Background to this inspection
Updated
18 September 2018
Croston Medical Centre, 30 Brookfield, Croston, PR26 9HY, is situated within a purpose-built health centre in a residential area of Croston, Leyland in Lancashire. The practice also has a
branch surgery in Eccleston Health Centre at Doctors Lane, Eccleston approximately three miles away from the main surgery. Patients can attend either surgery. We did not visit the branch surgery for this inspection. The practice website can be found at www.crostonmedicalcentre.nhs.uk
The practice delivers primary medical services under a General Medical Services (GMS) contract with the NHS Chorley and South Ribble Clinical Commissioning Group (CCG).
The practice provides services to approximately 3,911 patients. Information published by Public Health England rates the level of deprivation within the practice population group as nine on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. There are considerably more patients aged over 45 years of age on the practice register, 52%, compared to the national average of 43% but a lower percentage of patients with a
long-standing health condition, 39%, compared to the national average of 54%.
The practice has two female GP partners, one regular male long-term locum GP and one practice nurse. They are assisted by six administration and reception staff and one practice medicines co-ordinator. At the time of our inspection, there had been no permanent practice manager in post since January 2018. A practice manager from another GP practice was employed for an average of nine hours each week to assist the GPs in the management of the practice.
When the surgery is closed patients are directed to the local out of hours service (GotoDoc) and NHS 111. Information regarding out of hours services is displayed on the website and in the practice information leaflet.
The practice is registered with CQC to provide maternity and midwifery services, treatment of disease, disorder or injury and diagnostic and screening procedures as their regulated activities.
Updated
18 September 2018
This practice is rated as inadequate overall. (Previous rating January 2018 – Good)
The key questions at this inspection are rated as:
Are services safe? – Inadequate
Are services effective? – Requires improvement
Are services caring? – Good
Are services responsive? - Good
Are services well-led? – Inadequate
We carried out an announced comprehensive inspection at Croston Medical Centre on 28 June 2018 in response to concerns and to follow up breaches of regulations identified at our inspection in January 2018.
At this inspection we found:
•The practice did not have clear systems in place to manage risk so that safety incidents were less likely to happen. When incidents did happen, these were not always reported.
•The governance of the practice was poorly managed. Leaders lacked the capacity and capability to manage the practice effectively.
•Policies and procedures had not been established to enable the practice to operate safely and effectively.
•There was no management oversight of staff training and some staff had not been supported for their training needs.
•There was little evidence that quality improvement activity was embedded into practice to ensure continuous learning and development.
•Staff involved and treated patients with compassion, kindness, dignity and respect.
•Patients found the appointment system easy to use and reported that they could access care when they needed it.
•The practice took patient complaints seriously and responded to them appropriately.
•Staff reported a lack of leadership support from GPs. There was a lack of time in some meetings and during staff appraisal to allow meaningful discussion.
•There was little evidence of practice engagement with the patients, the public, staff and external partners.
•Our concerns with the governance and leadership of the practice identified in three previous inspections had not been addressed effectively. Governance and leadership of the practice was inadequate.
The areas where the provider must make improvements as they are in breach of regulations are:
•Ensure care and treatment is provided in a safe way to patients.
•Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
The areas where the provider should make improvements are:
•Consider the regular review of all vulnerable children and young people.
This service has been rated as inadequate for providing well-led services. This is in response to repeated ratings of requires improvement for this key question and a history of non-compliance. We rated the practice as requires improvement for providing well-led services following our inspections of the practice in November 2016, June 2017 and January 2018 for issues relating to the poor governance of the practice. We found that this had not improved at this inspection.
We are therefore taking action in line with our enforcement procedures but we are aware the provider has applied to cancel their registration with CQC and a new provider will be in place.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
Please refer to the detailed report and the evidence tables for further information.