We carried out an announced comprehensive inspection at Dr Cakebread and Partners on 23 January 2019 in response to concerns regarding poor care. These concerns were raised to the Parliamentary and Health Ombudsmen and not upheld. The practice were aware of the reason for our inspection. Our inspection team was led by a CQC inspector and included a GP specialist advisor and a practice nurse specialist advisor.
At the last inspection in June 2016 we rated the practice as good overall.
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 requires improvement overall.
We rated the practice as requires improvement for providing safe services because:
- The system to manage pathology results was ineffective. Shortly following the inspection, we received a policy which detailed how to manage these more safely.
- A complete record of staff immunisations was not held.
- Patient specific directions to allow vaccinations to be given by health care assistants were not always signed by a prescriber.
- There was no audit or competency assessments for non-medical prescribers however, appraisals were completed for these staff.
- We found breaks in the cold chain to safely store vaccinations that had not been appropriately escalated. Shortly after the inspection, we were provided evidence that this had been managed.
- There were adequate safeguarding systems in place.
- There were adequate recruitment systems in place.
We rated the practice as inadequate for providing effective services because:
- There were no systems in place to ensure action had been taken in regard to the most recent guidance or safety alerts. We found that not all patients were receiving the correct treatment for example patients suffering from asthma or respiratory diseases.
- There was not an effective system in place to follow up patients with mental health conditions who did not attend for repeat medicines.
We rated the practice as good for providing caring services because:
- Patients were supported, treated with dignity and respect and were involved as partners in their care.
We rated the practice as good for providing responsive services because:
- The practice offered flexible appointments that could be booked online.
- Patients told us that they could make an appointment when they needed however, it was sometimes difficult to contact the surgery by telephone.
- The practice listened to patient feedback and complaints and acted on it appropriately.
We rated the practice as requires improvement for providing well-led services because:
- There was a lack of clinical oversight and systems were not always effective. However, the leadership, governance and culture of the practice aimed for delivery of high quality person-centred care.
- Clinical policies were not always followed by all staff.
- Staff felt proud to work at the service and felt comfortable to raise concerns to the management team.
The areas where the provider must make improvements as they are in breach of regulation are:
- Ensure care and treatment is provided in a safe way to patients.
There were areas where the provider should make improvements are:
- Continue to monitor patient satisfaction scores and improve telephone access to the practice.
- Continue to identify and support carers.
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