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Cromwell Medical Centre Good Also known as Cromwell and Wormley Medical Centres

Inspection Summary


Overall summary & rating

Good

Updated 9 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Cromwell Medical Centre on 20 October 2016. This was to check that improvements had been made following the breaches of legal requirements we identified from our comprehensive inspection carried out on 21 April 2016. During our inspection in April 2016 we identified regulatory breaches in the safe care and treatment, staffing and governance at the practice.

This report only covers our findings in relation to the areas requiring improvement as identified on inspection in April 2016. You can read the report from this comprehensive inspection, by selecting the 'all reports' link for Cromwell Medical Centre on our website at www.cqc.org.uk. The areas identified as requiring improvement during our inspection in April 2016 were as follows:

  • Maintain accurate records of investigations of safety incidents and complaints.
  • Ensure an appropriate system is in place for the safe use and management of medicines including a system for tracking blank prescription forms and pads, having valid and approved Patient Group Directions (PGDs) and Patient Specific Direction (PSDs).
  • Carry out a risk assessment to ensure the appropriateness of emergency medicines stocked.
  • Ensure that systems designed to assess the risk of and to prevent, detect and control the spread of infection are fully implemented.
  • Ensure that all applicable staff receive a criminal records check and that the required information is available in respect of the relevant persons employed.
  • Ensure that all staff employed are supported, receive the appropriate supervision and complete the essential training relevant to their roles and accurate records are kept in respect of the relevant persons employed.
  • Make available a business continuity plan.
  • Ensure a record of meetings held within the practice is kept.
  • Review and date practice specific policies so these are reflective of current legislation and guidance.
  • Maintain an oversight of the governance system in place to monitor the quality of the service.

Our key findings on this focused inspection across the areas we inspected were as follows:

  • The practice had an effective system in place for reporting and recording significant events, including handling complaints and concerns.
  • The practice had appropriate systems in place for the safe use and management of medicines, including emergency medicines and prescriptions. The practice had up-to-date Patient Group Directions (PGD’s) and Patient Specific Directions (PSD’s) in place.
  • Systems and processes were in place to assess the risk of and to detect, prevent and control the spread of infection. For example, the practice had completed an infection control audit and had taken action to address improvements identified as a result.
  • The practice had risk assessed the roles of all non-clinical staff and appropropriate checks had been undertaken through the Disclosure and Barring Service (DBS) check where applicable.
  • A process was in place to ensure regular staff appraisals and all staff had completed essential training relevant to their roles.
  • Practice policies were specific and up-to-date and reflected current legislation and guidance.
  • Steps had been taken to review and make improvements to the disabled patient toilet facilities. For example, an emergency call bell had been installed.
  • The practice had a business continuity plan in place.
  • Records were maintained of practice meetings and the practice had an overarching governance system in place to monitor the quality of services provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016, we identified breaches of legal requirements. Improvements were needed to processes and procedures to ensure the practice provided safe services.

During our focused inspection on 20 October 2016, we found the practice had taken action to improve and the practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.
  • There were sufficient systems and processes in place to monitor and address risks to patients and staff.
  • Suitable arrangements were in place for the practice to respond to emergencies and major incidents.
  • Systems were in place to ensure that staff employed at the practice received the appropriate recruitment checks.
  • Systems and processes were in place to assess the risk of and to detect, prevent and control the spread of infection.
  • The practice had appropriate systems in place for the effective management of emergency medicines and prescriptions.

Effective

Good

Updated 12 July 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average with the exception of diabetic and hypertension indicators which were below CCG and national averages. The practice has introduced a revised recall system and monitoring system to address this shortfall and was monitoring the effects of the improved system.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Not all staff had received appraisals in the past 12 months.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 12 July 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 12 July 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.

  • 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.

  • Information about how to complain was available and easy to understand.  Although the practice kept a summary of seven complaints received in the last 12 months they had not kept the details of the investigations and actions taken. There was no evidence that patients had always received a verbal and written apology.

Well-led

Good

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016, we identified breaches of legal requirements. Improvements were needed to processes and procedures to ensure the practice provided safe services.

During our focused inspection on 20 October 2016, we found the practice had taken action to improve and the practice is rated as good for providing well-led services.

  • Practice policies were in place and included named leads and up-to-date contact details. The policies reflected current legislation and guidance and a system was in place for the policies to be reviewed on a regular basis.
  • The practice had an effective system in place for handling complaints and concerns.

  • Staff members had received, were in the process of receiving, an appropriate appraisal and all staff members had completed essential training relevant to their roles.
  • The practice had a business continuity plan in place.
  • Records were maintained of practice meetings and we saw evidence to confirm the practice had an overarching governance system in place to monitor the quality of services provided.
Checks on specific services

People with long term conditions

Good

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016 we found that the practice offered effective care to patients with long term conditions.

However, breaches of legal requirements were identified and improvements needed to be made to ensure the practice provided safe services and was well-led. During our focused inspection on 20 October 2016 we found the practice had taken action to improve. Consequently the practice is rated as good for the care of people with long-term conditions as they received care that was safe and well-led.

Families, children and young people

Good

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016 we found that the practice provided a good service to families, children and young people including those children living in disadvantaged circumstances and who were at risk

However, breaches of legal requirements were identified and improvements needed to be made to ensure the practice provided safe services and was well-led. During our focused inspection on 20 October 2016 we found the practice had taken action to improve. Consequently the practice is rated as good for the care of families, children and young people as they received care that was safe and well-led.

Older people

Good

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016 we found that the practice offered proactive, personalised care to meet the needs of the older people in its population.

However, breaches of legal requirements were identified and improvements needed to be made to ensure the practice provided safe services and was well-led. During our focused inspection on 20 October 2016 we found the practice had taken action to improve. Consequently the practice is rated as good for the care of older people as they received care that was safe and well-led.

Working age people (including those recently retired and students)

Good

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016 we found that the practice offered a good service to patients of a working age and ensured the needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

However, breaches of legal requirements were identified and improvements needed to be made to ensure the practice provided safe services and was well-led. During our focused inspection on 20 October 2016 we found the practice had taken action to improve. Consequently the practice is rated as good for the care of working age people as they received care that was safe and well-led.

People experiencing poor mental health (including people with dementia)

Good

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016 we found that the practice had systems in place to ensure good care for those patients experiencing poor mental health including those patients with dementia.

However, breaches of legal requirements were identified and improvements needed to be made to ensure the practice provided safe services and was well-led. During our focused inspection on 20 October 2016 we found the practice had taken action to improve. Consequently the practice is rated as good for the care of people experiencing poor mental health as they received care that was safe and well-led.

People whose circumstances may make them vulnerable

Good

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016 we found that the practice held a register of patients living in vulnerable circumstances including those with a learning disability. The practice informed vulnerable patients about how to access support groups and voluntary organisations and staff knew how to recognise signs of abuse in vulnerable adults and children.

However, breaches of legal requirements were identified and improvements needed to be made to ensure the practice provided safe services and was well-led. During our focused inspection on 20 October 2016 we found the practice had taken action to improve. Consequently the practice is rated as good for the care of people whose circumstances may make them vulnerable as they received care that was safe and well-led.