Archived: Caradoc Surgery

This is the third inspection of Caradoc Surgery. At the inspection on 29 August 2017 we rated the practice requires improvement overall and issued a requirement notice for the breach of regulation 17, Good governance. This was due to: the lack of improvement in the patient’s satisfaction of the service. We followed up on this breach of regulation with an inspection on 11 November 2018, when we rerated the practice. We rated the practice requires improvement overall and issued two requirement notices for regulation 12, safe care and treatment and regulation 17, Good governance. This was due to: poor monitoring of patients with long term conditions, those suffering from poor mental health, and the continued lack of improvement in patient satisfaction.. We carried out a further comprehensive inspection of the practice on 9 July 2019 and followed up on the breaches of regulation and rated the practice inadequate overall.

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 have rated this practice as Inadequate overall.

We rated the practice as inadequate for providing safe services because:

• Staff were unsure when asked who the safeguarding lead was at the practice.
• Patients had issues regarding ordering their repeat prescriptions and did not receive them within the practice five day given time-frame.
• Data reflected that anti-bacterial stewardship required improvement.
• The system for reporting significant events was not clear for all staff and learning was not being effectively shared.
• Frailty and falls risks had not been recorded in patients records

We rated the practice as inadequate for providing effective services because:

• Quality data seen showed some limited improvement however since the last inspection, however, was significantly below local and national practice averages in the majority.
• There was no evidence of clinical audit cycles, meaning, monitoring of patient outcomes and treatment was limited.
• Child immunisation and cervical screening data remained below national targets.

We rated the practice as requires improvement for providing caring services because:

• Patient satisfaction data published in the national GP patient survey of July 2019 had decreased significantly in the last 12 months.

We rated the practice as Inadequate for responsive services because:

• Patients could not access care and treatment in a timely way.
• The practice’s own survey and the data from national GP patient survey published in July 2019, reflected low patient satisfaction for ease of getting through on the phone, and for the experience of making an appointment. There had been no improvement in

the data published in the previous year.

We rated the practice as Inadequate for well-led services because:

• The governance, identification of risks and performance monitoring was not effective, as the leaders at the practice failed to identify and act on risk, had not improved performance in relation to QOF outcomes and patient satisfaction and did not have an effective system of clinical audit or other quality improvement activity.

These areas affected all population groups, so we rated all population groups as inadequate.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• 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:

• Update staff on the lead for safeguarding at the practice and the procedures to follow in the event of a safeguarding issue. Continue to improve anti-bacterial stewardship.
• Improve staff understanding of how to recognise the signs of sepsis and the action to take and embed this over time.

I am 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 Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Caradoc Surgery on 29 August 2017. The overall rating for the practice was requires improvement. The full comprehensive report on this inspection can be found by selecting the ‘all reports’ link for Caradoc Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 06 November 2018 as part of our inspection programme and to follow up on breaches of regulations found at our previous inspection in August 2017. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

The provider of this location is Anglian Community Enterprise, they have four GP practice locations registered with the Care Quality Commission.

Overall the practice remains rated as requires improvement

The key questions at this inspection are rated as:

Are services safe? – Good

Are service effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services Well-led – Requires Improvement

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• They had improved the system to act on patient safety and medicine alerts (MHRA) to ensure patient safety.
• Data for the year 2017/18 reflected poor achievement of clinical performance for patients with long term conditions and with poor mental health. Unverified data available on the practice computer system showed some improvement in some indicators. Improvements were below local and national averages.
• The system to monitor repeat prescriptions was effective. Prescribers reviewed patient’s diagnostic tests before issuing prescriptions.
• Recording, and the system to identify patients that were carers registered at the practice had improved. Further support was offered to assist carers.
• The practice had carried out their own patient survey to understand their patient’s level of satisfaction for their service and had acted on the findings. We saw actions taken on a plan to improve patient satisfaction. However, data from the national GP patient survey 2018 reflected low patient satisfaction in many areas.
• Leaders had the capacity and skills to deliver high-quality, sustainable care.
• Staff told us they felt supported, valued and that management listened to their opinions.
• The practice had a realistic strategy and supporting business plans to achieve their priorities.
• Staff involved with treating patients showed compassion, kindness, dignity and respect.
• Patients found it difficult to get an appointment and reported the new phone system to be problematic and it often took a long time to get answered.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements 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.
• 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.