The Croft Practice

Updated 7 November 2022

The practice provides general medical services to approximately 11,000 patients from its main surgery in Eastergate, near Chichester together with branch surgeries in Yapton and Walberton. We only visited The Croft surgery in Eastergate for this inspection.

The practice is situated within the Sussex Health and Care Integrated Care System (ICS) and delivers general medical services (This is part of a contract held with NHS England). The practice is part of a wider network of four local GP practices who work collaboratively to provide primary care services.

The practice population is spread over a largely rural area and serves all age groups, the proportion of which are in line with national average. However, it does however have a higher than average proportion of its population over the age of 65 years compared to the rest of England. The percentage of registered patients suffering deprivation (affecting both adults and children) is lower than average for England.

According to the latest available data, the ethnic make-up of the practice area is 1.4% Asian, 97% White, 15%, 0.4% Black, and 1.7% Mixed.

There are three female partner GPs. The practice also employs a paramedic practitioner, one nurse practitioner, three practice nurses, one assistant practitioner and one health care assistant. There is a practice manager, two assistant practice managers and a team of administrative and reception staff.

For information about practice services, opening times and appointments please visit their website at http://www.thecroft-practice.co.uk.

Patients requiring a GP outside of normal working hours are advised to contact the NHS 111 service where they will be given advice or directed to the most appropriate service for their medical need.

The practice is registered to provide the regulated activities of diagnostic and screening procedures; treatment of disease, disorder and injury; maternity and midwifery services; family planning, and surgical procedures.

Updated 7 November 2022

We carried out an announced comprehensive follow up inspection at The Croft Practice on 7 September 2022. Overall, the practice is rated as Good.

Safe - Good
Effective - Good
Caring – Good (carried over)
Responsive – Good (carried over)
Well-led – Requires improvement

Following our previous inspection in July 2021 we found that insufficient improvements had been made since our inspection in January 2020. The practice was rated inadequate and was placed in special measures. We issued two warning notices against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). In December 2021 we undertook a review that confirmed the practice had made enough improvements and was compliant with the warning notices issued.

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

Why we carried out this inspection

This focused inspection was carried out to confirm whether the provider now met the legal requirements of regulations and to ensure enough improvements had been made.

We focused on the following:

• The key questions; Safe, effective and well-led.
• Areas we said the practice should improve.

During this inspection we also considered the management of access to appointments.

We carried forward ratings for caring and responsive from previous inspections, as the information we held did not indicate any change to ratings.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

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
• Conducting a staff survey

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 found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• 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.
• The practice had established an active patient participation group and patient views were acted on to improve services and culture.
• Patients could access care and treatment in a timely way.
• Staff told us they felt supported by their managers and their well-being was prioritised.
• Staff had the training and skills required and were encouraged to develop in their role.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We rated the practice as requires improvement for providing well-led services because: -

• leaders lacked oversight of some processes and policies and therefore failed to identify risks when those processes did not operate as intended, for example in relation to significant events and complaints.

We found one breach of regulations. The provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Whilst we found no breaches of regulations, the provider should:

• Continue to review systems and processes to improve uptake of cervical screening.
• Ensure all patients with a potential missed diagnosis of chronic kidney disease are monitored and reviewed.
• Undertake comprehensive risk assessments for staff who have not had recommended vaccines or obtained immunity status.
• Ensure the health monitoring and review of patients with hypothyroidism is in line with national guidance.
• Continue to review patient access to appointments and ease of getting through on the phone.

This service was placed in special measures in September 2021. The practice has made significant improvements and is now rated good overall and good for the safe and effective key questions; However, improvement is still required in the well led key question. I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service. The service will be kept under review and requirement notices will be followed up within 12 months.

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