The Care Quality Commission
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  • GP practice

Oakham Medical Practice

Overall: Good read more about inspection ratings

Cold Overton Road, Oakham, Leicestershire, LE15 6NT (01572) 722621

Provided and run by:
Oakham Medical Practice

All Inspections

29 November 2022

During a routine inspection

We carried out an announced inspection at Oakham Medical Practice on 29 November 2022. Overall, the practice is rated as Good.

At our previous inspection in April 2022, the practice was rated as inadequate overall and inadequate for the key questions of effective and well-led. The key questions of safe and responsive were rated as requires improvement, whilst caring was awarded a good rating. The service was placed into special measures.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Oakham Medical Practice on our website at www.cqc.org.uk

Why we carried out this inspection.

This inspection in November 2022 was a comprehensive inspection including a site visit to review progress with the action plan the provider had sent us following the last inspection, and to reassess their special measures status.

Following this inspection the practice is now rated as good overall and for all the key questions with the exception of safe, which remains rated as requires improvement.

How we carried out the inspection

Throughout the pandemic the Care Quality Commission (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 less time on site. 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.
  • Completing remote clinical searches on the practice’s patient records system and discussing findings with the provider.
  • Requesting evidence from the provider to be submitted electronically.
  • A shorter 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 Good overall

We found that:

  • The practice did not always ensure care and treatment was provided in a safe way to patients. We found some concerns relating to medicines management and safety alerts.
  • 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.
  • Patients could mostly access care and treatment in a timely way, although further work was required to work with patients to promote new ways of working.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We found the following example of outstanding practice:

  • The practice had designed and implemented a suite of auto consultation templates. The focus was initially to ensure any high risk medicines were fully reviewed within recommended timescales by following a step by step automated process. This was being developed for use on a wider scale, for example, to be used as a guide to assess patients presenting with a potential emergency presentation such as sepsis.

We found the following breach of regulations. The provider must:

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

In addition, the provider should:

  • Continue to review and take any action needed in relation to access in terms of patient experience and satisfaction in collaboration with others such as their patient participation group, and with external agencies.
  • Complete the collation of evidence that staff have documented evidence of appropriate immunisations in line with national guidance.
  • Utilise staff involvement in the development of change and the formation of future service objectives.
  • Widen the scope of DNACPR documentation to look at all parameters and not solely a clinician’s signature.
  • Always record the reason to explain any deviation from the expected vaccine fridge temperature range on manual temperature logs.

I am taking this service out of special measures. This recognises the significant improvements that have been 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 Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

28 April 2022

During a routine inspection

We carried out an announced inspection at Oakham Medical Practice on 28 April 2022. Overall, the practice is rated as Inadequate.

Set out the ratings for each key question

Safe - Requires Improvement

Effective – Inadequate

Caring – Good

Responsive – Requires Improvement

Well-led – Inadequate

Why we carried out this inspection

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Leicestershire and Rutland. To understand the experience of GP providers and people who use GP services, we asked a range of questions in relation to urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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 all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • 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
  • A short 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 Inadequate overall.

We found that:

  • The practice had a safety alert protocol in place, however on reviewing recent safety alerts we found they had not been acted on appropriately.
  • During the remote review of the clinical system we found patients’ treatment was not reviewed or monitored on a regular basis. This included regular medication reviews.
  • We found patients had been prescribed high risk medicines without the appropriate reviews taking place.
  • The practice had some arrangements to identify risks, however we found staff had not received the recommended immunisations and no risk assessments had been carried out to identify potential risks to patients and staff in the absence of immunisation status.
  • Assurance systems were not effectively monitored to mitigate risk. For example: We found an emergency oxygen cylinder that had expired in 2019 had not been removed from the emergency medical bag.
  • The practice had some staffing issues which had impacted on recruitment. The practice was continually trying to recruit and in the past nine months had employed four salaried GPs, four advanced nurse practitioners and an assistant practice manager
  • On reviewing personnel folders, we found non clinical staff had not received recent appraisals and we identified gaps in staff training. For example: safeguarding and sepsis awareness.
  • 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.

We found breach of regulation. The provider must:

  • 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 provider should:

  • Continue to encourage patients to attend for cervical screening
  • Monitor staff training to gain assurances all staff are up to date with the latest training modules.

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.

Dr Rosie Benneyworth BM BS BmedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

1 June 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakham Medical Practice on 17 January 2017. The overall rating for the practice was good. The full comprehensive report on the 17 January 2017 inspection can be found by selecting the ‘all reports’ link for Oakham Medical Practice on our website at www.cqc.org.uk.

However at that inspection we found that:

  • Blank prescription pads were not being managed correctly.

  • Risks to patients and others had not been properly mitigated. There had been no inspection of fixed electrical wiring .

We issued the provided with requirement notices for breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The practice was rated as ‘requires improvement’ in the safe key question.

In addition we also found that:

  • The practice should address the issues highlighted in the national GP survey in order to improve patient satisfaction including access to appointments and ease of getting through to the practice by telephone.

  • The practice should review risk assessments in place for non-clinical members of staff who did not have a Disclosure and Barring Service (DBS) check to ensure the rationale for not requiring a DBS check was documented.

  • The practice should review processes in place in relation to clinical audits to ensure full cycle audits are carried out to improve patient outcomes.

  • The practice should review the system of appraisals to ensure all members of staff receive an appraisal at least annually.

This inspection carried out on 1 June 2017 was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 17 January 2017. This report covers our findings in relation to those requirements and to other improvements they had made.

Specifically we found that:

  • The practice had an effective system to manage the security of blank prescription forms.

  • The buildings had been inspected to help ensure their electrical safety.

  • The practice had taken action to address the low satisfaction scores for telephone access.

  • There was a clear and effective system in place to ensure that staff were subject to a DBS check or risk assessment where this was not the case.

  • The practice had carried out and were continuing to carry out full cycle clinical audits.

  • There was an effective system to ensure all staff received an annual appraisal.

Overall the practice is rated as ‘Good’. It is also rated as ‘Good’ in the safe key question.

It was already rated as ‘Good’ in the effective and responsive key questions and these ratings have not changed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

17 January 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakham Medical Practice on 17 January 2017. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice engaged in a scheme funded by the CCG which included four other local practices whereby an integrated care co-ordinator employed by Rutland County Council worked in the practice two days per week. This co-ordinator worked specifically with patients both in-house and in the community who suffered with long term conditions or were frail and at risk of falls and had been identified as at risk of unplanned admission to hospital.
  • Community diabetes nurse specialists worked in partnership with the practice and joined weekly nurse led diabetes clinics to review the management of diabetic patients and discuss pathways and agree join management plans for patients.
  • The practice provided a daily outreach clinic at a local school within its medical centre which was GP led. Pupils were guaranteed same day appointments with a GP during lunchtime clinics.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Risks to patients were assessed and well managed with the exception of those in relation to electrical and fire safety.
  • The practice had a system in place to ensure the safe storage of blank prescriptions and however, the system for monitoring their use required review.
  • 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 management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

  • Ensure that there are appropriate systems in place to properly assess and mitigate against risks including risks associated with electrical and fire safety.

  • Review system in place to ensure the safe storage of blank prescriptions and monitoring of their use.

The areas where the provider should make improvement are:

  • Address the issues highlighted in the national GP survey in order to improve patient satisfaction, including access to appointments and ease of getting through to the practice by telephone.
  • Review risk assessments in place for non-clinical members of staff who do not have a DBS check in place to ensure rationale for not requiring a DBS check in place is documented.
  • Review processes in place in relation to clinical audits to ensure full cycle audits are carried out to improve patient outcomes.

  • Review system of appraisals to ensure all members of staff receive an appraisal at least annually.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

20 January 2014

During a routine inspection

We spoke with six patients all of whom spoke of the practice in complimentary terms. Patients told us, "The quality of care is second to none. The GPs go the extra mile." Another patient told us, "The care is continuous, the GPs are excellent. They give space and time for me to have a say about my own care. The nursing staff are brilliant."

Patients told us that they had been able to make appointments at times that suited them and with a GP of their choice. One patient said, "I've always managed to see the doctor I've wanted." Another patient told us that they had not always seen the same GP but that had not been an issue. A newly registered patient told us, "The registration procedure was helpful and I was able to make an appointment at a time I wanted."

We found that patient's views and experiences had been taken into account by the practice. Patients had opportunities to provide feedback and comments using suggestions cards. The practice had an active and influential patient participation group that represented patient's views and which was valued and listened to by the practice.

We saw that care and treatment was provided in a clean environment because the practice had effective cleaning and infection control procedures. Patients were safe because the practice had effective adults and children safeguarding procedures.

The practice had quality monitoring systems and trained staff that ensured the practice was effectively run.