Clacton Community Practices

We carried out an announced comprehensive inspection at Clacton Community Practices on 29 September 2022. Overall, the practice is rated as requires improvement.

This was the first inspection of this service since they registered with the Care Quality Commission (CQC) in 2020.

Safe - Requires improvement

Effective - Good

Caring - Good

Responsive - Good

Well-led - Requires improvement

The provider (Ranworth Surgery) at short notice took over the management of this practice in February 2020 because the previous provider had failed to provide safe, effective and well-led care and treatment for the patient population. This resulted in the commissioning organisation cancelling the contract with the previous provider. At this time the provider inherited a huge backlog of work including medication reviews, summarising of records, deduction requests. Additionally, no improvement or audit work had been undertaken by the previous provider to understand the population needs. There was and continues to be over 100 requests per month made by new patients requesting registration. The provider has continued to register patients since taking on the contract despite the challenges faced.

A month after taking on the contract the provider had to manage COVID-19 pandemic restrictions whilst supporting the transition of staff to a new provider, the implementation of a completely new governance structure and policies, work processes, working arrangements, and staff training.

The provider was awarded the Alternative Provider Medical Services (APMS) contract from April 2021 following a successful procurement bid. At this time there was already a project in place to merge 2 of the 3 sites into a new larger more accessible building. The provider took on the required business management, planning, stakeholder, and public engagement required to finally complete this project in May 2021.

Why we carried out this inspection

We carried out this inspection in line with our inspection priorities and it included all of the key questions: safe, effective, caring, responsive and well-led to provide a rating for this practice .

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 short site visit.
• Staff 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:

• The practice leadership did not have oversight to ensure all systems and processes were in place to deliver effective care to all patients.
• The practice had safeguarding processes and procedures that kept patients safe from abuse. However, records viewed with a recorded safeguarding alert did not always have the reason the concern was documented.
• The practice had effective systems to ensure all emergency medicines and equipment were safe to use.
• The process used to monitor patients’ health in relation to the use of medicines including high risk medicines did not consistently provide appropriate monitoring and clinical review prior to prescribing.
• The system to identify patients with a potential missed diagnoses for chronic kidney disease was not effective.
• Some historical alert recommendations of the Medicines and Healthcare products Regulatory Agency (MHRA) had not been acted on.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Patients told us they could access care and treatment in a timely way.
• The practice respected patients’ privacy and dignity and patient confidentiality was maintained throughout the practice

We found a breach of regulations. The provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the provider should:

• Continue to embed the process to monitor the appropriateness of prescribing for antibiotics hypnotics, and high-risk medicines.
• Continue to encourage uptake for cervical screening and childhood immunisations.

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