The Care Quality Commission
  • Doctor
  • GP practice

Cricklade Surgery

Overall: Good read more about inspection ratings

113 High Street, Cricklade, Swindon, Wiltshire, SN6 6AE (01793) 750645

Provided and run by:
Dr Lanil de Silva

All Inspections

06 May 2022

During an inspection looking at part of the service

We carried out an announced inspection at Cricklade Surgery on 06 May 2022. Overall, the practice is rated as Good.

Set out the ratings for each key question

Safe - Good

Effective - Good

Well-led – Requires Improvement

Following our previous inspection on 31 March 2021, the practice was rated Requires Improvement overall for providing safe services.

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

Why we carried out this inspection

This inspection was a focused follow-up inspection to review:

  • Safe, Effective and Well-led domains
  • Breaches of regulations and ‘shoulds’ identified from the previous inspection
  • Aspects of Responsive domain with the ratings carried forward from the previous inspection

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 remote 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
  • A short 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

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.
  • Patient feedback overall was positive, including access to services.
  • Staff had the skills, knowledge and experience to carry out their roles. There was a system in place to monitor compliance with staff training. Staff were encouraged and supported to develop their skills and knowledge.
  • The way the practice was led and managed promoted the delivery of person-centre care.
  • Governance processes were in place but oversight of risk management was not always fully embedded.
  • Quality improvements had been made against the action plan from the last inspection.

We found breaches of regulations. the provider must:

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

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

31 March 2021

During an inspection looking at part of the service

We carried out an announced inspection at Cricklade Surgery on 31 March 2021. Overall, the practice is rated as Requires Improvement.

Set out the ratings for each key question

Safe - Requires Improvement

Effective - Good

Caring - not inspected

Responsive - not inspected

Well-led – Requires Improvement

Following our previous focused inspection on 1 October 2019, the practice was rated Good overall but Requires Improvement for providing effective services.

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

Why we carried out this inspection

This inspection was a focused follow-up inspection to review:

  • Breaches of regulation identified from a previous inspection.
  • Specific concerns received by CQC through external stakeholders.

At this inspection, we inspected the Safe, Effective and Well led domains.

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:

  • Completing remote clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing remotely patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short 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 Requires Improvement for providing Safe and Well led services because:

  • Processes for identifying, managing and mitigating risks did not demonstrate effective oversight.
  • Processes to review policies were not effective, for example, information was not brought up to date following changes in guidance or changes in circumstances.
  • Systems to ensure patients received appropriate monitoring were not always effective.

We have rated the practice as Good for providing Effective services and Good for all population groups.

Areas where the provider must make improvements:

  • 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.

Areas where the provider should make improvements:

  • Review arrangements to make sure recruitment information, including those for locum staff and checks conducted regarding staff registration with professional bodies, are recorded and remains valid and up to date.
  • Review arrangements to make sure consent is obtained and recorded appropriately across the practice.
  • Review processes to improve coding on patient records to reflect care and treatment received.
  • Review processes to formalise all staff meetings to support dissemination of information.
  • Monitor newly introduced policies to ensure they are embedded in practice.

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

1 October 2019

During an inspection looking at part of the service

This practice is rated as Good overall. (Previous inspection August 2016 – Good)

We carried out an announced focused inspection at Cricklade Surgery on 1 October 2019. We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a change to the quality of care provided since the last inspection.

This inspection focused on the following key questions: Effective and well-led.

Because of the assurance received from our review of information we carried forward the ratings for the following key questions: Safe, caring and responsive.

The key questions are rated as:

Are services effective? Requires Improvement

Are services well-led? Good

As part of our inspection process, we also look at the quality of care for specific population groups; Older People, People with long term conditions, Families, children and young people, working age people (including those recently retired and students, People experiencing poor mental health (including people with dementia). The concerns identified within effective affected all people which led to a rating of requires improvement for all population groups.

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.

At this inspection we found improvements were required in the following areas:

A significantly higher number of patients had been excepted from clinical reviews compared to local and national averages. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients decline or do not respond to invitations to attend a review of their condition or when a medicine is not appropriate.) There was no programme of clinical audit or quality improvement to enable improvements to be made in care and treatment.

Data showed that improvements needed to be made in prescribing practices.

We also found:

  • Systems were in place to ensure clinicians remained up to date with current best practice.
  • The practice encouraged involvement in care and treatment decision making. For example, through treatment escalation plans and long-term chronic conditions self-management plans.
  • Patient feedback was very positive about the care and treatment received.
  • Ongoing support and work with carers had resulted in the practice achieving the platinum award from Cares Support Wiltshire.
  • There was a stable leadership team which was inclusive and responsive to staff feedback.
  • The leadership team had fully engaged with the local primary care network to drive improvements within the practice.

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

  • Assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity.

The areas where the provider should make improvements are:

  • Continue to improve uptake of cervical screening to ensure public health targets are met.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

31 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cricklade Surgery on 31 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.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence-based guidance. Staff had 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.
  • The practice GPs delivered medicines to patients’ homes from the main and rural branch site. This service was mainly available for elderly patients who were unable to attend the practice, or could not make alternative arrangements to collect their medicines.
  • 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.
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

We found one area where the provider should make improvement:

  • The provider should seek support to recruit members to its patient participation group, to better reflect the patient population it serves. We saw that the practice had started to canvass patients to see who would be interested in joining an on-line group. There was a notice in the waiting area and information regarding this in the practice information leaflet.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice