Archived: Cross Hall Surgery

Updated 15 March 2018

The practice operates from one site in Bromley. It is one of 53 GP practices in the Bromley Clinical Commissioning Group (CCG) area. There are approximately 3300 patients registered at the practice. The practice had been taken over by the provider Living Care Medical Services Limited in January 2017. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder or injury, family planning, maternity and midwifery and surgical procedures.

The practice has an alternative provider medical services (APMS) contract with the NHS and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include extended hours access, facilitating timely diagnosis and support for people with dementia, influenza and pneumococcal immunisations, learning disabilities, patient participation, rotavirus and shingles immunisation and unplanned admissions.

The practice has a higher than average population of female patients aged from birth to 19 years and 30 to 39 years, and male patients aged from birth to 14 years and from 20 to 39 years. It has an above national average income deprivation affecting children and adults.

The clinical team includes one male and one female long term locum GP. The GPs work a combined total of 10 sessions per week. There is a female nurse practitioner, a female salaried practice nurse. The clinical team is supported by a practice manager, three receptionists and a prescription clerk.

The practice is currently open between 8am and 6.30pm Monday to Friday. It offers extended hours from 9am to 1pm one Saturday a month. Appointments are available from 9am to 1pm and from 3pm to 6.30pm Monday to Friday. There are two treatment/consulting rooms on the ground floor.

There is wheelchair access and baby changing facilities.

The practice has opted out of providing out-of-hours (OOH) services and directs patients needing care outside of normal hours to the local out of hours provision through the national 111 service.

Updated 15 March 2018

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Cross Hall Surgery on 17 May 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the 17 May 2017 inspection can be found by selecting the ‘all reports’ link for Cross Hall Surgery on our website at www.cqc.org.uk.

This inspection was a comprehensive inspection carried out on 16 January 2018 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 17 May 2017. 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 had effective systems and processes to make sure they assessed and monitored the service provided. There was an effective system in place for monitoring pathology results and ensuring Docman (a patient management system) were cleared daily.

• Staff were following National Institute for Health and Care Excellence(NICE) guidelines.

• The urgent referral policy had been reviewed since the last inspection and staff were following the new process.

• Patients’ outcomes had been monitored and improved, as full cycle audits had been undertaken since the last inspection.

• The practice had changed their process for processing two week urgent referrals to make it effective.

• The practice had reviewed temperature monitoring of their vaccine refrigerator to ensure they were in line with current guidance, they were using a second thermometer and were keeping daily logs.

• Nurse appointments had been reviewed and were flexible for patients.

• There was appropriate supervision and mentoring for the practice nurse.

• The provider had recruited a permanent lead GP, and lead nurse that worked across all Living Care Medical Services Limited locations. They had also recruited a healthcare assistant since the last inspection.

• The practice had reviewed, assessed and monitored staff training, records for cleaning equipment and labelling sharp bins.All staff members were up to date with role specific training.

• Governance arrangements operated effectively.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

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

The provider should:

• Review logging verbal complaints.

• Review how appointments for Saturdays are advertised.

• Review the need for a palliative care register and conducting multidisciplinary team meetings.

• Review accessibility for patients with hearing impairment.

• Review the arrangements for treating emergencies following a risk assessment.

• Review patient survey results relating to consultations with GPs.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 15 March 2018

Updated 15 March 2018

Updated 15 March 2018

Updated 15 March 2018

Updated 15 March 2018

Updated 15 March 2018