We carried out a review of the data available to us about Sleaford Medical Group on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Sleaford Medical Group, you can give feedback on this service.
We carried out an announced inspection at Sleaford Medical Group on 19 May 2021.
We have rated this practice as Good overall and Good for all population groups.
The practice is rated as follows;
Safe - Good
Effective – Good
Responsive - Good
Well-led – Good
We rated all the population groups as Good.
Following our previous inspection on 8 August 2019, the practice was rated Requires Improvement overall and for the safe, effective, responsive and well-led key questions. It was rated as Good for providing caring services. All the population groups were rated as Requires Improvement.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Sleaford Medical Group on our website at www.cqc.org.uk
Why we carried out this inspection
The inspection focused on:
How we carried out the inspection
Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.
This included:
Our findings
We based our judgement of the quality of care at this service on a combination of:
We found that:
Details of our findings and the evidence supporting our ratings are set out in the evidence table.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
We carried out an unannounced comprehensive inspection at Sleaford Medical Group on 8 August 2019.
Sleaford Medical Group was previously inspected in July 2018 and rated overall good, with requires improvement in the well led domain.
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.
We rated the practice as requires improvement for providing safe services because:
We rated the practice as requires improvement for providing effective services because:
We rated the practice as good for providing caring services because:
We rated the practice as requires improvement for providing responsive services because:
We rated the practice as requires improvement for providing a well led service because:
We rated all population groups as requires improvement .
The areas where the provider must make improvements are:
(Please see the specific details on action required at the end of this report).
In addition, the provider should:
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
Sleaford Medical Group (the provider) had been inspected previously on the following dates:
Reports from our previous inspections can be found by selecting the ‘all reports’ link for Sleaford Medical Group on our website at .
This inspection was undertaken following a six-month period of special measures and was an announced comprehensive inspection on 19 July 2018.
This practice is rated as Good overall. (Previous rating December 2017 – Inadequate)
The key questions at this inspection are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Requires Improvement
At this inspection we found:
The areas where the provider should make improvements are:
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.
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
Sleaford Medical Group (the provider) had been inspected previously on the following dates:
13 April 2017 under the comprehensive inspection programme. The practice was rated Inadequate overall and placed in special measures for a period of six months. Breaches of legal requirements were found in relation to governance arrangements within the practice. A warning notice was issued which required them to achieve compliance with the regulations set out in the warning notice by 24 August 2017.
20 September 2017 - A focused inspection was undertaken to check that they now met the legal requirements. As the practice had not made all the improvements to achieve compliance with the regulations a letter of concern was sent, and action plans were requested on a fortnightly basis to ensure the required improvements had been put in place.
19 December 2017 – a comprehensive inspection following a six month period of special measures. Insufficient improvements have been made such that there remains a rating of inadequate for this inspection. The practice was placed in special measures for a further period of six months. The Care Quality Commission therefore took 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.
Reports from our previous inspections can be found by selecting the ‘all reports’ link for Sleaford Medical Group on our website at www.cqc.org.uk.
We undertook this unannounced focused inspection on 20 March 2018 to check that they had now met the legal requirements of the Notice of Decision to impose conditions on their registration which was served on 22 December 2017 in relation to medication reviews. This report only covers our findings in relation to those requirements.
Our key findings from the areas we inspected for this focussed inspection were as follows:
Since the inspection in December 2017 the practice had taken significant steps in order to ensure patients health was monitored in a timely manner to ensure medicines were being used safely and followed up on appropriately.
New processes were in place and at the time of this inspection the practice had monitoring systems in place to ensure they were effective and kept patients safe from harm.
The areas where the provider must make improvements as they are in breach of regulations are:
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
The service will be kept under review and another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
Chief Inspector of General Practice
Sleaford Medical Group (the provider) had been inspected previously on the following dates:
13 April 2017 under the comprehensive inspection programme. The practice was rated Inadequate overall and placed in special measures for a period of six months. Breaches of legal requirements were found in relation to governance arrangements within the practice. A warning notice was issued which required them to achieve compliance with the regulations set out in the warning notice by 24 August 2017.
20 September 2017 - A focused inspection was undertaken to check that they now met the legal requirements. As the practice had not made all the improvements to achieve compliance with the regulations a letter of concern was sent, and action plans were requested on a fortnightly basis to ensure the required improvements had been put in place.
Reports from our previous inspections can be found by selecting the ‘all reports’ link for Sleaford Medical Group on our website at www.cqc.org.uk.
This inspection was undertaken following a six month period of special measures and was an announced comprehensive inspection on 19 December 2017.
This practice is still rated as inadequate overall. (Previous inspection April 2017 was Inadequate).
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Requires Improvement
Are services caring? – Requires Improvement
Are services responsive? – Inadequate
Are services well-led? - Inadequate
As part of our inspection process, we also look at the quality of care for specific population groups. The provider was rated as inadequate for safe, responsive and well led services and requires improvement for providing effective and caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.
The population groups are rated as:
Older People – Inadequate
People with long-term conditions – Inadequate
Families, children and young people – Inadequate
Working age people (including those retired and students – Inadequate
People whose circumstances may make them vulnerable – Inadequate
People experiencing poor mental health (including people with dementia) - Inadequate
At this inspection we found:
Staff understood their responsibilities to raise concerns and report incidents. These were discussed with relevant staff on a regular basis. However, further improvements were still required in the investigation and analysis of significant events in order to correctly identify appropriate and relevant learning from incidents , review of common themes and ensure that necessary actions were taken. For example, missed referrals.
Patients’ health was not always monitored in a timely manner to ensure medicines were being used safely and followed up on appropriately.
Most Disclosure and Barring checks were in place with the exception of a locum GP and a medicine delivery driver.Since the inspection the practice have told us the DBS checks are now in place.
The practice had made improvements to their governance arrangements and had taken some of the appropriate steps required to ensure patients remained safe. Further work was still required in regard to significant events quality improvement to improve patient outcomes and dealing with complaints.
Staff involved and treated patients with compassion, kindness, dignity and respect.
Patients we spoke with told us they found it difficult to use the appointment system. This aligned with the results of the national patient survey as only 64% describe their experience of making an appointment as good compared to the local (CCG) average of 75% and national average of 73%.
The new processes introduced in respect of complaints required further embedding to ensure all complaints were captured, investigated and appropriate learning identified, shared and acted upon.
There was limited quality improvement.
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
The areas where the provider should make improvements are:
This service was placed in special measures on 6 July 2017. Insufficient improvements have been made such that there remains a rating of inadequate for this inspection.
Therefore we are taking 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 six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
Chief Inspector of General Practice
We carried out an announced comprehensive inspection of this practice on 13 April 2017.
Breaches of legal requirements were found in relation to governance arrangements within the practice. We issued the practice with a warning notice requiring them to achieve compliance with the regulations set out in those warning notices by 24 August 2017.
We undertook this focused inspection on 27 September 2017 to check that they now met the legal requirements. This report only covers our findings in relation to those requirements.
At the inspection on 27 September we found that not all the requirements of the warning notice had been met.
Our key findings across the areas we inspected for this focussed inspection were as follows:
The practice had made improvements to their governance arrangements and had taken some of the appropriate steps required to ensure patients remained safe. Further work was required in regard to significant events, medicine reviews including high risk medicines and complaints.
Safe systems were now in place for patient safety alerts, monitoring of the cold chain and the management of patients with a suspected urinary tract infection (UTI).
Improvements had been put in place in regard to governance arrangements and some of the appropriate steps required had been taken to ensure patients remained safe.
The leadership structure had strengthened considerably and areas of responsibility had been identified. There was an updated documented leadership structure and it was clear who took overall responsibility for the surgery.
As the legal requirements of the warning notice were not met the Care Quality Commission has sent the practice a letter of concern in which we require them to send us fortnightly action plans.
The areas where the provider must make improvements are:-
Continue to review the system in place for significant events to ensure all events are captured, investigations are detailed, actions are identified and implemented.
In addition the provider should:
Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Sleaford Medical Group on 13 April 2017.
Overall the practice is rated as inadequate.
Our key findings across all the areas we inspected were as follows:
Patients were at risk of harm because some systems and processes in place were not effective to keep them safe. For example, patient safety alerts, monitoring of patients on high risk medicines, medication reviews, monitoring of the cold chain and management of patients with urinary tract infections.
Risk were assessed and well managed.
The practice had a system in place to keep patients safe and safeguarded from abuse. However some staff were not up to date with safeguarding training.
The July 2016 national patient survey results had not been reviewed and actions put in place to improve the areas of concerns identified by the patients registered at the practice.
There was a documented leadership structure but it was not clear who took overall responsibility for the surgery.
The areas where the provider must make improvements are:
Improve the process in place for the management of risks to patients and others against inappropriate or unsafe care. This should include: patient safety alerts, monitoring of patients on high risk medicines, medication reviews, monitoring of the cold chain and management of patients with urinary tract infections.
Ensure pathology results are reviewed to ensure action is taken where appropriate and they are filed on the patient record in a timely manner.
Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.
Gather patient views and experiences to ensure the services provided reflect the needs of the population served.
In addition the provider should:
Review procedures for carrying out regular balance checks of controlled drugs
Ensure safeguarding registers are updated and actions documented in regard to children who do not attend for hospital appointments.
Ensure all staff have completed safeguarding training relevant to their role.
I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.
Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 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.
Special measures will give people who use the service the reassurance that the care they get should improve.
Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Sleaford Medical Group on 6 May 2015. Overall the practice is rated as good.
Specifically, we found the practice to be providing safe, effective, caring, responsive and well led services. It was also good for providing services for all the population groups.
Our key findings across all the areas we inspected were as follows:
We saw an area of outstanding practice:
However there were areas of practice where the provider needs to make improvements.
The provider should :-
Chief Inspector of General Practice
We found that the practice did not have clear procedures for the reporting of medicine errors or systems in place to ensure that medicines were safely administered.
The practice did not have systems in place to keep their policies and procedures up to date.
We also found that the practice did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.
We found that the practice did not have clear procedures for the reporting of significant adverse events or systems in place to ensure that lessons had been learnt and information had been disseminated to all the staff who worked at the practice.
We asked them to take action.
At this inspection we spoke with the practice manager, lead dispenser and a receptionist. We spoke with four patients and a representative from the patient participation group (PPG). The PPG is a group of patients who have volunteered to represent patients' views and concerns and are seen as an effective way for patients and GP surgeries to work together to improve services and to promote health and improved quality of care.
Patients were happy with all aspects of the service the practice provided except getting through to the practice by telephone to make an appointment. Prior to this inspection we received information of concern regarding the appointment system and referral systems in place at the practice.
The practice had procedures for the reporting of medicine errors and systems in place to ensure that medicines were safely administered.
We found the practice had taken steps to carry out the required improvements since our last visit and there was now a system in place to ensure that all policies and procedures were accessible to staff.
The practice had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.
The practice did not have effective systems in place assess and monitor the quality of the service provision.
People told us the reception staff were responsive to their needs. One person told us they were, 'Absolutely fine, friendly and helpful.' People we spoke with told us they were happy with the service they received and were confident in the clinician they saw. One person told us they had felt, 'Really supported by the nurses.'
We saw systems ensured people received their medication when needed. One person said the staff who dispensed medication were, 'A happy bunch-always smiling and ready to help.' Medication was safely obtained, stored and disposed of. However, systems for investigating medication errors were not always completed in a timely fashion.
We saw there was sufficient numbers of staff with the appropriate skills and knowledge to meet people's needs.
The provider had systems in place to monitor the service people received. However systems for identifying risks and developing the service were not always completed in a timely fashion.