Cromer Group Practice

We carried out an announced comprehensive inspection at Cromer Group Practice on 12 June 2019 as part of our inspection programme. This was the first inspection at the new location for the practice. The practice moved premises and therefore re-registered with the Care Quality Commission in July 2018.

Our judgement of the quality of care at this service is based 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 requires improvement overall.

This means that:

• Patients had good outcomes because they received effective care and treatment that met their needs.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• There were several examples of the caring nature of staff.
• Outcomes from the GP Patient Survey in relation to the care provided by clinicians were generally in line with average.
• People’s needs were met by the way in which services were organised and delivered. For example, the practice had two domestic abuse champions to sign post patients appropriately.
• Outcomes for patients in the Quality and Outcomes Framework for 2018/19 showed the practice had maintained a high level of achievement and had reduced their exception reporting.

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

• We found several gaps in the recruitment files we viewed, including proof of identity, evidence of satisfactory former employment such as references, DBS checks and indemnity cover. There were some instances where there had been a recommendation of further immunisation that had not been completed or risk assessed by the practice.
• We found a fire risk assessment had been completed with a suggestion that another be carried out on 4 June 2019. The risk assessment had not been reviewed and another assessment had not been booked.
• We found that there was some evidence of an induction system for staff, including locum staff, although this was not always completed in staff files.
• We found the practice had a summariser, but notes awaiting summarising dated back to November 2016.
• We found three Patient Group Directions (PGDs) that had not been reviewed and were out of date.
• We found a medicine that was out of date on the emergency trolley. The practice removed this immediately.
• There were instances where the temperature of vaccine fridges were above recommended guidance and no evidence of any actions taken. There was also no evidence of formal stock checks or expiry date checks.
• There was a lack of oversight for medicines related alerts.

We have rated the practice as requires improvement for providing well-led services, and for all population groups, because:

• We asked the practice for a business plan or strategy, however they reported this was not written down.
• The governance systems in place were not always effective. For example, we found governance issues relating to the fire risk assessment review dates and induction and recruitment systems.
• We found there was a lack of oversight for managing risks within the practice including; safety alerts, patient group directions and the safe storage of vaccines.
• There was a lack of quality improvement methods such as clinical audit to monitor and drive improvements.
• There was insufficient oversight of performance by the leadership team. We spoke with the practice about their Quality and Outcomes Framework performance for 2017/18 and they were unable to explain why their exception reporting had been higher than average. They were also unsure why it had reduced in 2018/19.
• Staff reported to us that although they were happy working in the practice, they felt they often worked in silo and did not always see management staff.

We found the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure care is provided in a safe way to patients.

We found the provider should:

• Embed the new quality improvement system for the auditing the services provided.
• Review and improve outcomes relating to levels of patient satisfaction in relation to access.
• Review and document the business plans and strategy.
• Review how staff work together to deliver effective care and treatment.

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

Dr Rosie Benneyworth BS BM BMedSci MRCGP
Chief Inspector of General Practice