The Care Quality Commission
  • Doctor
  • GP practice

Castlegate & Derwent Surgery

Overall: Requires improvement read more about inspection ratings

Isel Road, Cockermouth, Cumbria, CA13 9HT (01900) 705750

Provided and run by:
Castlegate & Derwent Surgery

Important:

We served a warning notice on Castlegate and Derwent surgery on 9 August 2024 for Failure to comply with Regulation 17 (1)  of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Castlegate and Derwent Surgery have failed to establish policies, systems, governance and processes which operate effectively to assess, monitor and improve the quality and safety of care provided in the carrying on of the regulated activities at Castlegate and Derwent surgery.

All Inspections

During an assessment under our new approach

Castlegate & Derwent Surgery is located in Cockermouth at: Castlegate & Derwent Surgery, Isel Road, Cockermouth, Cumbria CA13 9HT The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury, family planning and surgical procedures. The practice is situated within the North Cumbria Integrated Care Board (ICB) and delivers General Medical Services (GMS) contract to a patient population of over 18,000. This is part of a contract held with NHS England. There is a team of 14 permanent GP’s, 3 Advanced Nurse Practitioners and 3 practice nurses who are supported by a team of treatment nurses, 5 health care assistants and GP assistants. Supporting the clinical team there is an operations manager, administration lead and admin and reception staff. At the time of the inspection the practice did not have a practice manager in place and this role was being undertaken by the GP partners alongside operational staff. Practice opening hours are from 08.00 – 18.30 Monday to Friday. Appointments are available from 08.00 – 18.30 Monday to Friday. The practice completed a poll with patients and offer appointments from 06:30 -08:00. The practice offers appointments on a Tuesdays, Wednesday and alternate Fridays evening between 18.30 – 20.00 and on weekends as part of the extended access service through the primary care network (PCN). The practice offers a range of appointments including, telephone consultation, video consultation and face to face appointments. When the practice is closed, patients can access out of hour’s services by telephoning NHS 111. The practice is registered as a dispensing practice with a community pharmacy located within the same building as the GP practice. The practice is part of a wider network of GP practices known as Cockermouth and Maryport PCN. Cockermouth and Maryport PCN is made up of 2 GP practices.

20 April 2023

During a routine inspection

We carried out an announced comprehensive inspection at Castlegate & Derwent Surgery on 17 – 20 April 2023. Overall, the practice is rated as Requires improvement.

Safe - Requires improvement

Effective - Good

Caring - Good

Responsive - Requires improvement

Well-led - Requires improvement

Following our previous inspection on 13 September 2019, the practice was rated good overall and for all key questions.

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

Why we carried out this inspection

We carried out this inspection to follow up on concerns reported to us.

How we carried out the inspection/review

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 (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.
  • Staff questionnaires
  • A short site visit
  • Feedback from patients

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 did not currently offer patients NHS electronic prescribing (ePS) or repeat dispensing (eRD) services. Patients were advised that prescriptions would be ready to collect after 72 hours (excluding weekends and bank holidays). An additional step of ‘logging out’ prescriptions collected by external pharmacies increased the time taken to process repeat prescriptions. As part of our inspection we spoke with 9 patients, 6 of whom told us about issues with their prescriptions.
  • There was no clear governance structure which meant systems were sometimes not reviewed. This included mandatory training, and we found that clinical staff training was not monitored effectively meaning some training had lapsed.
  • The practice’s governance and assurance systems were not always operating effectively.
  • We found the practice to be in a good state of cleanliness and staff understood the importance of infection prevention and control. However we found gaps in mandatory training on infection prevention and control across clinical members of staff.
  • There was not a thorough system in place to assure the competencies of non-medical prescribers
  • 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.
  • Recently senior leaders at the practice had changed and the new leadership team were making progress with the running of the practice. After the inspection the provider wrote to us and shared with us a list of improvement activities that had been initiated and shared with all staff.
  • Staff knew how to report significant events and deal with complaints, however we could not be assured that learning was always achieved.

We found a breaches of regulations. The provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

The provider should:

  • The provider should revisit decisions about the implementation of ePS and explore sources of support for the implementation of eRD with a view to improving their efficiency in processing prescriptions, thereby providing and a more efficient and responsive service to patients.

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

13 Sep 2019

During an inspection looking at part of the service

We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

This inspection focused on the following key questions:

  • is the practice effective;
  • is it responsive;
  • is it well-led?

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

  • is the practice safe;
  • is it caring?

Both of these key questions are rated good.

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 all population groups except Families, Children and Young People, which we rated outstanding.

We found that:

  • Patients received effective care and treatment that met their needs.
  • The practice organised and delivered services to meet patients’ needs. 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.

We rated the population group, families, children and young people as outstanding because:

  • The practice had achieved significantly higher than average immunisation rates for a large cohort of children. Childhood immunisation uptake rates were all above the World Health Organisation (WHO) targets.

We saw an area of outstanding practice:

  • We saw multiple examples of good communication between the practice and their patients and the benefits this was having. The practice scored highly for immunisation and screening uptake, for example they rated top in the county for abdominal aortic aneurysm screening, and they felt this was due to being able to communicate well with their patients and encourage them to attend. The practice used multiple approaches, such as frequent newsletters, social media and stalls in the local supermarket, to reach their patients.

However, there were some areas where the practice should make improvements:

  • Include all staff on the training matrix and make sure all mandatory training is completed within the recommended timeframes;
  • Ensure annual appraisals are available to all staff at the practice;
  • Take steps to ensure all staff receive the same level of induction when they begin work at the practice.

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

3 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Castlegate Surgery on 3 May 2016. Overall, the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Lessons were learned when incidents and near misses occurred.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Outcomes for patients were very good. The Quality and Outcomes Framework (QOF) data, for 2014/2015, showed the practice had performed very well in obtaining 99.9% of the total points available to them for providing recommended 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.
  • Information about services and how to complain was available and easy to understand.
  • Urgent appointments were available on the day they were requested. However, some patients told us that they had to wait two or three weeks for routine appointments and appointments with a named GP.
  • Extended hours appointments were available Monday to Friday between 7:30am and 8am.
  • 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 practice had engaged with the staff during the recent merger with another local practice, staff members had been part of the steering group for this merger.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • The practice had adapted their clinical system to support effective care of patients at increased risk of acute kidney injury due the medicines the patient was prescribed. When a clinician recorded relevant symptoms, the system checked the medicines prescribed and displayed a visual alert during the consultation. This reduced the risk of patients suffering acute kidney injury.

The areas where the provider should make improvement are:

  • The practice should continue to implement a system of staff appraisals as soon as possible to provide staff with a formal opportunity to discuss training, learning and development requirements.
  • Review the arrangements for clinical audit in order to be able to demonstrate a clear link between audits and quality improvement.
  • Continue to review patient access for routine appointments with a GP.
  • Review their staff induction and recruitment process for the checking of clinical and non-clinical staff immunity status against vaccine-preventable diseases such as measles.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

29 April 2014

During a routine inspection

Castlegate Surgery is located in the town of Cockermouth in Cumbria. The practice is situated within the newly built Cockermouth Community Hospital and provides services to approximately 10,500 patients. It is registered with the Care Quality Commission to provide the following regulated activities; diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

We carried out an announced inspection on 29 April 2014. The inspection team included the lead inspector, a GP, a practice manager and an expert by experience.

During the inspection we spoke with patients and staff. We also reviewed completed CQC comments cards. Feedback from patients was very positive. They told us they were happy with the practice and the premises. We saw the results of a patient survey which showed patients were consistently pleased with the service they received.

The practice had only moved into the community hospital premises in early 2014, and had previously been located in a temporary building following the floods of 2009. The new premises were purpose designed and built and were accessible to all.

The leadership team was very visible and staff found them approachable. There were excellent governance and clinical leadership measures in place.