Cambridge Medical Group

We carried out an announced comprehensive inspection at Cambridge Medical Group on 10 October 2019. This practice is rated as good overall. (Previous rating December 2018 was Inadequate)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – good

Are services caring? – requires improvement

Are services responsive? – good

Are services well-led? – Good

We previously carried out an announced comprehensive inspection at Cambridge Medical Group on 10 December 2018. We identified breaches of regulations at that inspection and was rated inadequate. We issued a warning notice and the practice was placed in special measures.

We went back to follow up the issues identified in the Warning Notices on 29 May 2019. At that inspection we found that significant progress had been made and the practice had met the requirements of the Warning Notices although some further improvement was still required.

At this inspection we have rated the safe, effective, responsive and well led key questions as good and caring and the working age population group as requires improvement. We have rated the practice as requires improvement for caring and the working age population group due to the results of the GP national patient survey and cervical and cancer screening results.

The reports for both inspections can be found by selecting the ‘all reports’ link for Cambridge Medical Group on our website at .

At this inspection 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 found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• 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.

Whilst we found no breaches of regulations, the provider should:

• Review and Improve the process for managing blank prescription forms throughout the practice.
• Review and improve the waiting times for non-urgent appointments.
• Improve on some results taken from the GP national patient survey
• Improve and monitor the patient uptake on cervical and cancer screening

We saw improvement to patient safety, and clinical care had significantly improved. There was an improved, structured process and governance system in place to keep patients safe. We were told the aim would be to maintain these standards and continue to improve in the Quality Outcome Framework areas and patient access and experiences.

I am taking this service out of special measures. This recognises the significant 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

We carried out an announced comprehensive inspection at Cambridge Medical Group on 10 December 2018. We identified seven breaches of regulations and issued a warning notice. This focused inspection carried out on 29 May 2019 was an announced focused follow-up inspection, without ratings, to check whether the provider had taken steps to comply with the legal requirements for these breaches of:

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3), Good governance

The full comprehensive report on the 10 December 2018 inspection can be found by selecting the ‘all reports’ link for Cambridge Medical Group on our website at www.cqc.org.uk.

This report covers our findings in relation to those requirements.

Our key findings were as follows:

Improvements had been made with respect to the provision of safe care and treatment, governance and staffing following our last inspection on 10 December 2018. For example:

• We found evidence of health and safety risk assessments, fire alarm checks, fire risk assessments and portable appliance testing.
• The provider encouraged reporting of incidents. This had increased the effectiveness of reporting, lessons learned and feedback to staff.
• The practice had robust systems in place for the recruitment of staff.

• The practice had carried out an infection prevention and control audit. There was evidence to show that staff had received training in infection prevention and control.

• The practice could demonstrate that all confidential information was stored securely.

• The practice could demonstrate that the learning from significant events had been shared with all staff.

• The practice had developed a patient participation group.

Following this inspection, the practice will remain 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.

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 are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Cambridge Medical Group on 10 December 2018.

We had previously inspected the practice on 10 November 2015. The overall rating was Good.

Since the previous inspection in 2015 the practice has undergone significant changes in the leadership. This has had an impact on how the practice is performing.

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.

We rated the practice as inadequate for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe.
• The practice did not have robust systems in place for the recruitment of staff.
• The practice did not have a fire risk assessment on the premises.
• The practice had not carried out an infection prevention and control audit. There was no evidence to show that staff had received training in infection prevention and control.
• The practice could not demonstrate that all confidential information was stored securely.
• The practice could not always demonstrate that the learning from significant events had been shared with all staff.

We rated the practice as requires improvement for providing effective services because:

• There was limited monitoring of the outcomes of care and treatment.
• Some performance data was significantly below local and national averages.
• The practice could not demonstrate that sufficient staff training was taking place.

We rated the practice as requires improvement for providing caring services because:

• The national GP survey results showed that patients said that last time they had a general practice appointment the clinician was not good at listening to them.
• The healthcare professional was not very good at treating them with care and concern

We rated the practice as inadequate for providing responsive services because:

• The national GP patient survey results showed that patients were not always able to access care and treatment in a timely way.
• The practice could not show that learning from complaints was shared with all staff.

We rated the practice as inadequate for providing well-led services because:

• Leaders were not always visible and approachable. They could not show that they had the capacity and skills to deliver high quality, sustainable care.
• The practice could not demonstrate that they had a clear written plan and vision for the future.
• The overall governance arrangements were not always effective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.
• The practice did not have formal full team meetings.

These areas affected all population groups so we rated all population groups as inadequate

The areas where the provider must make improvements are:

• Ensure that 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.

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

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.

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