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Alexandra Road Surgery Requires improvement Also known as Alexandra and Crestview Surgeries

Reports


Inspection carried out on 8 July 2021

During a routine inspection

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

Inspection carried out on 20 August 2019

During a routine inspection

We carried out an announced comprehensive inspection at Alexandra Road Surgery on 20 August 2019 as part of our inspection programme.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 11 October 2018.

At the last inspection we rated the practice as requires improvement for providing safe and effective services because:

  • There were out of date medicines on the emergency trolley and in clinical rooms.
  • Quality and Outcomes Framework (QOF) data was lower than local and national averages for people with long-term conditions and people experiencing poor mental health (including people with dementia).

At this inspection, we found that the provider had not fully addressed these areas; Quality and Outcomes Framework (QOF) data had improved but was still lower than local and national averages for people with diabetes and exception reporting rates were higher than local and national averages and had increased for some indicators relating to people experiencing poor mental health.

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.

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

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.

We rated the practice as Requires improvement for providing effective, caring and well-led services because:

  • The service had not sufficiently improved the quality of care provided to people with long term conditions.
  • Uptake rates for the cervical screening programme were below the national target.
  • Exception reporting rates were higher than local and national averages and had increased in some areas in 2018/19.
  • Childhood immunisation rates were below the national target rate in all four indicators.
  • GP patient survey data related to the provision of caring services was lower than local and national averages and had fallen since the last survey.
  • The practice had a clear vision, but that vision was not supported by a credible strategy.

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

  • Whilst patients could access care and treatment in a timely way in an emergency, the way the practice organised and delivered services did not meet patients’ needs. This was reflected in significantly lower national GP patient survey data which had fallen since the last survey.

These areas affected all population groups, so we rated all population groups as Inadequate.

The areas where the provider must make improvements are:

  • 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).

The areas where the provider should make improvements are:

  • Improve the system for monitoring test results to ensure timely review and action.

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

Inspection carried out on 11 Oct 2018 to 11 Oct 2018

During a routine inspection

This practice is rated as Requires Improvement overall. (Previous rating August 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Alexandra Road Surgery on 11 October 2018. We carried out this inspection as part of our inspection programme.

At this inspection we found:

  • The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • We found out of date items on the emergency trolley and in clinical rooms. These were removed immediately.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • There were clear plans in place that were being acted on to improve the Quality Outcomes Framework, where some outcomes were lower than local and national averages.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The practice hosted a number of groups to support patients including an art therapy group for patients experiencing poor mental health and a social prescribing group.
  • Patients found the newly changed appointment system easy to use and reported that access care when they needed it was becoming easier to get.
  • There was a focus on continuous learning and improvement at all levels of the organisation.
  • The practice had hosted a multidisciplinary event in conjunction with the local council, local GP practices, wellbeing, children’s services, housing, counselling organisations and social services. The event was attended by over 400 patients and free health checks were offered on the day. Feedback from patients and the providers that attended was positive, with many services wishing to hold the event again.

We saw areas of outstanding practice:

  • The practice had hosted an event for patients on high doses of opiates. This was in response to information from the Clinical Commissioning Group that there was an initiative to reduce opiate prescribing. The practice invited all patients on high dose opiates to the event and gave a presentation about opiates and associated risks. This event was hosted by the practice manager, practice pharmacist, GP and physiotherapist. At the end of the event, several patients volunteered to trial reducing their opiates and after consultation with the GP, pharmacist and physiotherapist began a reduction programme. The event was shared with, and adopted by, many local practices as good practice and utilised as a tool to reduce opiate prescribing.

The areas where the provider must make improvements are:

  • Ensure care and treatment is delivered in a safe way to patients.

The areas where the provider should make improvements are:

  • Continue to review, monitor and improve outcomes for patients, particularly those with diabetes and mental health conditions.
  • Continue to drive improvement and uptake for cervical screening.

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.

Inspection carried out on 28 July 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Alexandra Road and their branch surgery Crestview Medical Centre on 28 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for older people; people with long-term conditions; families, children and young people; working age people; people whose circumstances may make them vulnerable and people experiencing poor mental health.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned for.
  • 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.
  • Some patients said they found it difficult to see their own GP and had to wait some time.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by the management.
  • The practice proactively sought feedback from staff and patients which it acted on.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

  • Ensure that blank prescriptions are secured overnight in accordance with national guidelines.

Ensure the trolley containing emergency medicines is kept in a secure area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice