Caskgate Street Surgery

Updated 2 August 2023

Caskgate Street Surgery is located in Gainsborough:

3 Caskgate Street

Gainsborough

Lincolnshire

DN21 2DJ

The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services, surgical procedures, family planning and the treatment of disease, disorder or injury.

The practice is situated within the Lincolnshire Integrated Care System and delivers General Medical Services (GMS) to a patient population of about 12,000. The practice list is weighted to reflect the healthcare needs of its patient population. The reason for weighting for patient demographics is that certain types of patients place a higher demand on practices than others. The adjustment for deprivation acknowledges that deprived populations have higher health needs than less deprived populations with a similar demographic profile.

Information published by Office for Health Improvement and Disparities shows that deprivation within the practice population group is in the lowest decile (1 of 10). The lower the decile, the more deprived the practice population is relative to others.

Caskgate Street Surgery is part of the Trent Care Primary Care Network (PCN) which includes 5 surgeries covering aprox 40,000 patients.

Caskgate Street Surgery’s population is different from the Lincolnshire and England averages. It has a deprivation score of 41 in comparison to Lincolnshire 19.9 and Trent Health 24.7 with unemployment at 12.2% which is the highest in the PCN. The practice also has higher number of patients with asthma related conditions, mental health and depression.

According to the latest available data, the ethnic make-up of the practice area is 98% White, 1% Asian.

The practice is open between 8am to 6.30pm Monday to Friday. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments.

Extended access is provided locally by Cleveland Surgery where late evening and weekend appointments are available. Appointments are available between 6.30pm and 8pm Monday to Friday 10am to 12 noon Saturdays and 10am to 11.30am on Sundays.

Out-of-hours services are provided by Lincolnshire Intergrated Care Board.

Updated 2 August 2023

We carried out an announced comprehensive inspection at Caskgate Street Surgery on 24 May 2023. Overall, the practice is rated as Inadequate.

Safe - Inadequate,

Effective - Requires Improvement

Caring - Good

Responsive - Good

Well-led - Inadequate,

Following our previous inspection on 3 November 2016, the practice was rated good overall and for all key questions.

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

Why we carried out this inspection

We carried out this comprehensive inspection to follow up concerns in response to risk in line with our inspection priorities. During our inspection we reviewed our 5 key questions of safe, effective, caring, responsive and well led.

How we carried out the inspection/review

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.
• To ensure we gathered staff feedback we used a questionnaire which was given to staff electronically via email.
• Completing remote 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) and discussing findings with the provider.
• Reviewing patient records remotely to identify issues and clarify actions taken by the provider.
• Requesting evidence to be submitted to us electronically from the provider.
• A site visit.

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:

• The practice did not provide care in a way that kept patients safe and protected them from avoidable harm.
• Safety alerts were not being received and acted upon, which put patients at risk.
• There were gaps in systems to assess, monitor and manage risks to patient safety.
• Not all patients received effective care and treatment that met their needs. Patients with long tern conditions were not always reviewed effectively.
• Staff did not have the information they needed to deliver safe care and treatment.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Patients could access care and treatment in a timely way.
• Patients’ needs were not assessed, and care and treatment was not delivered in line with current legislation.
• Leaders could not demonstrate they had the capacity and skills to deliver high quality sustainable care.
• The overall governance arrangements were inadequate.

We found four breaches of regulations. The provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment
• Ensure all premises and equipment used by the service provider is fit for use.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

• Obtain Staff immunisation records for non-clinical staff.
• Improve the number of carers, childhood immunisations and cervical screening rates.
• Consider a patient feedback survey.

I am, therefore, placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration. Special measures will give people who use the service the reassurance that the care they get should improve.

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