Background to this inspection
Updated
9 October 2019
Crossroads Medical Practice is a GP practice which provides a range of primary medical services to 6090 patients from a surgery in North Hykeham, a suburb of the City of Lincoln. The practice has one location registered with the Care Quality Commission (CQC) at:
Crossroads Medical Practice, Lincoln Road, North Hykeham, Lincoln LN6 8NH. There are no branch surgeries and it is not a dispensing practice.
The practice is registered to provide the regulated activities of: Diagnostic and screening services;
Maternity and midwifery services; Treatment of disease, disorder or injury.
The practice’s services are commissioned by NHS Lincolnshire West Clinical Commissioning Group (LWCCG).
At the time of our inspection the service was provided by two GP partners, two part time salaried GP (two sessions a week) and one regular locum GP (four sessions per week) one advanced nurse practitioner, one nurse practitioner, three practice nurses and one healthcare assistant. They are supported by a practice manager, reception manager and reception and administration staff. The two GP partners who are not based at the practice but on occasions provide some clinical services. They did not have formal or regular clinical sessions at the practice.
The practice has a General Medical Services Contract (GMS). The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. Local community health teams support the GPs in provision of maternity and health visitor services.
The surgery is a two storey purpose-built premises with a large car park which includes car parking spaces designated for use by people with a disability. All patient facilities are on the ground floor.
We reviewed information from Lincolnshire West CCG and Public Health England which showed that the practice population had lower deprivation levels compared to the average for practices in England.
The practice has opted out of providing GP consultations when the surgery is closed. Out-of-hours services are provided through Lincolnshire out-of-hours Service which is provided by Lincolnshire Community Health Services NHS Trust. Patients access the service via NHS 111.
Updated
9 October 2019
We carried out an announced comprehensive inspection at Crossroads Medical Practice on 24 September 2015. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months.
On 7 July 2016 we carried out an announced comprehensive inspection to ensure that sufficient improvement had been made following the practice being placed in to special measures as a result of the findings in September 2015. The improvements were insufficient, and the practice remained in special measures.
On 9 March 2017 an inspection was undertaken to determine if sufficient improvements had been made. Overall the practice was rated as inadequate as insufficient improvements had been made. The practice remained in special measures and we issued a notice of proposal to begin the process of cancelling the registration.
We carried out an announced focussed inspection of Crossroads Medical Practice on 17 May 2017. This was to check compliance relating to the serious concerns found during the comprehensive inspection on 9 March 2017. We found that enough improvements had been made in relation to breaches of Regulation 12 (Safe care and Treatment) and Regulation 17 (Good Governance). We therefore withdrew the notice of proposal to cancel the service and the practice remained in special measures.
An inspection was conducted on 7 November 2017 following the third period of special measures to ensure improvements had been made and to assess whether the practice could come out of special measures. The practice was rated as requires improvement and was taken out of special measures as significant improvements had been made.
It was again inspected on 11 September 2018 to follow up on and check whether improvements had been sustained. The practice was rated as inadequate in safe, effective, responsive and well-led. It was rated as requires improvement in caring. It was inadequate overall and placed back into special measures.
As a result of that inspection we imposed conditions on the provider registration, namely;
- From 24 April 2017 the practice will plan a rota of the partners to have a daily presence at the practice and also to be on call for that day. Any issues will be the responsibility of that Partner to deal with on that day. This rota will be submitted as part of our ongoing commitment and reports submission on the 28th of each month.
- The Registered Person must have sufficient practice management capacity on a daily basis at Crossroads Medical Practice to secure and sustain improvements to deliver the regulated activities in accordance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
These conditions are still in force.
This inspection carried out on 8 August 2019 was an announced comprehensive inspection to see if sufficient improvements had been made for the service to come out of special measures.
We rated the practice as requires improvement for providing safe, effective, caring and responsive and inadequate for providing well-led services. We rated the practice as requires improvement overall. All of the population groups were rated as requires improvement as the cross-cutting themes leading to the overall ratings affected all patient groups.
Our key findings from this inspection were;
- Patients did not always receive effective care and treatment that met their needs.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- Patient feedback indicated that they found it difficult to get through to the practice by telephone.
- The availability of appointments with GPs and nurse practitioners made it difficult for patients to access care and treatment in a timely way.
- The way the practice was led and managed did not promote the delivery of high-quality, person-centre care.
- There was an emphasis on audit as means of assessing, measuring and improving outcomes for patients.
- The practice had achieved significant increases in attainment of the Quality Outcomes Framework during 2018/19.
- The systems and processes intended to keep people safe were not always effective.
The areas where provider must make improvements as they are in breach of the Regulations are:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
In addition, the provider should:
- Review the number of clinical appointments available and the most effective use of GP time when at the practice to the greater benefit of Crossroads Medical Practice patients.
- Continue to review the appointments system to help improve patient access to services.
- Review the telephony system to help improve access, especially during times of peak demand.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
This service was placed in special measures on 5 December 2018 following the inspection of 11 September 2018. Insufficient improvements have been made such that there remains a rating of inadequate for well-led. This service will remain in special measures. 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.
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