The Care Quality Commission
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  • GP practice

Christchurch Medical Practice

Overall: Good read more about inspection ratings

Christchurch Medical Centre, 1 Purewell Cross Road, Christchurch, Dorset, BH23 3AF (01202) 481901

Provided and run by:
Christchurch Medical Practice

All Inspections

During an assessment under our new approach

Christchurch Medical Practice is a GP practice and delivers services to approximately 15,500 people under a contract held with NHS England. The service is made up of 2 neighbouring sites, otherwise known as Orchard Practice and Barn Surgery. The service closed both of its branch surgeries, Burton Medical Centre and Bransgore Medical Centre. The service had since restructured its services including staffing and model of care to realign to the needs of the local community. In particular, using triage systems for access to services.

The National General Practice Profiles states demographics of people using the service are in line with local and national averages. Information published by Office for Health Improvement and Disparities shows that deprivation within the service population group is in the 7th decile (7 of 10). The lower the decile, the more deprived the service population is relative to others. This assessment considered the demographics of the people using the service, the context the service was working within and how this impacted service delivery. Where relevant, further commentary is provided in the quality statements section of this report. The assessment was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this assessment did not examine the circumstances of the incident. However, safeguarding people requiring a home visit and the subsequent coordination of care. This assessment examined those risks.

The service had a good learning culture and people could raise concerns. Leaders investigated incidents thoroughly. Staff understood and managed risks. The facilities and equipment met the needs of people, were well-maintained and any risks had been mitigated. The service did not always assess or manage the risk of infection effectively. Although the service had oversight of risks and performance, systems and processes were not always effective to address shortfalls in relation to a backlog of documents for clinical follow-up or filing, causing potential delays in care and treatment planning. The service did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development in line with national guidelines or service policy. The service did not ensure medicines and treatments were safe and met people’s needs, capacities and preferences. The service did not always have fully effective and embedded processes for monitoring people’s health in relation to asthma, safety alerts and some medicines prescribed which required monitoring. The service took action to address these issues following the assessment and provided evidence to demonstrate no harm had occurred.

Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people and took decisions in people’s best interests where they did not have capacity.

People were treated with kindness and compassion. Staff protected their privacy and dignity and supported people with their preferences on care and treatment. The service supported staff wellbeing.

People were involved in decisions about their care. The service provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it. People received fair and equal care and treatment. The service worked to reduce health and care inequalities through training and feedback. People were involved in planning their care and understood options around choosing to withdraw or not receive care. The service did not always ensure people could access care in a timely way via the telephone system. Average call waiting times and abandonment rates (percentage of callers who disconnect before reaching a call handler) consistently fell short of expected targets and national averages. This increased the risk of delays in accessing care and support.

Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. Staff understood their roles and responsibilities. The service worked with the local community to deliver the best possible care and were receptive to new ideas. There was a culture of continuous improvement with staff given time and resources to try new ideas.

We identified 2 breaches of the legal regulations in relation to safe care and treatment and good governance. We have asked the provider for an action plan in response to the concerns found at this assessment.

22 September 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a desktop review of the Orchard Surgery on 16 September 2016. This review was performed to check on the progress of actions taken following an inspection we made in May 2016. Following that inspection the provider sent us an action plan which detailed the steps they would take to meet their breach of regulation. During our latest desktop review on 16 September 2016 we found the provider had made the necessary improvements.

This report covers our findings in relation to the requirements and should be read in conjunction with the report published in August 2016. This can be done by selecting the 'all reports' link for the Orchard Surgery on our website at www.cqc.org.uk

Our key findings at this inspection were as follows:

The practice had improved the governance systems ensuring that mandatory training was managed effectively so that patient safety was promoted and any risks that could affect the quality of care were reduced. This included the introduction of:

  • A system to monitor training, which provided managers with an overview of all staff training at the practice.

  • The inclusion of training needs and gaps as a standing item for discussion at GP partnership meetings.

  • Oversight of fire safety training and drills was carried out by a named person and monitored at GP partnership meetings.

  • Chaperone training was provided in July 2016 for all staff undertaking this role.

  • Mental Capacity Act 2005 training was provided for 10 staff in July 2016.

  • A fire drill took place across Christchurch Medical Centre in September 2016.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

17 and 18 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Orchard Surgery located at Christchurch Medical Centre on 17 and 18 May 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. This was beginning to influence the development of a common approach across all three practices based at Christchurch Medical Centre.
  • Risks to patients were assessed and well managed. The practice provided leadership and managed a team, which proactively managed vulnerable patients and those at risk of unplanned hospital admission.
  • 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.
  • 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.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available 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.
  • Governance systems in regard of patient safety were not effective in picking up gaps in training for staff in regard to the role and responsibilities of a chaperone, the Mental Capacity Act 2005 or fire safety.

We saw two areas of outstanding practice:

  • Orchard Surgery provided leadership for the Action Management Before Emergency Risk team (AMBER), providing proactive support to vulnerable patients to avoid unplanned hospital admissions where ever possible. Data across all three practices demonstrated that patients were successfully cared for in the community limiting the number of unplanned hospital admissions for them.

  • GPs held lead roles with the Dorset Clinical Commissioning Group for prescribing and safeguarding. Through this engagement with local GP practices, the GPs promoted better patient experience and joined up working. A safeguarding template for both adults and children had been created, by a GP from the practice, with hyperlinks to current guidelines and had been rolled out to other practices in the area.

The areas where the provider must make improvement are:

  • Ensure that mandatory training is managed effectively so that patient safety is promoted andany risks that could affect the quality of care are reduced. These must include effective monitoring of fire safety training and drills, Mental Capacity Act 2005 training for all staff, and chaperone training for those staff undertaking this role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice