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Castlegate & Derwent Surgery Good


Inspection carried out on 13 Sep 2019

During an inspection looking at part of the service

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 significant change to the quality of care provided since the last inspection.

This inspection focused on the following key questions:

  • is the practice effective;
  • is it responsive;
  • is it well-led?

Because of the assurance received from our review of information we carried forward the ratings for the following key questions:

  • is the practice safe;
  • is it caring?

Both of these key questions are rated good.

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 and good for all population groups except Families, Children and Young People, which we rated outstanding.

We found that:

  • Patients received effective care and treatment that met their needs.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We rated the population group, families, children and young people as outstanding because:

  • The practice had achieved significantly higher than average immunisation rates for a large cohort of children. Childhood immunisation uptake rates were all above the World Health Organisation (WHO) targets.

We saw an area of outstanding practice:

  • We saw multiple examples of good communication between the practice and their patients and the benefits this was having. The practice scored highly for immunisation and screening uptake, for example they rated top in the county for abdominal aortic aneurysm screening, and they felt this was due to being able to communicate well with their patients and encourage them to attend. The practice used multiple approaches, such as frequent newsletters, social media and stalls in the local supermarket, to reach their patients.

However, there were some areas where the practice should make improvements:

  • Include all staff on the training matrix and make sure all mandatory training is completed within the recommended timeframes;
  • Ensure annual appraisals are available to all staff at the practice;
  • Take steps to ensure all staff receive the same level of induction when they begin work at the 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

Inspection carried out on 3 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Castlegate Surgery on 3 May 2016. Overall, the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Lessons were learned when incidents and near misses occurred.
  • 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.
  • Outcomes for patients were very good. The Quality and Outcomes Framework (QOF) data, for 2014/2015, showed the practice had performed very well in obtaining 99.9% of the total points available to them for providing recommended 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.
  • Urgent appointments were available on the day they were requested. However, some patients told us that they had to wait two or three weeks for routine appointments and appointments with a named GP.
  • Extended hours appointments were available Monday to Friday between 7:30am and 8am.
  • 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 practice had engaged with the staff during the recent merger with another local practice, staff members had been part of the steering group for this merger.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • The practice had adapted their clinical system to support effective care of patients at increased risk of acute kidney injury due the medicines the patient was prescribed. When a clinician recorded relevant symptoms, the system checked the medicines prescribed and displayed a visual alert during the consultation. This reduced the risk of patients suffering acute kidney injury.

The areas where the provider should make improvement are:

  • The practice should continue to implement a system of staff appraisals as soon as possible to provide staff with a formal opportunity to discuss training, learning and development requirements.
  • Review the arrangements for clinical audit in order to be able to demonstrate a clear link between audits and quality improvement.
  • Continue to review patient access for routine appointments with a GP.
  • Review their staff induction and recruitment process for the checking of clinical and non-clinical staff immunity status against vaccine-preventable diseases such as measles.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 29 April 2014

During a routine inspection

Castlegate Surgery is located in the town of Cockermouth in Cumbria. The practice is situated within the newly built Cockermouth Community Hospital and provides services to approximately 10,500 patients. It is registered with the Care Quality Commission to provide the following regulated activities; diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

We carried out an announced inspection on 29 April 2014. The inspection team included the lead inspector, a GP, a practice manager and an expert by experience.

During the inspection we spoke with patients and staff. We also reviewed completed CQC comments cards. Feedback from patients was very positive. They told us they were happy with the practice and the premises. We saw the results of a patient survey which showed patients were consistently pleased with the service they received.

The practice had only moved into the community hospital premises in early 2014, and had previously been located in a temporary building following the floods of 2009. The new premises were purpose designed and built and were accessible to all.

The leadership team was very visible and staff found them approachable. There were excellent governance and clinical leadership measures in place.