Archived: Buckden Surgery

Updated 2 September 2019

Our inspection team

Our inspection team was led by a CQC lead inspector. The team included a GP specialist adviser and a nurse specialist adviser.

Background to Buckden Surgery

• The provider of this service is West Cambs Federation CIC.
• The registered location is Buckden Surgery, Mayfield, Buckden, St. Neots, PE19 5SZ.
• The website address is: www.westcambsfed.nhs.net
• West Cambs Federation CIC.is an independent provider founded in 2015 and began providing routine GP services for improved access from September 2018. The service is open to 28 GP practices serving a population of approximately 200,000 patients.
• There is a West Cambs Federation Board, West Cambs Federation Executive, Director of Business and Operations. There is a Clinical Operations Manager, Service Manager and various administration staff. They employ four advance nurse practitioners, 23 nurses, 16 healthcare assistants and 24 receptionists. They also utilise 34 GPs and a further two advance nurse practitioners on a self-employed basis.
• West Cambs Federation CIC has three other sites located in the Huntingdonshire and Fenland area. These locations are registered separately with the CQC.
• The service is open between 6.30pm and 8pm on selected weekdays and is open on some weekends. The service displays the opening times for the site on their website and in the patients usual GP practice.

Before visiting, we reviewed a range of information we hold about the service and asked them to send us some pre-inspection information which we reviewed.

During or prior to our visit we:

• Spoke with a range of staff from the service including the registered manager, senior management team, GPs, Nurses, Health care assistants and reception staff.
• Reviewed a sample of records.
• Reviewed comment cards where clients had shared their views and experiences of the service.
• Looked at information the service used to deliver care and treatment plans.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 2 September 2019

This service is rated as Inadequate overall.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at West Cambs Federation CIC, Buckden Surgery as part of our inspection programme. West Cambs Federation is a Community Interest Company and is an independent provider of services to see patients for routine care who are registered with a GP practice across Huntingdonshire and Fenland.

This service is registered with Care Quality Commission (CQC) under the Health and Social Care Act 2008 and provides the following regulated activities:

• Diagnostic and screening
• Family planning
• Maternity and midwifery services
• Treatment of disease, disorder or injury
• Surgical procedures.

The regulated activities are available from four registered locations. Patients can be seen at any of these locations:

• Buckden Surgery, Mayfield, Buckden. St. Neots. Cambridgeshire. PE19 5SZ.
• Cromwell Place Surgery, Cromwell Place, St. Ives, Cambridgeshire. PE27 5JD
• Acorn Surgery, Oak Tree Centre, 1, Oak Drive, Huntingdon, Cambridgeshire. PE29 7HN
• Cornerstone Surgery, Elwyn Road, March, Cambridgeshire. PE15 9BF

One of the lead GPs is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

As part of our inspection we asked for CQC comment cards to be completed by clients prior to our inspection visit. In total across the four sites we visited, we received 47 comment cards which were wholly positive about the service and nature of staff and four that were mixed comments one reflecting poor care and three reflecting poor staff attitudes. Other forms of feedback, including patient surveys and social media feedback was generally positive.

Our key findings were:

• Patients were supported and treated with dignity and respect. The service offered four locations ensuring the service was accessible to all patients across Huntingdonshire and Fenland.
• The service had recently recruited new members to the management team and had, just before our inspection, employed an external consultant to develop an action plan to improve their service.

• West Cambs Federation CIC delivered primary care services from existing GP practice premises. They employed clinical and clerical staff who worked in the member practices across Huntingdonshire and Fenland.

However, we also found that:

• The service had not ensured care and treatment was always provided in a safe way to patients.
• People were not adequately protected from avoidable harm and abuse.
• The service was unable to assure themselves that people received effective care and treatment.
• The leadership, governance and culture of the service did not assure the delivery of high-quality care.
• The service could not evidence that all the checks required to employ staff appropriately were in place.
• The service had not ensured all staff had been appropriately trained to undertake the tasks delegated to them.
• The service had not implemented effective systems to ensure appropriate and safe provision of emergency medicines and equipment.
• The service did not have systems and processes in place to ensure that safety alerts were managed or that staff were using appropriate guidelines such as National Institute for Health and Care Excellence (NICE).
• We found there was a lack of policies and procedures that had been written, approved and shared with staff to govern activity and ensure staff were adhering to the same processes.
• The service did not have systems and processes to give assurance that staff would raise, share and record all significant events. There was no clear evidence to demonstrate that any identified learning was shared with the whole practice team.
• The service did not have oversight of the premises from where they delivered services from. For example, they did not have oversight of up to date fire safety, health and safety or infection prevention and control risk assessments.
• As a result of feedback given on the day of the inspection, the provider shared with us an action plan to drive the improvements needed.

The areas where the provider must make improvements as they are in breach of regulations 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.
• Ensure staff are suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

As a result of these multiple breaches we imposed urgent conditions on the providers registration.

These conditions are that the provider must:

• You must ensure that West Cambs Federation CIC, its employees, servants and/or agents do not carry out consultations in respect of patients’ in instances where they do not have full access to a patient’s medical records. In the interests of patient safety, should there be an emergency situation in which you feel that you have no choice but to proceed with patient consultation, without access to that patient’s full medical records then you must record in each instance where that occurs, as well as recording what the emergency was and why referring the patient elsewhere was not viable alternative.

• You must provide a report to the Commission by mid-day on 2nd August 2019 and again by mid-day on the Friday of each following week. The report must set out the following:

An update on your Action Plan submitted to the Commission on 23 July 2019 with details of:

any progress, completed actions, and how you intend to monitor compliance in respect of those actions moving forward.

The areas where the provider should make improvements are:

• Review and implement systems and processes to ensure significant events and complaints however minor is recorded and ensure there are mechanisms for sharing information and learning with all staff to encourage improvements.
• Implement and monitor systems to keep clinicians up to date with current evidence-based practice such as National Institute for Health and Care Excellence (NICE) best practice guidelines.

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 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.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care