Archived: Cramlington Medical Group

Updated 13 August 2015

Cramlington Medical Group is a town centre practice which provides care and treatment to 5,529 patients of all ages, based on a Personal Medical Services (PMS) contract agreement for general practice. The practice is part of NHS Northumberland Clinical Commissioning Group (CCG). The practice serves an area that has:

• Higher levels of deprivation affecting children than the local CCG average, but lower levels than the England average;
• Higher levels of deprivation affecting people in the over 65 years of age than the local CCG and England averages.

The practice’s population includes:

• Less patients aged under 18 years than the local CCG and England averages;
• Less patients aged over 65 years of age than the local CCG average, but more than the England average.

The practice provides services from the following address: Cramlington Medical Group, The Health Centre/Forum Way, Cramlington. NE236QN. We visited this address as part of the inspection.

The practice occupied a purpose built building which it shared with another GP practice and other social and healthcare services. The premises are fully accessible to patients with mobility needs. Staff provide a range of services and clinic appointments, including, for example, services and clinics for patients with diabetes and asthma. The practice consists of one senior GP partner (male), one long-term locum GP (male) and two other locum GP staff (one female and one male). The senior GP partner was absent from the practice at the time of our visit. The practice manager post was vacant as they had tendered their resignation in December 2014 and left their post the day before our inspection. The practice also had three practice nurses. One of these posts was vacant, and of the other two, one practice nurse worked 30 hours per week and the other worked four hours. A healthcare assistant was employed as were a range of administrative and reception staff.

When the practice is closed patients are directed to the out-of-hours service provided by Northern Doctors Urgent Care service.

Updated 13 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cramlington Medical Group on 12 May 2015. Overall, the practice is rated as inadequate. Specifically, we found the practice to be inadequate for providing safe, effective and well-led services and requires improvement for the provision of caring and responsive services. There were aspects of the practice which were ‘inadequate’ and that related to all population groups.

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

• The practice was going through a period of major upheaval. The senior GP partner was absent from the practice, and key members of staff, including the practice manager, who had tendered their resignation at the end of 2014 and vacated their post the day before our inspection. This had impacted upon staff morale and their capacity to provide patients with safe, good quality care and treatment;
• Effective leadership and governance arrangements were not in place. We found risks to patient safety that had not been identified by staff, consequently there were no plans to address these;
• Nationally reported data for 2013/14 showed the practice performed well in providing clinical care and treatment to patients with most of the long-term conditions and public health indicators covered by the Quality and Outcomes Framework (QOF). However, QOF data for 2014/15 indicated the practice had not performed as well as it had previously done with regards to the delivery of healthcare reviews for patients with long-term conditions. Although staff provided a range of services to meet the needs of patients with long-term conditions, the practice did not have an effective mechanism in place for identifying and monitoring patients who were unresponsive to ‘recall’ telephone contact or letters;
• We were unable to confirm that patients’ needs were assessed, and care was planned and delivered in line with current legislation and best practice guidance. This was because, for example, the practice had no system in place for reviewing and, where necessary, updating their clinical guidelines in light of changes to national and local CCG guidelines. Also, clinical staff had failed to carry out a structured programme of clinical audits;
• Most patients told us they were treated well and received a good service. Findings from the National GP Patient Survey of the practice, published in 2015, showed variable levels of satisfaction with the quality of services provided by the practice. Some of the results were better than or in line with the local CCG and national averages, whilst others clearly fell below both averages;
• Effective arrangements were not in place to ensure that locum GPs working at the practice had undergone the required pre-employment recruitment checks, to make sure they were suitable to work with children and vulnerable adults;
• Although there was a system in place for identifying, reporting on and learning from significant events, this did not always work effectively. The quality of the recording of significant events was not satisfactory and did not always demonstrate the steps taken by the practice to prevent their reoccurrence and safeguard patients;
• The practice was clean and hygienic throughout, and patients said they were satisfied with the levels of cleanliness;
• The practice had good facilities and was well equipped to treat patients and meet their needs.

The areas where the provider must make improvements are:

• Ensure required pre-employment checks for locum GP staff are carried out;
• Ensure suitable governance arrangements are in place to assess, monitor and improve the quality and safety of the services provided. In particular: undertake a structured programme of clinical audits to demonstrate improvements in patient care; review and update clinical guidelines to ensure patients receive the most effective care and treatment available; ensure clinical staff follow the practice’s clinical guidelines;
• Take action to ensure the safe management of medicines;
• Evaluate and improve the systems in place for identifying and monitoring patients who are unresponsive to ‘recall’ telephone contact or letters;
• Review the availability of appointments to ensure the numbers offered per patient per week are in line with current guidance;
• Ensure all staff, including the regular locum GPs who work at the practice, have completed all of the training they need to keep patients safe.

The areas where the provider should make improvements are:

• Make sure an effective system is in place for dealing with safety alerts, including those concerning the management of medicines;
• Take account of the advice contained in the Significant Event Analysis GP Mythbuster which can be found on the Care Quality Commission's website;
• Carry out a recorded risk assessment to determine which emergency medicines GPs should carry with them during routine visits, for use in an acute situation. When doing this, take account of the guidance issued by the CQC;
• Provide all staff who carry out lead clinical and non-clinical roles with clear guidance about their roles and responsibilities and how they should implement these;
• Improve the recording of complaints to ensure that it is clear what lessons have been learnt and how they should carry these out.

CQC has taken the decision not to put the practice into Special Measures for the following reasons: the Provider that was registered for this service at the time of the inspection, and who was rated as Inadequate, is no longer carrying on the Regulated Activities but has yet to cancel their registration with CQC. A new provider is carrying on the regulated activities at the location and is applying for the location to be added to their existing registration. CQC has confidence that the incoming provider will address the issues contained within the report, and that based on their track record as a Provider they do not need the support that would usually be provided to a practice in Special Measures. We believe that because of the unique circumstances surrounding this practice and the arrangements that have already been put in place to support them to improve, the same outcome will be achieved as if it had gone into Special Measures. As with any practice rated as inadequate CQC will inspect again in a shorter time frame and consider its findings on that inspection and take any necessary action.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 13 August 2015

The practice is rated as inadequate for the care of patients with long term conditions. This is because the practice is rated as inadequate for safe, effective and well led, and the concerns that led to these ratings apply to everyone using the practice, including this population group.

Nationally reported QOF data, for 2013/14, showed patient outcomes relating to the conditions commonly associated with this population group were mostly above the local CCG and England averages. For example, the data showed the practice had achieved 100% of the total points available to them for providing patients who have asthma with the recommended care and treatment. This was 0.4 percentage points above the local CCG average and 2.8 points above the England average. The practice nurse we spoke with had received the training they needed to provide good outcomes for patients with long-term conditions. Emergency care plans had been put in place for patients at risk of an unplanned hospital admission. However, QOF data for 2014/15 indicated the practice had not performed as well as it had previously done with regards to the delivery of healthcare reviews for patients with long-term conditions. Although staff provided a range of services to meet the needs of patients with long-term conditions, the practice did not have a robust mechanism in place for identifying and monitoring patients who were unresponsive to ‘recall’ telephone contact or letters.

Updated 13 August 2015

The practice is rated as inadequate for the care of families, children and young people. This is because the practice is rated as inadequate for safe, effective and well led, and the concerns that led to these ratings apply to everyone using the practice, including this population group.

Nationally reported QOF data, for 2013/14, showed the practice had achieved 100% of the total points available to them for providing maternity services and child health surveillance. These were above the England averages (i.e. by 0.9 and 1.2 percentage points respectively), and in line with the local CCG averages. Pregnant women were able to access a weekly antenatal clinic provided by a midwife. This also provided mothers with access to a post-natal check performed by the senior GP partner. Mothers-to-be were able to access a primary care mental health nurse for both ante-natal and post-natal support. The practice nurse provided a fortnightly immunisation clinic and supported a family planning clinic, operated by the health centre in which the practice was located. Appointments were available outside of school hours and the premises were suitable for children and babies. However, on the basis of the nationally reported data available to the Care Quality Commission (CQC), we saw that, where comparisons allowed, the delivery of most childhood immunisations was lower, in comparison to the overall percentages for children receiving the same immunisations within the local CCG area. For example, the numbers of children who were given six of the eight childhood immunisations that should be given to children aged five years were below each local CCG average.

Updated 13 August 2015

The practice is rated as inadequate for the care of older patients. This is because the practice is rated as inadequate for safe, effective and well led, and the concerns that led to these ratings apply to everyone using the practice, including this population group.

Nationally reported QOF data, for 2013/14, showed patient outcomes relating to the conditions commonly associated with this population group were mostly above the local Clinical Commissioning Group (CCG) and England averages. For example, the data showed the practice had achieved 100% of the total points available to them for providing patients with heart failure with the recommended care and treatment. This was 0.1 percentage points above the local CCG average and 2.9 points above the England average. Staff continued to meet the day-to-day needs of most older patients. However, the recent absence of the senior GP partner, and the short-term use of locum GPs to provide all medical cover, made it more difficult for the staff to provide continuity of care and proactive, personalised care to this group of patients.

Updated 13 August 2015

The practice is rated as inadequate for the care of working age patients. This is because the practice is rated as inadequate for safe, effective and well led, and the concerns that led to these ratings apply to everyone using the practice, including this population group.

Nationally reported QOF data, for 2013/14, showed patient outcomes relating to the conditions commonly associated with this population group were mostly above the local CCG and England averages. For example, the data showed the practice had achieved 100% of the total points available to them for providing care and treatment for patients with cardiovascular disease. This was 7.9 percentage points above the local CCG average and 12 points above the England average. The needs of this group of patients had been identified and steps taken in the past to provide accessible and flexible care and treatment. The practice was proactive in offering on-line services to patients, such as being able to order repeat prescriptions and book appointments on-line. Health promotion information was available in the waiting area. The practice provided additional services such as Well Woman and Well Men and travel clinics. However, the provision of extended hours appointments had recently ended due to circumstances within the practice.

Updated 13 August 2015

The practice is rated as inadequate for the care of patients experiencing poor mental health. This is because the practice is rated as inadequate for safe, effective and well led, and the concerns that led to these ratings apply to everyone using the practice, including this population group.

Nationally reported QOF data, for 2013/14, showed the practice had achieved 100% of the total points available to them for providing recommended care and treatment for patients experiencing poor mental health. This was 3.8 percentage points above the local CCG average and 9.6 points above the England average. The data also showed that, where appropriate, care plans had been completed for 92.2% of patients who were on the practice’s mental health register, in agreement with the patients. However, QOF data for 2014/15 indicated the practice had not performed as well as it had previously done with regards to the delivery of healthcare reviews for patients experiencing poor mental health. We saw evidence confirming that a significant number of the patients on the practice’s register for this group of patients had not received their annual healthcare review.

Updated 13 August 2015

The practice is rated as inadequate for the population group of patients whose circumstances may make them vulnerable. This is because the practice is rated as inadequate for safe, effective and well led, and the concerns that led to these ratings apply to everyone using the practice, including this population group.

Nationally reported QOF data, for 2013/14, showed the practice had achieved 100% of the total points available to them for providing recommended care and treatment for patients with learning disabilities.  This was 8.7 percentage points above the local CCG average and 15.9 points above the England average. However, QOF data for 2014/15 indicated the practice had not performed as well as it had previously done with regards to the delivery of healthcare reviews for patients with learning disabilities. We saw evidence confirming that a significant number of the patients on the practice’s register for this group of patients had not received their annual healthcare review.

Staff worked with members of the multi-disciplinary team to help meet the needs of vulnerable patients. The practice sign-posted vulnerable patients to various support groups and other relevant organisations. However, some staff had not received appropriate safeguarding training and this meant they might not be confident about recognising the signs of abuse and know what action to take to safeguard patients.