The Care Quality Commission
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  • GP practice

Archived: Caskgate Street Surgery

Overall: Inadequate read more about inspection ratings

3 Caskgate Street, Gainsborough, Lincolnshire, DN21 2DJ (01427) 619033

Provided and run by:
Caskgate Street Surgery

Important: The provider of this service changed. See new profile

All Inspections

24 May 2023

During a routine inspection

We carried out an announced comprehensive inspection at Caskgate Street Surgery on 24 May 2023. Overall, the practice is rated as Inadequate.

Safe - Inadequate,

Effective - Requires Improvement

Caring - Good

Responsive - Good

Well-led - Inadequate,

Following our previous inspection on 3 November 2016, the practice was rated good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Caskgate Street Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this comprehensive inspection to follow up concerns in response to risk in line with our inspection priorities. During our inspection we reviewed our 5 key questions of safe, effective, caring, responsive and well led.

How we carried out the inspection/review

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.
  • To ensure we gathered staff feedback we used a questionnaire which was given to staff electronically via email.
  • Completing remote 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) and discussing findings with the provider.
  • Reviewing patient records remotely to identify issues and clarify actions taken by the provider.
  • Requesting evidence to be submitted to us electronically from the provider.
  • A site visit.

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 did not provide care in a way that kept patients safe and protected them from avoidable harm.
  • Safety alerts were not being received and acted upon, which put patients at risk.
  • There were gaps in systems to assess, monitor and manage risks to patient safety.
  • Not all patients received effective care and treatment that met their needs. Patients with long tern conditions were not always reviewed effectively.
  • Staff did not have the information they needed to deliver safe care and treatment.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Patients could access care and treatment in a timely way.
  • Patients’ needs were not assessed, and care and treatment was not delivered in line with current legislation.
  • Leaders could not demonstrate they had the capacity and skills to deliver high quality sustainable care.
  • The overall governance arrangements were inadequate.

We found four breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure patients are protected from abuse and improper treatment
  • Ensure all premises and equipment used by the service provider is fit for use.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

  • Obtain Staff immunisation records for non-clinical staff.
  • Improve the number of carers, childhood immunisations and cervical screening rates.
  • Consider a patient feedback survey.

I am, therefore, 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 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 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.

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

3 November 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Caskgate Street Surgery on 3 November 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

  • Patient survey figures showed patients rated the practice higher than others for most aspects of care.

  • Comments about the practice and staff were positive. However two said they found it difficult to make an appointment with a named GP as they had to wait two to three weeks.Although they were able to be seen by an advanced nurse practitioner.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice had its challenges in a grade 2 listed building however it had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

  • Safety alerts and alerts from Medicines and Healthcare products Regulatory Agency (MHRA) were reviewed and cascaded to the appropriate persons.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular meetings.

  • The practice had identified 68 patients as carers (0.6% of the practice list). The practice said that they felt this could be improved.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

The areas where the provider should make improvement are:

  • Review process and methods for identification of carers and the system for recording this. To enable support and advice to be offered to those that require it.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

7 May 2014

During a routine inspection

Caskgate Street Surgery provides a range of primary care medical services to approximately 10,200 people.

During our visit to the practice on 07 May 2014 we spoke with patients who used the service and met with members of the Patient Participation Group. We spoke with doctors and other members of staff. We looked at procedures and systems used and considered whether the practice was safe, effective, caring, responsive to people's needs and well-led.

Caskgate Street Surgery was safe. There were appropriate safeguarding procedures in place, although the vulnerable adults safeguarding policy did not refer to the reporting guidelines the practice was following. Medicines were managed safely, the practice was clean and hygienic and there were arrangements in place to respond to emergencies. The emergency resuscitation equipment was not packed in readiness so that it could be easily transported by one person. Some areas of the building were worn and in need of redecoration.

The practice was effective and had procedures in place that ensured care and treatment was delivered in line with appropriate standards. There was an effective system in place to manage the health reviews of patients with long term conditions and there were effective working links with other health and social care providers.

The practice was caring, where patients were treated attentively and with dignity and respect. Patients spoke very positively of their experiences and of the care and of the attention offered by staff. The GPs provided personal intervention in people's end of life care.

The practice was responsive to people’s needs and had a good understanding of the demographic of its population and adjusted its resources to ensure patient’s needs were met.

The practice was well led. There was an active patient representation group in place. There was a philosophy of attentive care and kindness that was shared by all staff. There were effective governance procedures in place and a system of using information from patients and from records to monitor the effectiveness of the practice.