The Care Quality Commission
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  • GP practice

Coniston Medical Practice

Overall: Good read more about inspection ratings

Wraysdale House, Coniston, Cumbria, LA21 8ER (015394) 41205

Provided and run by:
Coniston Medical Practice

All Inspections

24 August 2021

During an inspection looking at part of the service

We carried out a desk top focused review of Coniston Medical Practice on 24 August 2021. Overall, the practice is rated as Good.

The key question ratings are as follows:

Safe - Good

Effective – Good (Carried forward from the last inspection in November 2020)

Caring – Good (Carried forward from the last inspection in November 2020)

Responsive – Good (Carried forward from the last inspection in November 2020)

Well-led – Good (Carried forward from the last inspection in November 2020)

Following our previous inspection on 2 November 2020, (published 9 December 2020), the practice was rated good overall and for the effective, caring, responsive and well-led key questions. All population groups were also rated good but the safe key question was rated requires improvement. The practice was rated as requires improvement for safe due to gaps in the practice’s oversight of premises and equipment safety checks.

The full reports for previous inspections can be found by selecting the ‘read previous reports’ link for Coniston Medical Practice on our website at www.cqc.org.uk

Why we carried out this desk top review

This desk top review was undertaken to review information submitted by the provider. The review did not include a site visit.

The purpose of the review was to follow up on:

• The requires improvement rating from the previous inspection for the safe key question.

• The breaches of regulations for Regulation 12 (safe care and treatment) identified at the last inspection.

• Progress with ‘shoulds’ identified in previous inspection.

How we carried out the review.

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 reviews differently.

This review was carried out remotely to eliminate the need for a site visit and involved requesting information and evidence from the provider as part of the process.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected previously.
  • 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 key questions and population groups.

We found that:

  • The provider had completed a log to confirm portable applicances had been appropriately inspected and had made arrangements for the condition of the electrical wiring installation and clinical equipment used in the practice to be independently inspected, calibrated and tested.
  • The provider also provided assurance as part of this desk top review that they had taken action to respond to any ‘shoulds’ that were recommended at the last inspection. For example, in relation to the recording of two-week wait referrals; updating of the dispensary standard operating procedures and recruitment procedure; the recording of maximum and minimum fridge temperatures; the review of systems for the management of patients on high risk medicines; the provision of additional coding training for staff and to improve cervical screening uptake.

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

02 November 2020

During a routine inspection

We carried out an announced focused inspection at Coniston Medical Practice on 18 September 2019. The inspection looked at the following key questions: Safe, Effective and Well-led. We did not inspect the caring or responsive key questions and therefore the ratings remained unchanged based on the findings from the previous inspection in May 2015.

Following our inspection in September 2019, we rated the practice inadequate overall and also for the safe and well-led key questions. The effective key question was rated requires improvement. The practice was placed in special measures.

At our inspection in September 2019, we identified that governance systems and processes were not effective in relation to clinical coding and the management of safety alerts, medicine reviews and high-risk medicines.

Following the inspection in September 2019, we issued a requirement notice for breaches of Regulation 12 (Safe Care and Treatment) and a warning notice for breaches of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We then undertook an announced focused inspection on 18 February 2020 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches identified within the warning notice.

The above inspection reports can be found by selecting the ‘all reports’ link for Coniston Medical Practice Medical Centre on our website at https://www.cqc.org.uk/location/1-541107281

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 2 November 2020.

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 for all key questions except for safe which was rated requires improvement. All the population groups were also rated good.

We have rated the practice as requires improvement overall for providing safe services because:

  • We were not assured that the management of premises safety checks for services and equipment was effective.
  • Systems for the appropriate and safe use of medicines, including medicines optimisation were in need of review. The management of patients on high-risk drugs and some patients with long term conditions was sub optimal and the storage of refrigerated vaccines was not monitored correctly in line with best practice guidance.

We have rated the practice as good overall for providing effective, caring, responsive and well-led services because:

  • Staff were consistent and proactive in helping patients to live healthier lives.
  • The practice obtained consent to care and treatment in line with legislation and guidance.
  • Staff treated patients with kindness, respect and compassion.
  • Patients were involved in decisions about their care and treatment.
  • The practice respected patients’ privacy and dignity.
  • The practice organised and delivered services to meet patients’ needs.
  • People were able to access care and treatment in a timely way.
  • Systems were in place to enable patients to raise complaints and provide feedback on the quality of care provided.
  • There were improved responsibilities, roles and systems of accountability to support good governance and management.
  • There were improved systems and processes for managing risks, issues and performance.
  • The was a demonstrated commitment to using data and information proactively and to support decision making.
  • The practice involved the public, staff and external partners to sustain high quality care.
  • There were systems and processes for learning, continuous improvement and innovation.

We saw the following outstanding practice:

  • The service provided by Coniston Medical Practice was personalised, holistic and patient focused. The GP partners often saw patients outside normal surgery hours to respond to the clinical needs of patients and to reduce the pressure on secondary care and emergency services.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

  • Ensure appropriate forms and referral processes are utilised for all two-week-wait referrals and provide additional coding training for non-clinical staff.
  • Continue to improve the uptake rate for cervical cancer screening.
  • Revise the standard operating procedures for the dispensary to include managing uncollected medicines and controlled drugs ordering and audit.
  • Update the recruitment policy to ensure all information listed in schedule 3 of the Health and Social Care Act (Regulated Activities) Regulations 2014 is obtained for new employees.
  • Record the maximum and minimum fridge temperatures in addition to the actual temperature.
  • Review systems for the management of patients on high risk medicines to ensure they are undertaken in accordance with best practice.

I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by this service.

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

18 February 2020

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Coniston Medical Practice on 18 September 2019 following our annual review of the information available to us.

The inspection looked at the following key questions: Safe, Effective and Well-led. We did not specifically inspect the Caring or Responsive key questions and those ratings therefore remained unchanged based on the findings from the last inspection in May 2015.

The inspection report can be found by selecting the ‘all reports’ link for Coniston Medical Practice on our website at https://www.cqc.org.uk/location/1-541107281.

We issued a warning notice for breaches of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance). This inspection was an announced focused inspection undertaken on 18 February 2020 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches identified within the warning notice.

At this inspection we found:

  • A programme of continuous quality improvement had been introduced; new audit processes allowed for better identification of patients missed from patient chronic disease registers.
  • The coding of patient problems and diagnoses had been improved and staff had received some training to allow for this to happen in the absence of the GP partners.
  • A new procedure to manage patient safety alerts effectively had been introduced.
  • Processes for the management of patient medicines had been improved. There were new systems in place to enable timely reviews of medicines and for monitoring patients taking high-risk medicines.
  • A new system of call and recall of patients had been put in place to allow for patients to receive effective reviews of their health conditions.
  • The practice had supplied their own emergency oxygen and equipment on the premises so they did not need to rely on oxygen being available off-site.
  • Staff had been empowered to manage new governance systems such as monitoring the patient health review system, cervical cytology and the monitoring system for patients taking high-risk medicines.
  • We saw there were new governance systems in place for the effective management of tasks to ensure a safe and effective service was maintained.

At our previous inspection on 18 September 2019, we rated the practice as inadequate and placed the service into special measures. As per our published inspection methodology, a further full comprehensive inspection visit will be carried out within six months of the publication date of the inspection report, to monitor the work the practice has started to produce the required improvements to the service and provide a new rating. No ratings have changed as a result of this inspection.

Details of our findings and the evidence supporting them are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

18/09/2019

During an inspection looking at part of the service

We carried out an announced focused inspection at Coniston Medical Practice on 18 September 2019. We looked at whether the service was safe, effective and well led. We did not specifically inspect the caring or responsive key questions and therefore the ratings remain unchanged based on the findings from the previous inspection in 2015.

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 inadequate overall.

  • Processes around coding patients were incomplete. Due to this incompleteness some patients were not placed on important clinical registers such as the chronic obstructive pulmonary disease register.
  • There was no system, process or audit in place to ensure that patients codes were correctly entered onto patients medical records.
  • Patient safety alerts, particularly those around medicines were not always thoroughly checked against the patient record system.
  • An audit of high-risk medicines we examined did not include all the high-risk medicines.
  • Only 58% of patients on four or more medicines had undergone a medicine review in the past 12 months.
  • The quality system had failed to identify the issues we found at the practice.
  • Patients were extremely positive about their experience at the practice.
  • The Patient Participation Group was very active and campaigning to ensure the practice remained open and accessible.
  • The GPs were accessible 24 hours a day to those who needed their support, including patients who received palliative care.
  • Appropriate chaperone services were not always available in the absence of GPs

The areas where the provider must make improvements are:

  • Provide care and treatment in a safe way.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Establish systems for the provision of chaperone services that are available at all times.
  • Update practice around immunisation and vaccines regularly.
  • Update the whistleblowing policy.
  • Improve uptake of cervical screening for eligible women.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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

19 May 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Coniston Medical Practice on 19 May 2015

Overall, we rated the practice as outstanding. Specifically, we found the practice to outstanding for providing caring and responsive services; and good for providing safe, effective and well led services.

Our key findings were as follows:

  • Staff knew their patients and the remote and rural area covered by the practice very well, and provided a holistic service which met their needs;
  • Feedback from patients was overwhelmingly positive; they told us staff treated them with respect and kindness;
  • Patients reported exceptional access to the practice.
  • Patients we spoke with told us they felt they had sufficient time during their appointment;
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance;
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed;
  • There was a clear leadership structure and staff felt supported by the management team. The practice actively sought feedback from patients;
  • The practice was clean and hygienic, and good infection control arrangements were in place.

We saw several areas of outstanding practice including:

  • The surgery was embedded in and was an essential part of the local community. Staff regularly liaised with the local primary and secondary schools and were first on call for any health concerns. This helped to avoid unnecessary ambulance call outs and A&E attendances.
  • Arrangements had been made to carry out joint home visits with district nurses and carers. This provided patients with a more co-ordinated care service.
  • Both of the GPs lived above the practice and often treated people outside of normal opening hours, this prevented many patients from having to travel to access hospital services, which were a considerable distance away.
  • The practice offered a range of compassionate services to address social isolation amongst its patient population.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice