Archived: Crankhall Lane Medical Centre

Updated 13 December 2018

Crankhall Lane Medical Practice is located in Wednesbury an area of the West Midlands. The surgery has good transport links and a local pharmacy is located nearby. The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury.

Crankhall Lane Medical Centre is situated within Sandwell & West Birmingham Clinical Commissioning Group (CCG) and provides services to 3,700 patients under the terms of a general medical services (GMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

The provider is a single handed female, the current registration of a partnership was registered with the CQC in February 2017. The provider’s current registration status is in the process of being changed from a partnership to a single handed provider due to the loss of one of the partners in June 2018. The practice employed two regular male locum GPs, a health care assistant and a number of administration staff. The practice is part of a wider network of GP practices.

The National General Practice Profile states that 84% of the practice population is from a white background with a further 9% of the population originating from Asian background. Information published by Public Health England, rates the level of deprivation within the practice population group as one, on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male life expectancy is 76 years compared to the national average of 79 years. Female life expectancy is 81 years compared to the national average of 83 years.

Crankhall Lane Medical Centre is open between 8am and 6.30pm Monday to Friday. Extended hours appointments are available to all patients at additional locations within the area as the practice is a member of a GP federation: Monday to Friday 6.30pm until 8pm and on Saturday and Sunday 10am until 1pm. Additional out of hours care is accessed by calling the NHS 111 service.

Updated 13 December 2018

We carried out an announced focused inspection at Crankhall Lane Medical Centre on 7 November 2018 to confirm that the practice had carried out their plan to meet the

legal requirements in relation to the breaches in regulations we identified in our previous inspection in October 2017 where breaches of the Health and Social Care Act 2008 were identified. You can read the report from our last comprehensive inspection on 18 October 2017; by selecting the ‘all reports’ link for Crankhall Medical Centre on our website at . This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Our inspection team was led by a CQC inspector and included a GP specialist advisor.

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information from the provider, patients, the public and other organisations.

I have rated this practice as good overall.

This means that:

• People were protected from avoidable harm and abuse and legal requirements were met.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• Data from the 2017/18 Quality and Outcomes Framework (QOF) showed patient outcomes for diabetes had improved and were in line with local and national averages.
• The practice continued to be below the national average for cervical screening, but had systems in place to encourage patients to attend screening.
• The practice had reviewed the 2018 national patient survey and had discussed this with the patient participation group, that had started to meet again since the previous inspection.
• Following our previous inspection, the practice had reviewed the supervision of clinical staff to ensure they had the appropriate support in the management of patients with long term conditions.
• People’s needs were met by the way in which services were organised and delivered.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care, this included a review of the practice business plan to review the vision and values and drive forward the changes the practice had recently implemented.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 5 December 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance rates for the diabetes related indicators were lower than local and national averages. For example, the practice had achieved 68% of the total points available for patients with diabetes, compared with the CCG average of 88% and national average of 90%. The practice was aware of this and working to make improvements.
• The practice hosted a specialist diabetes clinic with a secondary care consultant and one of the regular locum GPs had attended training and also sat in this clinic. The nurse had attended training in insulin initiation.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• Longer appointments and home visits were available when needed.
• Multidisciplinary meetings were held to discuss those patients with the most complex needs and to ensure their needs were met.

Updated 5 December 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• The practice was able to demonstrate that immunisation rates were relatively high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice held regular meetings with health visitors where they discussed any safeguarding concerns.
• The practice’s uptake for the cervical screening programme was 66%, which was lower than the CCG average of 80% and national average of 82%. However, the practice had reported lower exceptions of 2%, when compared with the CCG average of 9% and national average 7%, meaning more patients had been included. There was an effective system in place for recording, monitoring and chasing up of cervical screening results. The practice was aware of the low achievement and was proactive in encouraging patients to attend their screening.

Updated 5 December 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• Patients had access to telephone appointments with the GP if requested.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 5 December 2017

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

• 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 needs of these populations 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, extended opening was available from 6.30pm to 7pm on Wednesdays, Thursdays and Fridays. Saturday and Sunday access was available through hub working arrangements (although there were currently some ongoing IT issues affecting access).
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 5 December 2017

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 73% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was lower than the local CCG average and the national average of 84% (2015/16 QOF data).
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 5 December 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice provided carer support, sign posting, information packs, completed a carers register, and displayed information on their notice board.
• The practice offered longer appointments for patients with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 extended opening hours between 6.30pm and 7pm on Wednesdays, Thursdays and Fridays which was useful for this group of patients.