Crown Medical Centre

Updated 5 January 2017

The practice operates from one site in Bromley. It is one of 45 GP practices in the Bromley Clinical Commissioning Group (CCG) area. There are approximately 10,600 patients registered at the practice. Deprivation levels affecting adults and children at the practice are below the national average, and the practice’s patient population is predominantly white British males and females aged between 15 and 64 years of age.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning services, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The practice has a personal medical services 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 avoiding unplanned admissions, childhood immunisation and vaccination, dementia, extended hours, influenza and pneumococcal immunisations, learning disabilities, minor surgery, patient participation, risk profiling, rotavirus and shingles immunisation, and violent patients.

The clinical team includes a female and four male GP partners, and a female and a male salaried GP. The GPs provide a combined total of 41 fixed sessions per week. There are two female salaried practice nurses and a female health care assistant. The clinical team is supported by a practice manager, a senior practice administrator, and a reception manager. There are 13 receptionists (some of whom have other duties such as prescribing clerk/scanning and coding/administration), a general administration clerk, a medical notes summariser and three medical secretaries.

The practice is open from 8.00am to 6.30pm Monday to Friday. It is closed on bank holidays and Sundays. Appointments with GPs and nurses are available at various times during opening hours. Extended hours appointments are available from 6.30pm to 7.30pm on Mondays, 6.30pm to 8.00pm Tuesdays, Wednesdays and Thursdays, and 9.00am to 11.00am every first and third Saturday of every month.

The premises operates over the ground floor of a leased purpose built building. There are seven consulting rooms, two treatment rooms (one of which is shared with another practice on the same premises), a waiting/reception area, and two wheelchair accessible patient toilets. There is wheelchair access throughout the ground floor, disabled parking and baby changing facilities available.

The practice directs patients needing urgent care out of normal hours to contact the local contracted out of hours service - Emergency Doctors On Call (EMDOC).

Updated 5 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crown Medical Centre on 26 September 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 a system in place for reporting and recording significant events; however, an incident had not been recorded as a significant event and there was no significant event policy.

• Risks to patients were assessed and well managed.

• 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. Performance for some clinical indicators related to the Quality and Outcomes Framework were slightly below expected averages.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• 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.

• Patient satisfaction was generally in line with most national averages, but was slightly below average for some responses and above average for access to appointments. There were 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review the process for significant event recording to ensure that incidents are appropriately recorded and discussed.

• Review the system for exception reporting, in relation to the Quality and Outcomes Framework, to improve outcomes for patients.

• Continue to audit and improve patient satisfaction, particularly in relation to telephone access.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 5 January 2017

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.

• In the previous 12 months of 2015/2016, 73% of patients with diabetes had well-controlled blood sugar. This was in line with the Clinical Commissioning Group (CCG) average of 76% and the national average of 78%. Exception reporting was higher than expected.

• Longer appointments and home visits were available when needed.

• All patients with a long-term condition had a named GP and the majority had received a structured annual review to check their health and medicines needs were being met.

• In the previous 12 months of 2015/2016, 76% of patients with asthma had an asthma review. This was in line with the CCG average of 73% and the national average of 76%.

• In the previous 12 months of 2015/2016, 94% of patients with chronic obstructive pulmonary disease had a review of their condition. This was in line with the CCG average of 89%, and above the national average of 90%. Exception reporting was higher than expected.

• 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.

Updated 5 January 2017

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 attendances to Accident & Emergency.

• Immunisation rates were high for all standard childhood immunisations, in comparison to the local average.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice provided sexual health screening and distributed free condoms to ensure they were accessible to young people.

• We saw positive examples of joint working with midwives and health visitors that held clinics in-house.

• In the previous 12 months of 2015/2016, 83% of women aged between 25 to 64 years had a cervical screening test. This was in line with the local and national average of 82%.

Updated 5 January 2017

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.

• All patients aged over 75 had a named GP.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice provided care for approximately 300 older people residing in seven local care homes. Four of the GP partners had contributed to strengthening co-working with these homes in order to improve outcomes for patients.

Updated 5 January 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 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.

• Extended hours appointments were available from 6.30pm to 7.30pm on Mondays, 6.30pm to 8.00pm Tuesdays, Wednesdays and Thursdays, and 9.00am to 11.00am every first and third Saturday of every month, for working patients that were unable to attend the practice during normal opening hours.

Updated 5 January 2017

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

• In the previous 12 months of 2015/2016, 78% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive agreed care plan in their record. This was slightly below the Clinical Commissioning Group (CCG) average of 83% and the national average of 89%. Exception reporting was higher than expected.

• In the previous 12 months of 2015/2016, 81% of patients diagnosed with dementia had their care reviewed in a face to face meeting, which was in line with the CCG average of 82% and the national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients 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 5 January 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 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.

• 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.