Craneswater Group Practice

Updated 30 March 2017

Craneswater Group Practice is the registered location for the provider created by a merger of two practices. The main location is at 34-36 Waverley Road, Southsea, Portsmouth, PO5 2PW and the provider has branch at Salisbury Road Surgery. The two practices are known collectively as the Craneswater Group Practice.

At the time of our visit in April 2016 the practice inspected was known as Waverley Road Surgery. Since then the provider has changed the name of the practice to Craneswater Group Practice.

A branch location is situated at: Salisbury Road Surgery, Southsea, Portsmouth, PO4 9QX. The branch has undergone recent extensive refurbishment including a new reception area, new clinical and treatment rooms and a lift to the first floor of the building. At this inspection we visited both the registered location and the branch practice.

Craneswater Group Practice provides general medical services, with staff working across both. Patients can access services on both sites.

Craneswater Group Practice at Waverley Road is situated towards the end of Portsea Island, Southsea, close to university student flats, older people’s flats and homes of multiple occupancy. The current practice population is 10,662, with around 50% of this being working age people (25-64 years).The population is classed as having a fifth higher deprivation score than the average for England. The mix of ethnicities includes small groups of Indian and Polish families, with the majority of patients identifying themselves as White British.

There are five GP partners, two of whom are female and three are male who work across both sites. The practice also employs three salaried GPs. This equates to 6.5 whole time equivalent doctors, one of whom is part time. Craneswater Group Practice is a training practice for doctors who are training to be GPs.

Craneswater Group Practice is also supported by four practice nurses and three health care assistants. The clinical team are supported by a business manager and an operations manager. Also at Craneswater Group Practice Waverley Road, there are 10 reception and administration staff.

The Craneswater Group Practice at Waverley Road is located in two converted Victorian houses. The practice is accessed via a ramp and automatic doors at the front. There are stairs up to one treatment room and one clinical room. There is no lift; staff told us they come downstairs to see patients who cannot manage stairs. There is a second waiting room on the first floor.

Reception has a lowered desk area for wheelchairs users. From reception there is a second door through to the main waiting room with several steps down, with a small lift to enable disabled access.

A further clinical room is located up another small set of stairs. The nurse’s rooms and the triage clinical room are off one corridor, on the same level as the ground floor waiting room.

The practice is open from 8am until 6.30pm with appointments starting at Craneswater Group Practice at Waverly Road at 9.00am to 12.45pm every morning and 3.15pm to 6.15pm daily. There are pre-bookable appointments which are routinely 15 minutes long, apart from one salaried GP who only offers ten minute appointments. The urgent appointment system is managed using a walk-in system. Any patient can walk-in between 9am and 11am and wait to see a duty GP. Patients can attend either site and urgent appointments are also available in the afternoon. There are extended opening times in the week and on some Saturdays as follows:

The practice offered extended hours on Monday and Tuesday evenings until 8.00pm aimed at patients who could not attend during normal opening hours. Early opening is also offered on Wednesday and Thursday morning from 7.30am and one Saturday morning surgery per month.

Patients are directed to use the NHS 111 system when the practice is closed.

Updated 30 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Craneswater Group Practice on 12 April 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Waverley Road Surgery on our website at www.cqc.org.uk.

At the time of our visit in April 2016 the practice inspected was known as Waverley Road Surgery. Since then the provider has changed the name of the practice to Craneswater Group Practice.

As a result of the inspection a warning notice was served. The practice was re inspected in November 2016 and was found to have completed the requirements of the notice.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 10 January 2017. Overall the practice is now rated as Good.

Our key findings 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 managed.
• 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.
• 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.
• Risks assessments for areas such as fire and infection control had been carried out, and there was a system to monitor and act on the findings of the assessments.
• Practice policies and procedures were now appropriately reviewed and updated to ensure their content was current and relevant.
• Systems and processes for ensuring all staff were suitably trained had been addressed and the practice had ensured that all staff had the necessary skills and competencies to carry out their role.
• Systems were now in place to monitor the cleanliness of the premises and protect patients from risk of infection.
• There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 March 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.
• The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less (01/04/2015 to 31/03/2016) was 84% compared to the clinical commissioning group average of 79%.
• Longer appointments and home visits were available when needed.
• 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.

Updated 30 March 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• 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.
• 74% of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2015 to 31/03/2016), which is lower than the national average of 82%. The practice was aware that they were not achieving the desired target level for cervical smears. The practice told us that they continually chased up patients by letter and telephone.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 30 March 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 patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with greater needs.
• A health care assistant had been given specialised training in caring for older patients.
• The practice had multi-disciplinary team meetings with other healthcare professionals to review the needs of older people and coordinated anticipatory care plans with out of hours and secondary care services to manage patients at the end of life.

Updated 30 March 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.

Updated 30 March 2017

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

• 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher to the national average at 84%.
• 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2015 to 31/03/2016) which is higher than the national average of 89%.
• 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 carried out advance care planning for patients living 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 those living with dementia.
• The practice has signed up for the iSpace dementia friendly GP practice project.

Updated 30 March 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 patients 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.