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Cramlington Medical Group Good

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Reports


Review carried out on 9 September 2021

During a monthly review of our data

We carried out a review of the data available to us about Cramlington Medical Group on 9 September 2021. 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 Cramlington Medical Group, you can give feedback on this service.

Inspection carried out on 16 July 2019

During an inspection looking at part of the service

We decided to undertake an inspection of this service following our annual review of the information available to us.

The provider was registered to deliver care and treatment at this practice in 2015. At the last inspection, in November 2016, we rated the practice as requires improvement for providing effective services, but good overall. This was because:

  • Effective processes were not in place for recording and monitoring the training staff required to carry out their role.

  • The practice’s Quality and Outcomes Framework (QOF) performance was variable, when compared to the local clinical commissioning group (CCG) national averages.

This report reflects the impact of the improvements made by the provider, and their clinical team at Cramlington Group, and provides evidence of improving patient outcomes, and strong systems for learning, continuous improvement and innovation.

This inspection looked at the following key questions:

  • Effective

  • Well led.

At this inspection, we found the provider had put effective processes in place to record and monitor staff training. We also found they had continued to improve their arrangements for providing patients with effective care and treatment that met their needs. The practice’s QOF achievement, for 2017/18, demonstrated how they had improved patient outcomes overall. However, the overall exception reporting rate, for the 2017/18 QOF year, was higher than both the local CCG and national averages. Unverified, unpublished QOF data, for 2018/19, indicated exception reporting levels for the majority of clinical indicators which were previously twice the national average, had reduced, in some cases significantly, whilst patient register numbers had remained broadly similar over both QOF years.

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 have rated this practice as good overall, good for the effective key question, and good for all of the population groups.

We have also rated the practice as outstanding for the Well Led key question. This is

because there was an embedded and systematic approach to improvement, which was improving patient safety. Leaders used improvement methods to deliver change, and to support development and innovation. Staff felt empowered to lead and deliver change.

We found that:

  • Patients’ needs were assessed and care and treatment was delivered in line with current legislation, standards and evidence-based guidance.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Patient feedback from our CQC comment cards was overall very positive.

  • There was a very strong focus on continuous learning and improvement at all levels of the organisation, and the practice made effective use of external reviews to help them make improvements.

  • There was a strong commitment to developing the practice’s leadership team.

  • Leaders had a very good understanding of the issues and challenges they faced in developing the practice further, and they had a strong strategy and improvement plan in place to help them do this. The practice and their provider had a systematic approach to monitoring and reviewing progress.

We saw examples of outstanding practice:

  • In response to feedback from the local emergency department, the practice had strengthened their arrangements for managing the extra demands and challenges they faced during the winter period. Improvements included: the nursing team carrying out earlier home visits to vulnerable patients; collaborating with the provider’s specialist frailty nurse to carry out weekly reviews of all hospital discharges, to help reduce hospital admissions; targeted use of 15-minute appointments for vulnerable patients.

  • The practice operated a system of external clinical peer review, to help improve the quality of the services they delivered. Examples of reviews carried out to date included: palliative and diabetic care; quality care planning; referral management and safeguarding children. The practice was able to demonstrate improvements had been made as a result of these reviews.

  • Following a learning event at the practice, leaders had set up a Quality Summarising Project, to help ensure the accuracy of their medical records. To date, out of approximately 5000+ medical records, 28% (1544) had been re-summarised, to help provide clinicians with assurances that the information they used to support their clinical decision-making was accurate.

  • The practice had initiated an in-house, safe prescribing project, to help reduce the prescribing of a certain group of medicines that can result in dependence, misuse and opioid-related deaths. These demonstrated progress had been made in reducing opiate, gabapentinoid and benzodiazepine prescribing, which had previously been very high. Statistical data included in this evidence table indicates the practice’s prescribing of hypnotics (drugs that can be used to treat insomnia) was well below the national average.

Whilst we found no breaches of regulations, the provider should:

  • Continue to reduce their QOF exception reporting rates, particularly in relation to the care and treatment provided to patients with long-term conditions.

  • Continue to develop approaches to support the uptake of cervical smear tests.

  • Review the practice’s whistleblowing policy to make sure it is consistent with the guidance in the NHS Improvement Raising Concerns (Whistleblowing) Policy

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

Inspection carried out on 18 November 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We first carried out an announced comprehensive inspection at Cramlington Medical Group on 1 February 2016. Overall, we rated the practice then as requires improvement. There was a breach of legal requirement. In particular, we found that staff had not completed all of the training they needed to effectively and safety carry out their roles and responsibilities.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the above regulation. We carried out a comprehensive inspection on 18 November 2016 to check whether the provider had taken steps to comply with the above legal requirement. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Cramlington Medical Group on our website at www.cqc.org.uk.

Overall, the practice is rated as good.

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

  • The practice had complied with the requirement notice we set following the last inspection. We found that the practice had ensured that all relevant staff had completed training on the Mental Capacity Act 2005 as stated in the action plan the practice produced following the previous inspection.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Lessons were learned when incidents and near misses occurred.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • 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 on the practice website and easy to understand.
  • Most patients said they found it easy to make a routine appointment with a GP and there was continuity of care, urgent appointments were available on the same day.
  • The practice 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 regulation.

The areas where the provider should make improvements are:

  • Review the processes for recording and monitoring the training that is required by staff to carry out their role. 
  • Continue to take action to improve the practice’s Quality and Outcomes Framework (QOF) performance.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection carried out on 01 February 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cramlington Medical Group, on 1 February 2016. Overall, the practice is rated as requires improvement.

Following our previous inspection in May 2015, we rated the practice as inadequate. However, the CQC made a decision not to place the practice into Special Measures, as the previous provider was no longer carrying on the Regulated Activities, and a new provider was in the process of applying for the location to be added to their existing registration.

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

  • The new provider had made good progress in addressing the concerns and breaches of regulation we identified during our previous inspection, in May 2015.

  • There was an open and transparent approach to safety and a good system for reporting and recording significant events

  • The new provider had introduced systems, processes and protocols, which were helping to make sure patients’ needs, were assessed and care was planned and delivered, in line with current evidence based guidance.

  • The new provider had made good progress in making sure services were tailored to meet the needs of individual patients. All staff were actively engaged in monitoring and improving quality and patient outcomes, and were committed to supporting patients to live healthier lives through a targeted and proactive approach to health promotion.

  • Nationally reported Quality and Outcomes Framework data, for 2014/15, showed that the previous provider’s performance, regarding the provision of recommended care and treatment to patients, was variable. The new provider was taking active steps to address the underlying causes of this and improve the practice’s performance.

  • The new provider had made good progress improving the practice’s systems and processes and arrangements had been put in place to identify risks to patients and staff. However, although staff had made improvements to the practice’s patient call and recall systems, potentially inaccurate disease registers kept by the previous provider, posed a continuing risk to some groups of patients.

  • The new provider's staff team worked closely with other organisations, and healthcare professionals, when planning how to provide services which met patients’ needs.

  • Patients’ emotional and social needs were seen as being as important as their physical needs, and it was evident there was a strong, person-centred culture. Patients said they were treated with compassion, dignity and respect and that they were involved in decisions about their treatment.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • The new provider had taken active steps to assure the delivery of high-quality, person-centred care. They supported learning and innovation, and promoted an open and fair culture. Good governance arrangements had been put in place.

However, there are areas where the new provider must make improvements. The provider must:

  • Ensure staff complete all of the training they need to effectively and safely carry out their roles and responsibilities.

There are areas where the new provider should make improvements. The provider should:

  • Make sure blank prescriptions are stored in line with national guidance and keep them secure at all times.

  • Continue to take action to improve the practice’s QOF performance.

  • Ensure all patients over 75 years of age have a named GP.

  • Continue to demonstrate quality improvement and effective care through the completion of two-cycle clinical audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice