is rated as requires 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 continuity of care with a named GP for this population group. It offered longer appointments and carried out annual health checks for people with a learning disability. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients how to access various support groups and voluntary organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children and had a safeguarding team who worked closely with social services. 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.