Background to this inspection
Updated
17 September 2021
- The name of the registered provider is Alexandra Road Surgery. The service operates from two sites; Alexandra Road Surgery, Alexandra Road, Lowestoft, Suffolk, NR32 1PL and Crestview Medical Centre, 141 Crestview Drive, Lowestoft, Suffolk, NR32 4TW.
- The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning, surgical procedures, maternity and midwifery services and treatment of disease, disorder or injury.
- Alexandra Road Surgery is situated within the Great Yarmouth and Waveney Clinical Commissioning Group (CCG) and provides services to 15,000 patients under the terms of a general medical services (GMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.
- The website for the practice is http://www.alexandracrestviewsurgeries.co.uk/
- The practice clinical team consists of two GP partners (both male), three salaried GPs (two male, one female), long term locum GPs, four nurse practitioners, five practice nurses, a paramedic, six healthcare assistants, two phlebotomists and a clinical pharmacy team of five. The practice non-clinical team is led by a practice manager supported by a deputy practice manager, three department managers and a team of 29 administrative staff.
- The practice is a teaching practice for medical students.
- The practice is open from 8am to 6.30pm Monday to Friday. The practice is able to offer extended hours appointments on Monday, Thursday and Friday evenings and additional appointments through a local improved access scheme, however the scheme is suspended during the COVID-19 pandemic.
- When the practice was closed patients were directed to access out of hours services via NHS 111.
- The most recent data available from Public Health England showed the practice has a lower than average number of patients aged between 24 to 44 and a higher than average number of patients aged between 65 and 84. Income deprivation affecting children and older people is higher than the CCG and national average. Life expectancy for patients at the practice is comparable to the national average.
Updated
17 September 2021
We carried out an announced inspection at Alexandra Road Surgery on 8 July 2021. Overall, the practice is rated as Requires Improvement.
The ratings for each key question are:
Safe - Requires Improvement
Effective - Requires Improvement
Caring - Good
Responsive - Good
Well-led - Requires Improvement
Following our previous inspection on 20 August 2019, the provider was rated Requires Improvement overall. We rated the provider as Inadequate for providing responsive services. and requires improvement for providing effective, caring and well-led services. We rated the provider as good for providing safe services.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Alexandra Road Surgery on our website at www.cqc.org.uk
Why we carried out this inspection
This inspection was a comprehensive follow-up inspection:
- We inspected the Safe, Effective Caring, Responsive and Well-led key questions.
- We followed up on breaches of regulations identified at our previous inspection to ensure the required action had been taken.
How we carried out the inspection
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 inspections differently.
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with data protection and information governance requirements.
This included:
- Conducting staff interviews using staff questionnaires
- Completing clinical searches on the practice’s patient records system and discussing findings with the provider
- Reviewing patient records to identify issues and clarify actions taken by the provider
- Requesting evidence from the provider, other stakeholders and people who use the service
- A site visit.
Our findings
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 Requires Improvement overall and for the population groups families, children and young people, and working age people. The population group people with long term conditions is rated Inadequate. The population groups older people, people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia) are rated as Good.
We found that:
- The practice provided care in a way that kept patients safe and protected them from avoidable harm, however the provider is required to improve the way high risk medicines and other medicines requiring monitoring are managed.
- Patients did not always receive effective care and treatment that met their needs, especially people with long term conditions.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. 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-centred care, however improvements were required in order to ensure high-quality, person-centred care was delivered.
We found breaches of regulations. The provider must:
- 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.
There were other areas the provider could improve and should:
- Continue to review and improve consistency in recording do not attempt cardiopulmonary resuscitation (DNACPR) decisions.
- Continue to improve staff communication and engagement.
- Continue to monitor and take action on long standing medicines safety alerts.
- Continue to monitor and reduce where appropriate, prescribing rates for Gabapentin and Pregabalin and multiple psychotropic medicines.
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