All inspections: Crewkerne Health Centre

We carried out a review of the data available to us about Crewkerne Health Centre 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 Crewkerne Health Centre, you can give feedback on this service.

Why we carried out this inspection

At our inspection in September 2019 we rated the service as requires improvement overall. The key questions for safe, effective and well led were rated as requires improvement; the key questions for caring and responsive were rated as good. We issued requirement notices for regulation 12 (safe) and regulation 17 (good governance) of the Health and Social Care Act 2014.

We carried out an announced inspection at Crewkerne Health Centre on 19 July 2021. At this inspection we found the provider had taken action to address the issues raised at the previous inspection including in the areas where there were breaches to regulations. The provider is now compliant with regulations. At this inspection we have rated the practices as good.

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led - Good

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

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:

Conducting staff interviews using video conferencing
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting evidence from the provider
Reviewing documentation, policies and procedures
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 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.
The clinical needs of patients were monitored by clinicians in a timely way and appropriate care and treatment was provided.
Staff were trained and competent to carry out their roles. Infection control procedures ensured safety and reduced the risk of cross infection.
A programme of refurbishment was in progress and included the replacement of carpets within clinical areas; changing ceiling window blinds so they were easier to use; and clean and decoration of some areas.
Governance arrangements were formalised to ensure non-medical prescribers were competent and PGDs complied with national guidelines.
Comprehensive checks and records were undertaken to ensure the safety of emergency equipment and medicines.
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 adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way. The practice monitored and reviewed the telephone systems and provided data to support this monitoring. However, during our inspection we saw there had been a number of calls abandoned and patients waiting for their call to be answered.
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:

Continue to monitor the telephone access for patients and take appropriate action so that patients do not abandon their call and are answered in a timely way.
Continue to follow the identified actions to improve the environment so that infection control and prevention is promoted in all areas.
Continue to take action to meet the national targets for cervical screening.

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

We carried out an announced comprehensive inspection at Crewkerne Health Centre on 11 September 2019 as part of our inspection programme and in response to concerns identified at a previous inspection.

At the last inspection in September 2018 we rated the practice as requires improvement for providing safe, effective and well-led services because:

There were not adequate systems in place to mitigate risk relating to fire, infection control and the storage of hazardous chemicals.
There was insufficient information relating to the immunisation status of staff.
Management of medicines did not mitigate risk.
Patient records were not adequately and accurately maintained.
Not all patients had received regular reviews of their care and treatment when needed.

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 requires improvement overall.

We rated the practice as requires improvement for providing safe, effective and well led services because:

Information regarding medicine reviews was not consistent and did not ensure reviews were carried out in line with practice policy and relevant guidance.
Processes to ensure patients received appropriate monitoring of high-risk medicines, were not always effective to ensure patients received safe and appropriate care and treatment.
Processes to ensure patient group directions were signed and authorised in line with guidelines was not followed correctly.
Oversight of staff training was not effective. The practice was unable to demonstrate that all relevant staff had received appropriate training in line with practice policy.
The practice could not demonstrate how they were assured of the competencies of non-medical prescribers.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as good for providing caring and responsive services because:

Most 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 areas where the provider must make improvements 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:

Establish systems to review the care and treatment provided by locum clinicians to ensure best practice.
Continue to improve uptake of cervical screening.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Rosie Benneyworth

Chief Inspector of PMS and Integrated Care

This practice is rated as Requires Improvement overall. (Previous rating under a previous provider: September 2015 – Good)

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? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Crewkerne Health Centre on 5 and 6 September 2018 as part of our inspection programme. During this inspection we visited Crewkerne Health Centre and the branch surgery West One Surgery.

At this inspection we found:

The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
The practice routinely reviewed the effectiveness and appropriateness of the care they provided. They ensured that care and treatment was delivered according to evidence-based guidelines.
Staff involved and treated patients with compassion, kindness, dignity and respect.
There was a focus on continuous learning and improvement at all levels of the organisation.
There were systems in place for reviews of patients and their medicines (polypharmacy – concurrent use of multiple medications by a patient) where they were taking four or more different medicines daily.
There had been significant delays in the programme of annual reviews of patients with long term conditions, mental health needs and dementia, although improved recently they were still below the expected local and national targets.
Staff encouraged and supported patients to be involved in monitoring and managing their own health, for example through social prescribing schemes.
The patient participation group had a positive effect on the practice and the community with working with the practice to provide emergency first aid training for parents or carers of children.
There were new policies and procedures and a system of governance which needed to have time to be fully implemented and embedded.

The areas where the provider must make improvements are:

Ensure the necessary information is available regarding staff immunisation status in line with Public Health England(PHE) guidance.
Ensure they monitor and address the gaps in maintaining meeting the patients’ needs including patients with long term conditions, mental health and dementia.
The provider must ensure patient records at West One Surgery are adequate maintained so that there is continuity of care.
Ensure there are safe systems in place for fire safety, checks for safe equipment, safeguarding training and training for persons undertaking health and safety audits and risk assessments, for infection prevention and control and for chemicals used by the practice.
Ensure medicines are stored safely.
Ensure there is a system of safe storage and handling of prescription stationery.

The areas where the provider should make improvements are:

Review and continue to monitor the progress to bring employment information up to date regarding staff transferred to the provider organisation such as training, skills and qualifications.
Review and continue to monitor regular audits for health and safety.
Review and continue to monitor patient confidential information is kept securely and in line with General Data Protection Regulation (GDPR) 2018.
The practice should continue to proactively identify carers.

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.

Crewkerne Health Centre

All Inspections

6 July 2023

During a monthly review of our data

19 July 2021

During a routine inspection

11 Sep 2019

During a routine inspection

5 September to 6 September 2018

During a routine inspection