Archived: Crosby Village Surgery

Updated 29 October 2015

Crosby Village Surgery is registered with the Care Quality Commission to provide primary care services. The practice holds an Alternative Provider Medical Services (APMS) contract and is located close to the centre of Crosby in Liverpool. The practice is managed by SSP Health Ltd a

corporate provider which has a number of GP practices across the North West of England. The practice provided GP services for approximately 2991 patients living in the Sefton area. The practice is run with one regular GP working two days per week and a mix of locum and agency GPs covering the rest of the week. They have a practice manager, one nurse practitioner and practice nurse, one health care assistant, administration and reception staff.

The practice opening hours are Monday to Friday from 8am to 6pm with extended hours on some days to accommodate working patients. The practice treats patients of all ages and provides a range of primary medical services and is part of the Sefton Clinical Commissioning Group (CCG). The practice population has a higher than national average patient group aged 65 years and over. There are lower deprivation scores for patients in this area compared to national figures.

Updated 29 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crosby Village Surgery on 12 August 2015. Overall the practice is rated as Requires Improvement.

Specifically, we found the practice to be requires improvement for safety and well led and for the population groups it serves. They were rated as good for providing effective, caring and responsive services.

Our key findings across all the areas we inspected were as follows:

• Systems were not in place to ensure incidents and significant events were identified, investigated and reported for all cases that had occurred.
• Patients’ needs were assessed and care was planned and delivered in line with best practice guidance. Staff had received training appropriate for their roles and any further training needs had been identified and planned.
• Patients spoke highly about the practice and its staff. They said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Patients also reported their concerns for the high use of locum and agency GPs.
• Information about services and how to complain was available and easy to understand.
• There was a clear leadership structure and staff felt supported by management. However, the new role of clinical lead GP was not supported with a written job description which includes the practice priorities.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that serious and adverse patient incidents are reported, investigated and appropriate actions taken. They should be monitored to ensure that action is taken swiftly to ensure improvements are made as a result of a serious event analysis process. All relevant staff should be notified of the incidents that occur to promote learning and to reduce further harm to patients.

In addition the provider should:

• Ensure that the role of clinical lead GP is supported with a written job description which includes the practice prioritises.
• Improve the systems in place for monitoring medicines, including their storage and expiry dates.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 October 2015

There were aspects of care and treatment that required improvement that related to all population groups. 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 structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice monitored unplanned admissions to hospital for patients with long term conditions and those assessed as at risk of hospital admission. Any patients admitted to hospital were contacted within one week to assess if they require additional primary care support services.

Updated 29 October 2015

There were aspects of care and treatment that required improvement that related to all population groups.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 higher than the CCG average for most of the standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. The practice undertakes a joint six week child assessment including the administration of childhood vaccines. Patient information sign posted young people to sexual health services in the area. The practice had a lead for safeguarding children and practice staff had protected time to undertake an extended role to monitor those vulnerable children at risk.

Updated 29 October 2015

There were aspects of care and treatment that required improvement that related to all population groups. Nationally reported data showed that outcomes for patients were good for conditions commonly experienced by older people. The practice undertook patient record searches of older people, including identifying those patients who lived alone, who had caring responsibilities and who had been seen in the last 12 months. Older patients with chronic, complex medical conditions and social needs had their own community matron assigned to them, undertaking home visits as required. As part of their contract the practice had a Dementia Enhanced Service offering health and dementia screening to older patients. The practice offered proactive, personalised care to meet the needs of the older people in its population. It was responsive to the needs of older people, offering flu vaccination and home visits if needed.

Updated 29 October 2015

There were aspects of care and treatment that required improvement that related to all population groups. 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 offers a range of appointment times for working people including late night evening appointments for GPs and nurses. The practice was proactive in offering online and telephone services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 29 October 2015

There were aspects of care and treatment that required improvement that related to all population groups. Systems were in place to ensure people experiencing poor mental health had received an annual physical health check. This included identifying those patients on the practice register that may benefit from a dementia needs review. The practice had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia. The practice offered a full mental health support service for patients in partnership with neighbouring mental health trusts. Patients can self-refer for counselling for anxiety, stress and depression. A number of patient information leaflets and posters were available in the waiting area, sign posting patients to agencies that could provide support to the patient or their families.

Updated 29 October 2015

There were aspects of care and treatment that required improvement that related to all population groups. The practice held a register of patients living in vulnerable circumstances and annual health checks were carried out for this population group. Staff were knowledgeable about how to support patients with alcohol and drug addictions sign posting them to support services locally. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. 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. The practice offered annual reviews to all patients with learning disabilities. Patients in nursing homes or who were housebound were offered a home visit for full review.