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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crawley Down Health Centre on 12 April 2016. Overall the practice is rated as good.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was an open and transparent approach to safety and an effective system in place for reporting significant events, although we found the recording processes could be improved.
• 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.

• The practice building was purpose built and they had contributed to the design with patients at the heart of their planning.

• 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 and there was continuity of care, with urgent appointments available the same day. The patients we spoke with on the day of the inspection who told us they were happy with the care and treatment they received.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and almost all staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• The patient participation group was active and had made a number of improvements to the practice and ensured regular communication with the patients.

• The provider was aware of and complied with the requirements of the duty of candour.
• Most risks to patients were assessed and well managed. However, some systems and processes to address risks were not implemented well enough to ensure patients and staff were kept safe. This included the storage and disposal of medicines and the completion of risk assessments.

The areas where the provider must make improvements are:

• Ensure 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

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

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

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

• Ensure 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.

In addition the provider should:

• Ensure that all lessons learnt from complaints are communicated to the appropriate staff to support improvement at all levels.

• 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.
• 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.
• Ensure patients who are carers and who are cared for are pro-actively identified and supported.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice