All inspections: The Crossroads Surgery

We carried out an announced comprehensive inspection at The Crossroads Surgery on 12 July 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 24 July 2018.

At that inspection we found that:

The practice had not always learnt from incidents to improve their processes.
Formal arrangements to provide GP support to the nursing team in the absence of the provider had not been introduced.
Systems were not effective in assessing and monitoring the quality and safety of all aspects of the service.
The safeguarding policy did not provide staff with information required for them to meet their legal obligations.
Systems for dealing with mental capacity were not sufficiently detailed.
Processes for promoting confidentiality were not followed.
The complaints policy was not specific to the service and information about making a complaint was not readily accessible.
Some policies and procedures were not sufficiently detailed and did not provide staff and patients with enough information about what to do in given circumstances.
The patients right to complain was not promoted by the service because information about how to complain was not readily available.

At this inspection we found the provider had satisfactorily addressed these areas.

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 and good for all population groups.

We found that:

The practice provided care in a way that kept patients safe and protected them from avoidable harm.
Patients received effective care and treatment that met their needs.
Staff dealt with patients with kindness and respect and involved them in decisions about their care.
The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

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

Increase the information about support groups available on the practice website.
Develop a formal written business plan which relates to implementing and monitoring the services strategy.
Be explicit about the agencies that need to be contacted in the event of actioning the Business Continuity plan. For example, include when it would be required to complete a Care Quality Commission notification.
Make the monitoring processes easier to review.

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

This practice is rated as Requires Improvement overall. (Previous rating November 2017 –Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? –Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? –Requires Improvement

Are services well-led? –Requires Improvement

We carried out an announced comprehensive inspection at The Crossroads Surgery on 24 July 2018 to follow up on breaches of regulations and requirement notices we had made. This report covers our findings in relation to those requirement notices, additional improvements made since our last inspection and a comprehensive review of all other key questions.

At our previous inspection on 21 November 2017 we rated the practice as requires improvement overall and for providing safe, responsive and well-led services. This was because: -

References were not available for staff to demonstrate their conduct in previous employment.
The registered person had failed to inform the relevant health or social care regulator about the fitness of a person employed.
There were no formal arrangements to provide GP services to patients and support to the nursing team in the absence of the provider.
Systems were not effective in assessing and monitoring the quality and safety of the service.
Formal systems were not in place to review consultations, prescribing or referrals. Reviews which were completed had not been documented.
Policies and procedures, including the locum induction pack, did not provide enough guidance to staff.
The provider had not ensured all staff had appropriate indemnity insurance.

At this follow-up comprehensive inspection, we found most of these matters had been resolved, however we found additional areas of concern.

The practice had systems to manage risk so that safety incidents were less likely to happen. However, when incidents did happen, the practice did not always learn from them and improve their processes.
The practice routinely reviewed the effectiveness and appropriateness of the care it provided and ensured care and treatment was delivered according to evidence- based guidelines.
The recruitment records had improved and indemnity information was readily available.
Staff involved and treated patients with compassion, kindness, dignity and respect.
The practice planned cover for holiday in advance of when needed and a protocol was in place for getting additional clinical staff at short notice.
Patients found the appointment system easy to use and reported that they could access care when they needed it.
Equipment was safe to use.
Formal arrangements to provide GP support to the nursing team in the absence of the provider had not been introduced.
Systems were not effective in assessing and monitoring the quality and safety of all aspects of the service.
The safeguarding policy did not provide staff with information required for them to meet their legal obligations.
Systems for dealing with mental capacity were not sufficiently detailed.
Processes for promoting confidentiality were not followed.
The complaints policy was not specific to the service and information about making a complaint was not readily accessible.
Some policies and procedures were not sufficiently detailed and did not provide staff and patients with enough information about what to do in given circumstances.
The patients right to complain was not promoted by the service because information about how to complain was not readily available.

The areas where the provider must make improvements are:

Ensure the care and treatment of patients is only provided with the consent of the relevant person.
Ensure care and treatment is provided in a safe way to patients.
Ensure patients are protected from abuse and improper treatment.
Ensure that any complaints received are investigated and proportionate action is taken in response to any failure identified by the complaint investigation, and ensure there is an effective system for identifying, receiving, recording and handling and responding to complaints by patients and other persons in relation to carrying out the regulated activity.
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:

Act to assure themselves with regards to the immunisation status of all clinical staff working at the practice.
Introduce systems to ensure staff complete the training available to them.
Develop a system to ensure all water outlets are tested within the required period.
Review the risk and formalise arrangements for GP cover when the advanced nurse practitioners are alone at the practice.
Use the systems in place to investigate incidents.
Develop a formal practice strategy or plan for audit and quality improvement work.
Prioritise improving privacy and confidentiality in the patient waiting area.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

We rated the population groups as requires improvement overall because the issues identified as requires improvement relating to patient safety, responsiveness and providing a well-led service affected all patients.

We carried out an announced comprehensive inspection at The Crossraods Surgery on 21 November 2017 as part of our inspection programme.

At this inspection we found:

There were systems in place to manage medication safely.
Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

Staff were aware of their responsibilities in relation to safeguarding children and vulnerable adults however the deputy safeguarding lead was not clear about some processes.

Recruitment records did not contain all the necessary information to demonstrate the suitability of staff.
Policies and procedures did not provide appropriate guidance to staff.
There were no formal arrangements in place to provide GP services to patients and support to nursing staff when the GP was not available at the practice.
All the required safety checks of the premises had not taken place.
Patients’ needs were assessed and care was planned and delivered following best practice guidance.

Staff felt supported and they had access to training and development opportunities appropriate to their roles.

Patients said they were overall treated with compassion, dignity and respect. We saw staff treated patients with kindness and respect.
Seven out of 30 patients who returned comment cards made comments about lack of access to a GP or not being able to see the same GP.

Complaints were taken seriously however improvements were needed to make the process more robust.
The systems to promote good governance and management were not sufficiently robust.

The areas where the provider must make improvements as they are in breach of regulations are:

Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment
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:

The distribution of patient safety alerts should be monitored to ensure all clinicians receive them.
The significant event policy should include examples of what constitutes such an event.

Cleaning schedules should be put in place, checks of cleaning standards should be documented and a recorded action plan put in place to show how the actions from the external infection control audit are to be met.
A system to enable safety checks of the premises to be undertaken at the required frequencies should be put in place.
The deputy safeguarding lead should familiarise themselves with all processes relating to adult and child safeguarding so that they can operate them effectively in the absence of the designated lead.
Written information about the role and remit of the advanced nurse practitioner should be publicised so that patients can make an informed choice about which clinician they request an appointment with.
A copy of the non-medical prescribers declaration that has been signed by the provider should be held at the practice.
The practice website should contain further information for patients to refer to such as relevant policies and procedures, information about health conditions and support organisations.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Archived: The Crossroads Surgery

All Inspections

12 July 2019

During a routine inspection

During a routine inspection

21 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice