Background to this inspection
Updated
10 November 2021
Castlecroft Medical Practice is located in Wolverhampton at Castlecroft Avenue, Castlecroft, Wolverhampton, West Midlands WV3 8JN.
The provider is registered with CQC to deliver the Regulated Activities; Diagnostic and screening procedures, Family planning, Maternity and midwifery services, Surgical procedures and Treatment of disease, disorder or injury.
Services provided at the practice include the following clinics; long-term condition management including asthma, diabetes, hypertension (high blood pressure), minor surgery and immunisation.
Castlecroft Medical Practice is a member of the NHS Black Country and West Birmingham Clinical Commissioning Group (CCG). The practice provides services to patients of all ages based on a General Medical Services (GMS) contract with NHS England for delivering primary care services to a patient population of about 12,380.
Information published by Public Health England shows that deprivation within the practice population group is in the seventh decile (seven of 10). The lower the decile, the more deprived the practice population is relative to others.
According to the latest available data, the ethnic make-up of the practice area is, 77% White, 14.9% Asian, 3.3% Black, 3.5% Mixed and 1.3% Other ethnicity.
The team of clinical staff at Castlecroft Medical Practice is made up of a total of eight GPs. Five GP partners, (three female and two male) one of whom is the senior partner and three salaried GPs, (two females and one male). The GPs work a total of 50 sessions per week between them. Other clinical staff include five practice nurses and two nurse practitioners, the nurses work both full and part time hours. Clinical support is also provided by a pharmacist, when available and a health care assistant. The clinical staff are supported by a business manager, practice manager and a team of reception/administration staff.
Due to the enhanced infection prevention and control measures put in place since the pandemic and in line with the national guidance, most GP appointments were telephone consultations.
The practice is part of the Unity West Primary Care Network, a wider network of GP practices. Extended access is provided locally at identified sites through the Wolverhampton Unity Hub Primary Care Network where late evening and weekend appointments are available. The practice does not provide an out-of-hours service to its own patients but directs patients to out of hours services.
Additional information about the practice is available on their website:
www.castlecroftmedicalpractice.co.uk
Updated
10 November 2021
We carried out an announced inspection at Castlecroft Medical Practice over a period of five days, the final inspection date was the 12 August 2021 when we carried out an onsite inspection visit. Overall, the practice is rated as good.
Ratings for each key question:
Safe – Good
Effective – Good
Well Led – Good
Castlecroft Medical Practice was previously inspected in September 2019 and rated requires improvement overall and for all population groups.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Castlecroft Medical Practice on our website at www.cqc.org.uk
Why we carried out this review
This inspection was an announced inspection to follow up on:
- the requirement notices issued at the last inspection in September 2019.
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 reviews differently. This was with consent from the provider and in line with all data protection and information governance requirements.
This included:
- Conducting staff interviews using video conferencing / telephone
- Completing clinical searches on the practice’s patient records system and discussing the findings with the provider
- Reviewing patient records to identify issues and clarify actions taken by the provider
- Requesting evidence from the provider
- Carrying out 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
- information from the provider, patients, the public and other organisations.
We have rated this practice as Good overall and good for all population groups
We found that:
- Effective systems had been implemented to ensure medicines and equipment were secure and safe to be used.
- Arrangements had been put in place to support the management and monitoring of patients prescribed high risk medicines.
- The practice had ensured all clinical staff had access to safety alerts related to patients care and treatment and these were monitored to ensure appropriate action was taken.
- The arrangements for the management of incidents and complaints was reviewed and systems introduced to demonstrate learning and improvements at the practice.
- Staff were clear and knowledgeable about their lead roles and responsibilities.
- Effective governance arrangements had been implemented to mitigate risks and ensure patients were kept safe.
Whilst we found no breaches of regulations, the provider should:
- Continue to improve the monitoring and review of patients prescribed high risk 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