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Archived: Cauldwell Medical Centre Good

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Inspection carried out on 06 Mar 2019

During a routine inspection

We carried out an announced comprehensive inspection at Cauldwell Medical Centre on 23 February 2018. The overall rating for the practice was requires improvement. The full comprehensive report on the February 2018 inspection can be found by selecting the ‘all reports’ link for Cauldwell Medical Centre on our website at .

We carried out an announced comprehensive inspection at Cauldwell Medical Centre on 6 March 2019 to follow up on practice improvements.

Our judgement of the quality of care at this service is based 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.

The practice is rated as good overall.

We rated the practice as good for providing safe services because:

  • People who used the service were protected from avoidable harm and abuse, and legal requirements were met.
  • The systems for infection prevention and control were adequate and the premises were visibly clean and tidy.
  • Prescriptions were managed safely and the practice ensured they were logged in and out of clinical sessions
  • Safety alerts were appropriately managed. Clinical records we looked at confirmed this.

We rated the practice as requires improvement for providing effective services because:

  • Clinical indicators for patients with long-term conditions and patients suffering from a mental health condition were below the local and national averages.
  • Childhood immunisation uptake rates were below the World Health Organisation (WHO) targets.

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

  • Staff showed commitment to patient care and ensured their privacy and dignity was maintained at all times.
  • The practice maintained a carers register and offered appropriate support to these patients.

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

  • The GP National Survey results were in line with local and national averages.
  • Complaints were appropriately responded to and analysed. Learning from complaints was regularly shared with staff members.
  • The practice had responded to patient feedback and made improvements to the service.

We rated the practice as good for providing well-led services because:

  • The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.
  • Staff told us that they felt supported and that management teams were visible and responsive to concerns.
  • Key policies were accessible to all staff.

There were areas where the provider should make improvements:

  • Continue to monitor and improve clinical indicators and ensure reviews are completed.
  • Explore how the uptake of cancer screening could be improved.
  • Continue to encourage patients to join a patient participation group.
  • Improve levels of patient satisfaction in particular, those in relation to being treated with kindness, respect and compassion and also in relation to access.
  • Continue to ensure patient safety by completing regular fire drills and completing a security risk assessment.

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

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 23 February 2018

During a routine inspection

This practice is rated as Requires improvement overall.

The key questions 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

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 recently 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 carried out an announced comprehensive inspection at Cauldwell Medical Centre on 23 February 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Cauldwell Medical Centre was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

In addition to providing a general practice service, Cauldwell Medical Centre delivers primary urgent care services, patients can access this service through Bedford Hospitals Accident & Emergency (A&E) department. The provider is commissioned to provide this service to up to 20 patients per day. We did not inspect this primary urgent care service as part of our inspection, this inspection was conducted using our GP primary care methodology where we inspected the GP service only.

At this inspection we found:

  • The practice had clear systems to keep people safeguarded from abuse. All staff received up-to-date safeguarding and safety training appropriate to their role.

  • There was a system for recording and acting on significant event and there were effective systems for reviewing and investigating when things went wrong. However, we found that there was a lack of regular practice meetings in place and areas such as lessons learnt from significant events and complaints were not being shared on a formal basis. Specifically, minutes viewed as part of our inspection did not demonstrate lessons learnt or sharing of learning as a result of incidents or significant events.

  • Clinicians knew how to identify and manage patients with severe infections such as sepsis. However, during our inspection we found that the practice had not formally assessed risk in the absence of specific paediatric emergency equipment.

  • In addition, we found that processes to support the appropriate and safe use of medicines were not effectively embedded. Specifically, we found that there was a lack of consistency on the reauthorisation of prescriptions for long-term medications and that the historical ineffective use of the patient record system made it difficult to identify those patients needing a review of their medicines.

  • At the point of our inspection we found that there was no formal programme of multi-disciplinary team (MDT) meetings in place to help deliver a co-ordinated approach to patients needing end of life care, palliative care and complex care support. Following our inspection the provider explained that there had been local changes to teams and boundaries and a contractual change of their community services. Additional evidence was provided following our inspection which demonstrated that an MDT meeting had since taken place on 3 April 2018.

  • There was a lack of focus on continuous learning and improvement within the practice. For instance, although there was a lead GP in place to offer informal supervision and support, we found that clinical supervision was provided only on an informal basis.

  • In addition, clinical audits were due to be repeated and therefore did not demonstrate quality improvement or improved patient outcomes at the time of our inspection.

  • Although the practice had identified less than 1% of their practice list as carers, we found that the practice was actively working at increasing their carers register. For example, the practice had carer’s notices, posters and leaflets in place. They utilised carer’s registration forms and also had two carer’s champions in the practice.

  • During our inspection the practice did not provide evidence to demonstrate that they had a process in place to offer bereavement support or advice if families had experienced bereavement. Following our inspection the practice provided further information and supporting evidence which clarified that correspondence was sent to those who had suffered bereavement. In addition to this, the practice highlighted posters and leaflets in place. Although evidence of this was provided following our inspection, we did not see this in place on the day of our visit.

  • There was no patient participation group to engage with patients to improve services, the practice informed us that they were working on this as part of a practice improvement plan which was provided as part of our inspection.

  • Furthermore, we noted that the practice had taken some steps to improve appointment access by increasing the number of administrative staff during busy times and were looking at the possibility of extending their service hours in the evenings.

  • However, our inspection findings highlighted that the overall leadership and accountability structures were not always clear and fully embedded; furthermore they did not demonstrate how improvement in the practice would be sustained.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure clinical leadership and good governance in accordance with the fundamental standards of care.

  • Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

  • Continue to identify carers in order to offer them support where needed.

  • Ensure that annual reviews are completed for patients where needed including patients with a learning disability and patients experiencing poor mental health (including people with dementia.

  • Continue to work on the development of a patient participation group in order to gather and act on patient feedback and improve services.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice