The Crouch Hall Road Surgery

Updated 25 April 2016

The Crouch Hall Road Surgery operates from 48 Crouch Hall Road, Hornsey, London N8 8HJ. The premises were converted from domestic use.

The practice provides NHS services through a Personal Medical Services (PMS) contract to 7,132 patients. It is part of the NHS Haringey Clinical Commissioning Group (CCG) which is made up of 45 general practices. The practice is registered with the CQC to carry out the following regulated activities - diagnostic and screening procedures, family planning, maternity and midwifery services, treatment of disease, disorder or injury, surgical procedures.

The patient profile for the CCG has a higher number of working age adults than the national average, with fewer older patients and younger people aged under-19.

The practice has a staff of six doctors, comprised of two GP partners (female and male) and four salaried GPs (three female, one male). The GPs cover 35 clinical sessions per week; the partners working seven clinical sessions each, with the remainder divided roughly equally between the salaried GPs. The partners also worked two administrative sessions each per week. The clinical team is completed by two female nurses (one working up to 34 hours a week, the other 17 hours) and a female health care assistant. Two staff members share the practice manager role and the support team is made up of seven administrative staff. It is a training practice, with GP registrars working there from time to time, although none were attached at the time of the inspection.

The practice’s opening hours are 8.00am to 6.30pm, Monday to Friday. It operates extended hours on Monday evening, from 6.30pm to 8.00pm; on Tuesday to Thursday evenings from 6.30pm to 7.00pm; and on Friday morning between 7.30am and 8.00am. Appointments are available throughout the day and can be booked online by patients who have previously registered to use the facility.

In addition, a duty doctor runs a session each morning from 9.00am to 11.30am for emergency patients. Telephone consultations are available each morning between 11.30am and 12 noon. The GPs also make home visits.

The practice has opted out of providing an out-of-hours service. Patients calling the practice when it is closed are connected with the local out-of-hours service provider. There is a link to the NHS 111 service on the practice website, which also includes details of local urgent care centres.

Updated 25 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 8 February 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said it was easy to make an appointment, 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.
• The practice was aware of and complied with the requirements of the Duty of Candour.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• There was an active patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 25 April 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.
• The practice maintained a register of 176 patients on the diabetes register, of whom 72% had received an annual eye check and 86% had received a foot check.
• All 26 patients on the practice’s heart failure register had had a medication review.
• Longer appointments and home visits were available when needed.
• The flu vaccination rate for at risk patients was higher than the national average.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Records showed that 1,783 patients had received advice promoting healthy lifestyles.

Updated 25 April 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. Immunisation rates were relatively high for all standard childhood immunisations.
• The percentage of patients with asthma on the register who had an asthma review in the preceding 12 months was above the national average.
• There were 19 mothers on the asthma and diabetes registers; all had had medication reviews within the last year.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The rate of uptake for cervical screening tests was above the national average.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses, for example with the health visitor attending practice meetings on a monthly basis.

Updated 25 April 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Records showed that 777 patients (100%) prescribed more than four medications had received a structured annual review
• Records showed that 219 patients had been offered cognition testing.
• The flu vaccination rate for older people was above the national average. Staff made home visits to administer the vaccines if patients were unable to attend the surgery.

Updated 25 April 2016

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 practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Records showed that 3,478 (49%) of patients aged between 18 and 75 had received a health check.

Updated 25 April 2016

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

• All but one of the 35 of patients on the dementia register had had their care reviewed in a face to face meeting in the last 12 months, which was above the national average. Advanced care planning was done in relation to 25 of the patients on the register.
• All 10 patients with schizophrenia, bipolar affective disorder and other psychoses have a comprehensive, agreed care plan documented in the record, in the preceding 12 months. This was above the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 25 April 2016

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

• The practice maintained registers of vulnerable adults (91 patients); vulnerable children (37 patients) and homeless patients, who were able to register at the practice address to receive health care related correspondence.
• The practice had a register of 18 patients with learning disabilities, 15 of whom had had an annual assessment and care plan review.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. 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.