The Care Quality Commission
  • Doctor
  • GP practice

The Caxton Surgery

Overall: Requires improvement read more about inspection ratings

Oswald Road, Oswestry, Shropshire, SY11 1RD (01691) 654646

Provided and run by:
The Caxton Surgery

All Inspections

28 November 2022

During a routine inspection

We carried out an announced comprehensive at The Caxton Surgery on 28 November 2022 Overall, the practice is rated as Requires Improvement.

Safe – Requires Improvement

Effective - Requires Improvement

Caring - good

Responsive - good

Well-led - good

Following our previous inspection on 8 September 2016, the practice was rated good overall and for all key questions with the exception of responsive, where the practice was rated as outstanding.

At the last inspection we rated the practice as outstanding for providing responsive services because:

  • The practice had developed its staff’s skillset in order that its clinical staff could deliver care directly at a refuge for domestic abuse patients with highly complex needs.
  • The practice had devised a five point Dementia Action Alliance Action plan; including investigating the ways in which the practice physical environment could be improved to be more welcoming and accessible for patients with dementia, which was in progress.
  • The practice had identified and liaised with local employers whose employees included 800 people from an ethnic minority group and provided literature in the most appropriate language to meet their needs.

At this inspection, we found that those areas previously regarded as outstanding practice were now embedded throughout the majority of GP practices. While the provider had maintained this good practice, the threshold to achieve an outstanding rating had not been reached. The practice is therefore now rated good for providing responsive services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Caxton Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection due to the length of time the practice was previously rated. We assessed all key questions.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A site visit.
  • Staff feedback questionnaires.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We found that:

  • Not all patients received effective care and treatment that met their needs.
  • The practice had exceeded the 95% WHO target in four of the five indicators for child immunisations.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care. Ninety seven and a half percent of patients who responded to the GP patient survey felt they were involved as much as they wanted to be in decisions about their care.
  • Patients could access care and treatment in a timely way. The practice achieved higher than local and national averages for providing responsive services within the national patient survey.
  • The practice exhibited an open culture, the leadership team were freely accessible to staff and staff felt included and listened to.

We found a breach of regulations. The provider must:

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

In addition, the provider should:

  • Continue the work to re-establish the Patient Participation Group
  • Develop an effective system for the management of administrative tasks.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

8 September 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Caxton Surgery on 8 September 2016. Overall, the practice is rated as good and outstanding in providing a responsive service.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Feedback from patients about their care was consistently positive.

  • 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.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, they had improved opening times, and completed surveys of extended access available. They also completed building improvements such as automated doors with the PPG involved.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • The practice had a clear vision, which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

  • The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

  • The practice has developed its staff’s skillset in order that its clinical staff can deliver care directly at a refuge for domestic abuse patients with highly complex needs.

  • The practice had devised a five point Dementia Action Alliance Action plan; including investigating the ways in which the practice physical environment could be improved to be more welcoming and accessible for patients with dementia, which was in progress.

  • The practice had identified and liaised with local employers whose employees included 800 people from an ethnic minority group and provided literature in the most appropriate language to meet their needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice