The Care Quality Commission
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  • GP practice

The Croft Practice

Overall: Good read more about inspection ratings

The Croft Surgery Barnham Road, Eastergate, Chichester, West Sussex, PO20 3RP (01243) 543240

Provided and run by:
The Croft Practice

All Inspections

7 September 2022

During a routine inspection

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

N/A

During an inspection looking at part of the service

We carried out an announced focused review at The Croft Practice on 8 December 2021 to assess compliance against two warning notices. The Croft Practice is currently rated inadequate overall. This review was not rated; therefore, the previous ratings remain unchanged.

We carried out an announced comprehensive follow up inspection of The Croft Practice between 13 and 16 July 2021. We found that insufficient improvements had been made. The practice was rated inadequate and was placed in special measures. In August 2021, we issued warning notices against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

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 review

This focused review was carried out on the 8 December 2021 to confirm whether the practice was compliant with the warning notices issued in August 2021. This report only covers our findings in relation to the warning notices.

How we carried out the review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, considering the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections and reviews differently.

This review was carried out in a way which meant we did not have to spend any 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

Our findings

We based our judgement of the quality of care on what we found during this review.

At this review we found that improvements had been made and the practice was compliant with the two warning notices.

We found that:

  • The practice had made improvements to way it recorded, acted on and shared the learning from significant events and complaints.
  • Urgent issues identified from a health and safety audit undertaken in May 2021 had been acted on and there was an ongoing action plan that was being monitored.
  • The practice had set up a patient participation group which met initially in December 2021.
  • Appropriate action had been taken in relation to a medicine’s safety alert.
  • Records of staff vaccination were maintained in line with current Public Health England (PHE) guidance.
  • Patients who had been identified as pre-diabetic had received appropriate reviews, care and treatment.

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

  • Continue to embed systems for monitoring and acing on risks, significant events and complaints.
  • Continue to develop the patient participation group and ensure patient views are used to help improve the service.

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

15 July

During a routine inspection

We carried out an announced follow up inspection at The Croft Practice between 13-15 July 2021. Overall, the practice is rated as inadequate.

Safe - Inadequate

Effective – Good

Caring – Not inspected

Responsive – Not inspected

Well-led - Inadequate

Following our previous inspection on 28 January 2020, the practice was rated requires improvement overall and requires improvement for safe, effective and well led. All six population groups were rated as good. 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 inspection was a follow-up inspection that focused on:

  • Safe, effective and well-led domains.
  • Breaches of regulations 12 Safe care and treatment, 17 Good governance,18 Staffing and 19 Fit and proper persons employed.
  • Areas we said the practice should improve.

How we carried out the inspection.

Throughout the pandemic CQC has continued to regulate and respond to risk. However, considering 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
  • 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 have rated this practice as inadequate overall and inadequate for the safe and well-led key questions The effective domain is rated as good. All six population groups are rated as good.

We found that:

  • 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.
  • The premises were clean and hygienic, and the practice had put enhanced infection control measures in place during the Covid-19 pandemic.
  • Staff told us they felt supported by their managers and that their well-being had been a priority during the pandemic period.
  • Staff had the training and skills required for their role.
  • Recruitment checks were undertaken in line with regulations.

We rated the practice inadequate for providing safe services because:

  • Staff vaccination was not maintained in line with current Public Health England (PHE) guidance relevant to their role.
  • The practice had not fully implemented its policy for reporting and recording significant events. There was limited evidence to show that lessons learned had been identified and shared.
  • The system for recording and acting on safety alerts was not always effective.
  • Appropriate actions had not always been taken in relation to health and safety risk assessments and drug safety alerts.
  • Test results were not always followed up appropriately in order to diagnose long term conditions. For example, diabetes.

We rated the practice inadequate for providing well-led services because:

  • Arrangements for identifying, managing and mitigating risks were not always effective.
  • The practice did not always act on appropriate and accurate information. For example, in relation to significant event records and complaints.
  • The practice did not always involve patients and the public in the planning and delivery of services. It did not have a Patient Participation Group.

We found two breaches of regulations. The provider must:

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

In addition the provider should:

  • In line with prescribing guidelines, ensure that patients have had all the necessary health monitoring in relation to the repeat prescribing of high-risk medicines.
  • Ensure all internal safeguarding meetings are documented.
  • Improve the uptake for cervical screening to ensure at least 80% coverage in line with the national target.
  • Continue to implement and review measures to improve the patient experience of making and getting an appointment.
  • Continue with measures to reduce the backlog of correspondence resulting from the change to a new clinical information system.

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

28 January 2020

During an inspection looking at part of the service

We carried out an inspection of The Croft Practice on 28 January 2020 due to the length of time since the last inspection. Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions: Safe, Effective and Well Led.

Because of the assurance received from our review of information we carried forward the ratings for the following key questions: Caring and Responsive.

We based our judgement of the quality of care provided by the practice 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 requires improvement for the safe, effective and well-led domains.

All population groups have been rated as requires improvement.

Our overall findings were: -

  • Patients told us that staff treated them with compassion, kindness, dignity and respect. They were involved in their care and decisions about their treatment.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The premises were clean and hygienic.
  • 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 was a strong culture of multi-disciplinary working. All the GPs were actively engaged in meetings with representatives from health and social care to discuss those with complex health and social care needs and adults and children at risk.
  • The practice sought and acted on feedback from patients.
  • The practice had a clear vision to improve patient services across the rural area.
  • Staff were positive about working in the practice and felt valued and supported by the leadership.

We rated the practice requires improvement for safe because:

  • Not all staff had received up to date training on safeguarding children and vulnerable adults relevant to their role.
  • Recruitment checks for locum GP staff had not been carried out in accordance with regulations.
  • The practice did not have a system to ensure the registration of clinical staff (including nurses and professions and paramedic practitioners) was checked and regularly monitored.
  • There were no records to show that staff vaccination was maintained in line with national guidance.

We rated the practice requires improvement for effective because:

  • The practice was unable to demonstrate that staff had been trained to provide them with the skills and knowledge and experience to deliver effective care and treatment.

We rated the practice requires improvement for well led because:

  • The practice did not always act on appropriate and accurate information.
  • Arrangements for identifying, managing and mitigating risks were not always effective.

The areas where the provider must make improvements are:

  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development necessary to enable them to carry out the duties.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the practice should make improvements are:

  • Improve the uptake for cervical screening to ensure at least 80% coverage in line with the national target.
  • Continue to look at ways to reduce exception reporting rates where they are higher than average.
  • Continue to implement and review measures to improve the patient experience of making and getting an appointment.
  • Provide increased support to the establishment of an active patient participation group so that a wider range of patient views can be heard.

17 July 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Croft Practice on 17 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for the six population groups.

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.
  • 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.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The GPs were proactive in identifying and undertaking regular audits of clinical care to improve treatment and ensure best practice was being implemented.
  • There was a strong culture of multi-disciplinary working. All of the GPs were actively engaged in meetings with representatives from health and social care in order to avoid hospital admissions for patients with complex health and social care needs.
  • The practice had expertise in providing high quality end of life care and bereavement support.
  • Patients said they could always get to see a GP on the same day if they needed to but that it was sometimes difficult to get through on the telephone, particularly in the mornings.
  • Staff felt supported by management.
  • The practice premises were clean and hygienic.

We saw one area of outstanding practice:

  • All of the GPs were actively engaged in multi-disciplinary team meetings to discuss patients with complex needs. For example, those with multiple long term health conditions and complex social needs. All of the GPs attended fortnightly meetings with the “pro-active care” (PAC) team which included community nurses, social workers, and a community pharmacist where decisions about care planning were made and documented in a shared care record. The practice provided us with evidence that demonstrated the number of patients under the care of the PAC team had increased by 65% since 2013. It was also able to demonstrate a reduction in hospital admissions.

The areas where the provider should make improvement are:-

  • Ensure that a written policy and procedure is in place for reporting significant events which includes the definition of a significant event and the procedure for recording and reporting.
  • Ensure significant events and safety alerts are recorded in a consistent format in order to demonstrate what lessons have been learned, how these have been shared with staff and what action has been taken as a result.
  • Organise regular clinical meetings for medical and nursing staff to facilitate knowledge sharing and learning from significant events on a more structured basis.
  • Continue to implement and review measures to improve telephone access for appointment booking.
  • Ensure that measures being implemented to improve patient participation are fully embedded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

29 January 2014

During a routine inspection

The Croft Surgery is the main surgery and all practice administration is run from there. Meadowcroft and Flintcroft Surgeries are smaller and have more limited opening times. Flintcroft Surgery is for advance booked appointments only. We visited The Croft and Meadowcroft Surgeries for this inspection.

We spoke with nine patients on the day of the inspection visit. We also spoke with four GPs, the practice manager, one practice nurse, four administration staff and three external community health care professionals.

Patients told us that they felt well informed and involved in making decisions about their care and treatment. They said that all staff were approachable. Confidentiality was protected. Patients were happy with the care and treatment they received and valued the local services provided.

We found that there were systems and processes in place to protect patients from abuse and that staff demonstrated knowledge of how to report any concerns.

There were good recruitment processes in place. Whilst there was no formal training programme in place for everyone, staff told us that they had training and development opportunities and that they were well supported by the provider. They felt qualified for their roles and responsibilities.

We found processes in place to review and monitor the quality of the service provided. There was learning from the processes and the information was used to improve the service.