The Care Quality Commission
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Archived: Cross Plain Health Centre

Overall: Inadequate read more about inspection ratings

84 Bulford Road, Durrington, Salisbury, Wiltshire, SP4 8DH (01980) 600600

Provided and run by:
Cross Plain Health Centre

Important: We are carrying out a review of quality at Cross Plain Health Centre. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

7 August 2019

During an inspection looking at part of the service

This practice is rated as Inadequate overall.

We carried out an unannounced focused inspection on the 25 June 2019 where we identified significant risks to patients. We issued the practice a Section 31 Notice of Decision on the 28 June 2019 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.

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. Following this inspection, we rated the practice inadequate overall and for the key questions of safe, effective and well led. All population groups were also rated as inadequate. The rating for the caring domain was good and for responsive, requires improvement. The overall rating of inadequate has led to the practice being placed into special measures.

The full report on these inspections can be found by selecting the ‘all reports’ link for Cross Plain Health Centre on our website at .

This inspection on the 7 August 2019 was an unannounced focused inspection. The purpose was to gather evidence on improvements made by the practice following the concerns identified at the previous inspections, which led to the urgent conditions being imposed on the provider’s registration.

At this inspection, we found some improvements had been made in relation to the concerns we previously identified. Specifically:

  • Staff who worked in the role of paramedics, the trainee nurse associate, trainee assistant practitioner, assistant practitioner apprentice, trainee physician associate and the physician associate were not working in those roles at the practice.
  • Gaps in staff recruitment had been addressed, with appropriate checks being completed.

However, we also identified further improvements were required. Specifically:

  • The practice had engaged with the NHS Wiltshire Clinical Commissioning Group to undertake a review of patients identified in condition four of the notice. However, this had not progressed beyond identifying patients who fall within the categories specified in that condition.
  • The practice could not provide evidence in relation to improvements undertaken to meet the requirements of condition 5 of the notice.

Following the focused inspection on the 7 August 2019, those conditions were amended to reflect the improvements made by the practice as well as the further improvements required. These amended conditions were also reviewed at a First Tier Tribunal on the 14 August 2019 and further amendments were made based on the tribunal’s decision.

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

25 June 2019

During an inspection looking at part of the service

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

23 & 24 January 2019

During a routine inspection

This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

On 11 June 2018 we carried out an announced focused inspection at Cross Plain Health Centre in response to concerns that were reported to us. We found there were breaches in the regulations relating to staffing and good governance. We carried out a second announced focused inspection at Cross Plain Health Centre on 11 September 2018, to follow up on the issues identified on our previous inspection of 11 June 2018. The full report on these, inspections can be found by selecting the ‘all reports’ link for Cross Plain Health Centre on our website at www.cqc.org.uk.

This report covers the announced comprehensive inspection we carried out at Cross Plain Health Centre on 23 and 24 January 2019, as part of our inspection programme, 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.

At this inspection we found:

  • The practice had adopted an innovative use of staff in the role of GP Assistants. The use of staff in this role in GP practices was still in development in England and we saw evidence the practice was engage with the national development of staff working these roles.
  • We found that staff working in the role of GP Assistant were working within their areas of competency. The clinical notes we saw evidenced safe and supportive care that had been appropriately reviewed by a suitably qualified clinician. These findings are in line with what we found on our previous inspections in June and September 2018.
  • The practice had made significant changes to their processes and systems relating to staffing and good governance since our inspection in June 2018 and were now meeting the regulatory requirements. However, there were a few areas where the changes had not been fully embedded.
  • Staff treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

We saw one area of outstanding practice:

  • The practice had their own mental health support team that were able to offer same day appointments and provided a special access service for patients registered with other practices in Wiltshire, who were at risk of being excluded due to their behaviour. We saw evidence the service was in the process of being adopted by other GP practice in the locality and training on the service was being prepared both for other GP practices in Wiltshire and local Ministry of Defence primary care services.

The areas where the provider should make improvements are:

  • Take appropriate action to ensure all staff have appropriate references on file.
  • Review their standard operating procedure for dispensing medicines and ensure it is in line with their actual practice and best practice guidance.
  • Continue to embed changes of staff titles into the practice culture and procedures.
  • Review how they record complaints and significant events to ensure learning points are clearly identified and they are able to spot trends and patterns that might relate to staff working in the new roles the practice had developed.
  • Continue to make all appropriate efforts to establish an active patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

11 June 2018

During an inspection looking at part of the service

We carried out an announced focused inspection at Cross Plain Health Centre on 11 June 2018 in response to concerns that were reported to us. We did not rate the practice as part of this inspection.

At this inspection we found:

  • The practice had a long-term plan to develop the role of Physician Assistants (PA) within the practice and an interim strategy to develop the role and competence of non-qualified staff to enable them to take on duties previously done by qualified and registered clinicians. However, this was not supported by evidence found on inspection.
  • The practice vision was in line with national strategies and priorities. They had engaged with other external stakeholders and received financial support for the development work from Wiltshire Clinical Commissioning Group (CCG).
  • We found the practice had employed staff in a number of different roles who they called GP Assistants. It was not clear to patients what these different roles were or the competency of staff performing these roles.
  • We looked at the clinical work of a number of staff working in the role of GP Assistant and found evidence they were working within their areas of skills and experience, and there had been some appropriate oversight and support from a GP.
  • We saw evidence the practice monitored the work done by staff in the role of a GP Assistant.
  • The practice governance arrangements for the employment, training, supervision and monitoring of staff working in the role a GP Assistant lacked clarity.

The areas where the provider must make improvements are:

  • The practice must ensure staff employed receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.

  • The practice must assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity (including the quality of the experience of service users in receiving those services).

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

1 August 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Salisbury Plain Health Partnership on 8 December 2016. Overall the practice was rated as requires improvement. We found the practice to be requires improvement for providing safe and effective services, and good for providing caring, responsive and well led services. The full comprehensive report on the 8 December 2016 inspection can be found by selecting the ‘all reports’ link for Salisbury Plain Health Partnership on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 1 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in our previous inspection on 8 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe and effective services. Overall the practice is now rated as good. All six population groups have also been re-rated following these improvements and are also rated as good.

Our key findings were as follows:

  • The practice had reviewed their standard operating procedures with regard to controlled drugs and had ensured those medicines were checked regularly.

  • The temperature of the medicines fridge in the dispensary was checked regularly.

  • The practice had reviewed their process for the exception reporting of patients with long term conditions and had ensured patients who had previously been excepted, had received the appropriate reviews. (Exception reporting is the removal of patients from Quality Outcome Framework calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

  • The practice had reviewed its systems to ensure patients who had not collected their medicines from the dispensary were contacted in a timely manner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

8 December 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Salisbury Health Partnership, also known as, Cross Plain Surgery, on 8 December 2016. Overall the practice is rated as requires improvement.

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 for reporting and recording significant events. Incidents and significant events were discussed at a range of meetings including weekly clinical meetings and monthly team meetings.
  • Although risks to patients were assessed and well managed, systems and processes to manage risks in the dispensary were not applied consistently.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. The practice had a positive ethos for the continuous development of staff.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice worked with Wiltshire County Council in hosting well-being courses for patients with mental health problems, obesity and substance and alcohol misuse problems.

  • 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 had strong and visible clinical and managerial leadership and governance arrangements.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice:

  • The practice recognised the need of its local population and took part in various initiatives to improve outcomes for patients. They developedled an initiative called “Serving on UK” where practice staff who had knowledge of the armed forces supported veterans and families of serving military personnel to have better access to NHS services. The practice had worked with the South West Armed Forces Network, NHS England, the local clinical commissioning group and local military charities so that this initiative could be rolled out nationally.

  • The practice had set up a specific Mental Health team which included two mental health support workers employed by the practice under the leadership of a lead GP who had specific qualification and experience in mental health and substance misuse issues. This enabled patients to be reviewed and have increased access to support when they needed it.

The areas where the provider must make improvement are:

  • Ensure controlled drugs are checked in accordance with their standard operating procedures.

  • Ensure the temperature of the medicines fridge in the dispensary is checked daily.

  • Ensure the number of patients with long term conditions who had been excluded from reviews are appropriately reviewed and identify ways to improve uptake for these reviews.

The areas where the provider should make improvement are:

  • Ensure uncollected medicines are acted upon in a timely way.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice