The Care Quality Commission
  • Doctor
  • GP practice

Tollgate Health Centre

Overall: Good read more about inspection ratings

London Road, Stanway, Colchester, CO3 8NZ (01206) 574483

Provided and run by:
Dr Kamal Kumarapriya Abeysundara

All Inspections

26 September 2023

During a routine inspection

We carried out an announced comprehensive inspection) at Tollgate Health Centre on 26 September 2023. Overall, the practice is rated as good overall.

Safe - good

Effective - good

Caring - good

Responsive - good

Well-led - good

Following our previous inspection on 11 February 2022, the practice was rated requires improvement overall and good for safe, effective, and well-led but requires improvement for caring and responsive key questions.

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

Why we carried out this inspection

We carried out this inspection to follow up concerns from a previous inspection and in response to risks and concerns reported to us.

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 (add/delete as appropriate):

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.
  • Staff questionnaires

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.
  • There were appropriate infection control procedures in place, that were regularly monitored for assurance this was sustained.
  • Staff recruitment procedures were appropriate, and training, competencies, and immunisation status recorded.
  • 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 access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

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

  • Continue to work on reducing the percentage of co-amoxiclav, cephalosporins and quinolones prescribed inline with local and national averages.
  • Continue to encourage and increase access to cervical screening for patients.
  • Continue the work to identify any patients they may have a missed diagnosis.

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 Health Care

11 February 2022

During a routine inspection

We carried out an announced comprehensive inspection at Tollgate Health Centre on 11 February 2022. Overall, the practice is rated as requires improvement.

The ratings for each key question are as follows;

Safe - Good

Effective - Good

Caring – Requires Improvement

Responsive - Requires Improvement

Well-led - Good

Following our previous inspection on 09 April 2021, the practice was rated inadequate overall and specifically, inadequate for caring and responsive services, and requires improvement for safe, effective and well-led services. They were placed in special measures.

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

Why we carried out this inspection

This inspection was a comprehensive follow-up inspection to follow up on:

  • The breaches of regulations and the recommendations identified at the previous inspection.

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 remotely to identify issues and clarify actions taken by the provider to improve patient outcomes.
  • Requesting evidence of improvement work and action plans 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
  • information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall.

We found that:

  • The practice had acted on the issues identified at the last inspection and had made a number of improvements.
  • The practice safeguarding policy included both adults and children. This policy had received approval from the local safeguarding lead at the local clinical commissioning group.
  • A procedure had been developed to support staff help patients when they presented with deteriorating health or were acutely unwell.
  • A formal process to carry out premises health and safety risk assessments to mitigate risks had been developed.
  • Controlled drug prescribing was monitored and the process to raise concerns around controlled drugs with the NHS England Area Team Controlled Drugs Accountable had been added to the prescribing policy.
  • Infection control monitoring and auditing was well documented including extra cleaning and regular hand washing procedures to mitigate the risks of COVID-19 .
  • Patients told us they received timely, effective care and treatment that met their needs.
  • Staff were seen to deal with patients in a kind and respectful manner and involved them in decisions about their care.
  • The practice had safely adjusted the delivery of services to meet the needs of patients during the COVID-19 pandemic. This included access care and treatment in a timely way.
  • Clinical oversight procedures and processes to ensure effective care and treatment had been improved.
  • Appropriate monitoring was in place to assure the quality of care and was seen to be effective when we performed the remote searches as part of this inspection.
  • Although data for the management of patients with asthma and those suffering from poor mental health was lower than local and national averages, there had been a positive improvement over the last year.
  • Evidence of information to inform patients how to access and to protect online information. The practice had also developed an information sharing protocol.
  • There were regular multidisciplinary meetings both at the practice and with external clinical stakeholders.
  • Some GP survey indicators published in July 2021 were still below local and national averages. However, there had been an overall improvement since and a plan was in place for improvement, which included seeking patient views.
  • The practice had improved their system to identify patients who were carers, to enable them to support access for carers to support their needs.
  • A leadership development, and succession plan had been established.
  • A programme of clinical and administrative audits was now in place. A number of audits had been undertaken since the last inspection.
  • Policies had been reviewing and updated to meet local and national guidelines.
  • The practice had an active Patient Participation Group.

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

  • Continue to improve patient satisfaction.
  • Continue to identify carers including young carers.

We found an outstanding feature:

  • The provider had pro-actively sought out care and treatment opportunities to improve the quality of services delivered to their patients throughout the Covid-19 restrictions. This initiative resulted in the practice being awarded a ‘Hidden Heroes’ award for outstanding performance during the Covid-19 pandemic.

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 Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

09 April 2021

During a routine inspection

We carried out an announced comprehensive inspection at Tollgate Health Centre on 05 February 2019. The practice was rated good overall, specifically they were good for safe, caring, responsive, and well-led services and requires improvement for effective services.

As a result of the findings at the February 19 inspection the practice was issued a requirement notice for a breach of Regulation 17 (Good Governance).

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

We carried out an announced comprehensive inspection at Tollgate Health Centre on 09 April 2021. At this inspection we followed up on the breach identified at our previous inspection, and investigated concerns raised during quality visits made by the clinical commissioning group (CCG). There had also been concerns raised to the Care Quality Commission (CQC) by patients and staff that worked at the practice.

We took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering how we carried out this inspection. We therefore:

  • Conducted staff interviews using video conferencing.
  • Completed clinical searches on the practice’s patient records system and discussed the findings with the provider on 08 March 2021.
  • Reviewed patient records to identify issues and clarified the actions to be taken by the provider 09 April 2021.
  • Requested evidence prior to the site visit from the provider.
  • Carried out a short site visit on 09 April 2021.

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 the practice as inadequate overall.

We rated the practice requires improvement for providing Safe services because:

  • There was no adult safeguarding policy.
  • There was no formal process to carry out premises health and safety risk assessments.
  • There was no documented hand washing monitoring or auditing.
  • There was no process within the prescribing policy to raise concerns around controlled drugs with the NHS England Area Team Controlled Drugs Accountable Officer.
  • There was no procedure for patients presenting that were deteriorating or acutely unwell.

We rated the practice requires improvement for providing Effective services because:

  • A continued lack of a quality improvement process, including clinical audit.
  • There was no consistent practice process to follow up patients presenting with symptoms which could indicate serious illness in a timely and appropriate way.
  • The data for the management of patients with asthma and those suffering from poor mental health was significantly below the local and national average.
  • The practice did not monitor their consent process for assurance it was sought and recorded appropriately.
  • There had not been multidisciplinary meetings for over a year.
  • There was no advice for patients regarding how to protect their online information or an information sharing protocol.

The issues identified affected all population groups, so they were also rated as inadequate.

We rated the practice inadequate for providing Caring services because:

  • Many of the national survey indicators published in July 2020 were significantly below local and national averages and there was a lack of an action plan to improve.
  • The practice did not have an effective system to identify patients who were carers to enable them to access the care and support they need.

We rated the practice inadequate for providing Responsive services because:

  • Many of the national survey indicators published in July 2020 were significantly below local and national averages and there was no action plan to improve.

The issues identified affected all population groups, so they were also rated as inadequate.

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

  • There was a lack of understanding to the challenges to quality and sustainability at the practice.
  • There was a lack of a leadership development, and succession plan.
  • There was no systematic programme of clinical and internal audit or effective arrangements for identifying, managing and mitigating risks.
  • There was a lack of performance management.
  • There was no system in place to act on patient feedback.

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. (Please see further details at the end of this report of how the regulation was not being met).

In addition, the provider should;

  • Document and audit staff hand washing procedures.
  • Produce a follow-up procedure for deteriorating or acutely unwell patients.
  • Improve the identification of patients that are carers.
  • Monitor and audit consent process to ensure they are effective.
  • Continue to update and review all practice policies, procedures and the business continuity plan.
  • Advise patients how to protect their online information and produce an information sharing protocol.
  • Continue to make improvements as highlighted in the agreed action plan initiated by the Clinical Commissioners.

This service will be placed into special measures and 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.

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

05/02/2019

During a routine inspection

We carried out an announced comprehensive inspection at Tollgate Health Centre, on 05 February 2019 as part of our inspection programme.

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 and good for safe, caring, responsive and well-led.

We found that:

  • The practice had clear 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.
  • The practice provided care in a way that kept patients safe and protected them from preventable harm. However, they had not formally recorded the infection control work taking place, to evidence any improvement actions that may be needed.
  • There was an induction system for new and temporary staff members.
  • 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 and treatment.
  • The practice listened to their patients to organise and deliver services to meet patients’ needs. This included hosting services normally delivered in secondary care settings.
  • Patients told us they 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.
  • Leaders at the practice had the capacity and skills to deliver high-quality, sustainable care.
  • Staff told us they felt supported, valued, and that clinicians and management valued their support and their opinions.
  • Staff and leaders focused on continuous learning and improvement at the organisation, but this required strengthening.

We have rated the practice as requires improvement for providing effective services because;

  • We found no system of clinical audit to provide patient quality improvement.

This affected all population groups in the effective domain so they were all rated as requires improvement.

The areas where the provider should make improvements are:

  • Continue to evidence formally the infection control work being carried out, to ensure any trends or themes can be recognised.
  • Improve the identification of carers to enable this group f patients to access the care and support they need.

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.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice