Background to this inspection
Updated
5 November 2019
Cross Plain Health Centre is a GP practice located on the southern edge of Salisbury Plain in Wiltshire. It is one of 47 practices within the Wiltshire Clinical Commissioning Group (CCG) area and has around 5,200 patients.
The main practice premises in the village of Durrington are in a converted domestic house and includes two consulting rooms and one treatment room on the ground floor, and one consulting room on the first floor which is mainly used for counselling services.
The branch surgeries at Tidworth and Ludgershall closed in July 2019. We were told the practices telephone lines still operate from the Tidworth site, however, the practice’s registered patients were not seen at this site. The practice also had a branch in operation in Larkhill. Patients residing within the Tidworth boundary were offered the option to register with another local practice by the clinical commissioning group.
The practice has a dispensary at their Durrington and Larkhill surgeries, offering pharmaceutical services to those patients on its practice list who live more than one mile (1.6km) from their nearest pharmacy premises.
The practice partnership includes two GP partners and a business partner. At the time of this inspection, the practice was receiving clinical support from GPs from another local practice. They were also supported by the local Out of Hours provider with clinical triage during core opening hours.
At the time of this inspection, the practice was working on merging with another local GP practice they were receiving clinical and management support from the other local practice.
The practice is registered to provide the following activities:
• Diagnostic and screening procedures;
• Family planning;
• Maternity and midwifery services;
• Surgical procedures;
• Treatment of disease, disorder or injury.
The practice has a General Medical Services contract with NHS England (a nationally agreed contract negotiated between NHS England and the practice).
The practice provides services from the following sites:
- Durrington Surgery, 84 Bulford Road, Durrington, Wiltshire, SP4 8DH.
- Willoughby Road, Larkhill, SP4 8DG
The concerns which led to the Section 31 Notice of Decision on the 28 June 2019 to impose conditions on the provider’s registration applied to all their locations.
Updated
5 November 2019
This practice is rated as Inadequate.
We carried out inspections at this practice as follows:
December 2016: The practice was formerly known as Salisbury Plain Health Partnership was rated as Requires Improvement overall and for providing safe and effective services including all the population group. They were rated as good for providing caring, responsive and well-led services.
August 2017: We found the practice had implemented actions to become compliant with the previous breaches of regulations. We rated the practice as good for providing safe, effective and all the population groups as well as overall.
June 2018: the practice was inspected in response to concerns that were reported to us and was not rated as part of this inspection. There were breaches in the regulations relating to staffing and good governance. The practice was served a Warning Notice in relation to Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014- Staffing and a Requirement Notice in relation to Regulation 17 – Good Governance.
September 2018: This inspection was to follow up on the Warning notice which was issued in June 2018. The practice was not rated as part of this inspection.
January 2019: This inspection was carried out as part of our inspection programme and to review the actions taken by the practice to improve the quality of care and to confirm that the practice was meeting legal requirements in relation to staffing. We rated the practice as good in all key questions and population groups as well as overall.
The full report on these inspections can be found by selecting the ‘all reports’ link for Cross Plain Health Centre on our website at .
The inspection on the 25 June 2019 was an unannounced focused inspection in response to concerns shared with the Care Quality Commission around staffing and the provision of safe care and treatment. We undertook a further comprehensive inspection on the 9 July 2019 to gather more information and evidence following our inspection on the 25 June 2019.
We issued the practice a Section 31 Notice of Decision to impose conditions on the provider’s registration with immediate effect as we found several breaches of regulations relating to safe, effective, responsive and well-led services. Specifically:
- There was no evidence that non-medically qualified staff working in a clinical role were adequately supervised, mentored and monitored.
- There was evidence that some patients who had been seen by non-medically qualified staff had not been adequately reviewed and seen by a qualified clinician.
- Risks to patients were not adequately assessed and actions had not been implemented to mitigate those risks.
- Inadequate recruitment checks were undertaken so that the practice could assure themselves that staff employed to undertake clinical roles were of good character and that they had immunity to the hepatitis B virus.
- Significant events were not always managed in line with best practice.Significant events were not always managed in line with best practice.
- The practice had not implemented actions from our previous inspections to ensure sustained and continuous compliance with all the relevant regulations.
The areas where the provider must make improvements are:
- Ensure care and treatment is provided in a safe way.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
- Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
- Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
- Ensure specified information is available regarding each person employed.
The areas where the provider should make improvements are:
- Improve the arrangements for the security of prescriptions in the practice so that all staff are aware of current agreed systems and processes.
- Improve and sustain uptake for the cervical screening programme and other cancer indicators.
- Improve the current systems for obtaining consent in relation to minor surgery and consider implementing written consent for these procedures.
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