Archived: Croston Medical Centre

This practice is rated as inadequate overall. (Previous rating January 2018 – Good)

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? - Good

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Croston Medical Centre on 28 June 2018 in response to concerns and to follow up breaches of regulations identified at our inspection in January 2018.

At this inspection we found:

•The practice did not have clear systems in place to manage risk so that safety incidents were less likely to happen. When incidents did happen, these were not always reported.

•The governance of the practice was poorly managed. Leaders lacked the capacity and capability to manage the practice effectively.

•Policies and procedures had not been established to enable the practice to operate safely and effectively.

•There was no management oversight of staff training and some staff had not been supported for their training needs.

•There was little evidence that quality improvement activity was embedded into practice to ensure continuous learning and development.

•Staff involved and treated patients with compassion, kindness, dignity and respect.

•Patients found the appointment system easy to use and reported that they could access care when they needed it.

•The practice took patient complaints seriously and responded to them appropriately.

•Staff reported a lack of leadership support from GPs. There was a lack of time in some meetings and during staff appraisal to allow meaningful discussion.

•There was little evidence of practice engagement with the patients, the public, staff and external partners.

•Our concerns with the governance and leadership of the practice identified in three previous inspections had not been addressed effectively. Governance and leadership of the practice was inadequate.

The areas where the provider must make improvements as they are in breach of regulations are:

•Ensure care and treatment is provided in a safe way to patients.

•Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

•Consider the regular review of all vulnerable children and young people.

This service has been rated as inadequate for providing well-led services. This is in response to repeated ratings of requires improvement for this key question and a history of non-compliance. We rated the practice as requires improvement for providing well-led services following our inspections of the practice in November 2016, June 2017 and January 2018 for issues relating to the poor governance of the practice. We found that this had not improved at this inspection.

We are therefore taking action in line with our enforcement procedures but we are aware the provider has applied to cancel their registration with CQC and a new provider will be in place.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Croston Medical Centre on 28 June 2017. The overall rating for the practice was good. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Croston Medical Centre on our website at www.cqc.org.uk.

Following our inspection in June 2017 we rated the practice as requires improvement for providing well-led services and as good overall. We issued a requirement notice in relation to staffing.

This inspection was an announced focused inspection carried out on 23 January 2018 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection on 28 June 2017. At this inspection, we found the breaches previously identified had been addressed, however, we identified another area of concern and the practice is still rated as requires improvement for providing well-led services. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good.

Our key findings were as follows:

• The practice generally had clear systems to manage risk so safety incidents were less likely to happen; however, the practice policy for the management of refrigerated vaccines was not being followed. Fridge temperatures were not being monitored and there was no audit of that monitoring as the policy required.
• We noted new documentation of clinical meetings since our last inspection in June 2017, however, this documentation did not include discussion of quality improvements associated with patient safety alerts or best practice guideline changes to share learning. Patient safety alerts and guideline changes received by staff were not kept for locums.
• At our last inspection in June 2017, we saw there was insufficient monitoring of stocks and expiry dates of medicines held in the practice. We saw at this inspection this had improved.
• At our previous inspection, we saw the practice had identified few patients on the practice list who were carers. At this inspection, this had improved and the practice had identified just over 1% of patients who were carers.
• At our inspection in June 2017 we identified the practice had not assessed staffing capacity to ensure there were sufficient hours of clinical and non-clinical staff time available to meet the requirements of the service. At this inspection we saw this had been addressed. The practice had recruited a regular practice nurse assisted by a locum nurse and a new administrative staff member had been employed to work at the branch surgery. The practice had also commissioned an independent consultant to review how work was carried out in the practice to identify better ways of working. This review was in progress at the time of our inspection.

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

Importantly, the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition the provider should:

• Record comprehensive minutes of clinical meetings to include discussion of actions taken and learning related to national patient and medicines safety alerts, best practice guideline changes and audit activity.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice