Archived: Cramlington Medical Group

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cramlington Medical Group on 12 May 2015. Overall, the practice is rated as inadequate. Specifically, we found the practice to be inadequate for providing safe, effective and well-led services and requires improvement for the provision of caring and responsive services. There were aspects of the practice which were ‘inadequate’ and that related to all population groups.

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

• The practice was going through a period of major upheaval. The senior GP partner was absent from the practice, and key members of staff, including the practice manager, who had tendered their resignation at the end of 2014 and vacated their post the day before our inspection. This had impacted upon staff morale and their capacity to provide patients with safe, good quality care and treatment;
• Effective leadership and governance arrangements were not in place. We found risks to patient safety that had not been identified by staff, consequently there were no plans to address these;
• Nationally reported data for 2013/14 showed the practice performed well in providing clinical care and treatment to patients with most of the long-term conditions and public health indicators covered by the Quality and Outcomes Framework (QOF). However, QOF data for 2014/15 indicated the practice had not performed as well as it had previously done with regards to the delivery of healthcare reviews for patients with long-term conditions. Although staff provided a range of services to meet the needs of patients with long-term conditions, the practice did not have an effective mechanism in place for identifying and monitoring patients who were unresponsive to ‘recall’ telephone contact or letters;
• We were unable to confirm that patients’ needs were assessed, and care was planned and delivered in line with current legislation and best practice guidance. This was because, for example, the practice had no system in place for reviewing and, where necessary, updating their clinical guidelines in light of changes to national and local CCG guidelines. Also, clinical staff had failed to carry out a structured programme of clinical audits;
• Most patients told us they were treated well and received a good service. Findings from the National GP Patient Survey of the practice, published in 2015, showed variable levels of satisfaction with the quality of services provided by the practice. Some of the results were better than or in line with the local CCG and national averages, whilst others clearly fell below both averages;
• Effective arrangements were not in place to ensure that locum GPs working at the practice had undergone the required pre-employment recruitment checks, to make sure they were suitable to work with children and vulnerable adults;
• Although there was a system in place for identifying, reporting on and learning from significant events, this did not always work effectively. The quality of the recording of significant events was not satisfactory and did not always demonstrate the steps taken by the practice to prevent their reoccurrence and safeguard patients;
• The practice was clean and hygienic throughout, and patients said they were satisfied with the levels of cleanliness;
• The practice had good facilities and was well equipped to treat patients and meet their needs.

The areas where the provider must make improvements are:

• Ensure required pre-employment checks for locum GP staff are carried out;
• Ensure suitable governance arrangements are in place to assess, monitor and improve the quality and safety of the services provided. In particular: undertake a structured programme of clinical audits to demonstrate improvements in patient care; review and update clinical guidelines to ensure patients receive the most effective care and treatment available; ensure clinical staff follow the practice’s clinical guidelines;
• Take action to ensure the safe management of medicines;
• Evaluate and improve the systems in place for identifying and monitoring patients who are unresponsive to ‘recall’ telephone contact or letters;
• Review the availability of appointments to ensure the numbers offered per patient per week are in line with current guidance;
• Ensure all staff, including the regular locum GPs who work at the practice, have completed all of the training they need to keep patients safe.

The areas where the provider should make improvements are:

• Make sure an effective system is in place for dealing with safety alerts, including those concerning the management of medicines;
• Take account of the advice contained in the Significant Event Analysis GP Mythbuster which can be found on the Care Quality Commission's website;
• Carry out a recorded risk assessment to determine which emergency medicines GPs should carry with them during routine visits, for use in an acute situation. When doing this, take account of the guidance issued by the CQC;
• Provide all staff who carry out lead clinical and non-clinical roles with clear guidance about their roles and responsibilities and how they should implement these;
• Improve the recording of complaints to ensure that it is clear what lessons have been learnt and how they should carry these out.

CQC has taken the decision not to put the practice into Special Measures for the following reasons: the Provider that was registered for this service at the time of the inspection, and who was rated as Inadequate, is no longer carrying on the Regulated Activities but has yet to cancel their registration with CQC. A new provider is carrying on the regulated activities at the location and is applying for the location to be added to their existing registration. CQC has confidence that the incoming provider will address the issues contained within the report, and that based on their track record as a Provider they do not need the support that would usually be provided to a practice in Special Measures. We believe that because of the unique circumstances surrounding this practice and the arrangements that have already been put in place to support them to improve, the same outcome will be achieved as if it had gone into Special Measures. As with any practice rated as inadequate CQC will inspect again in a shorter time frame and consider its findings on that inspection and take any necessary action.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice