This practice is rated as requires improvement overall. (Previous rating published 6 February 2018 – Requires improvement)
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Requires improvement
We carried out an announced comprehensive inspection at Crown Medical Centre on 19 June 2018. At the previous Care Quality Commission (CQC) inspection in September 2017, the practice received an overall requires improvement rating. The practice was deemed to require improvements for providing safe, responsive and well-led services, and good for providing effective and caring services. The practice provided us with an action plan to address the areas which we identified as problematic during this inspection. This inspection on 19 June 2018 was undertaken to check that the practice had made improvements and was compliant with regulations.
At this inspection we found:
- The practice had some systems to manage risk so that safety incidents were less likely to happen. However, not all risks were identified and acted upon appropriately.
- We found a significant backlog of patient records which required their notes summarising, and an additional backlog of letters which required clinical coding.
- Recruitment checks had not been sufficient and systems to ensure safe recruitment were found to be lacking. This included the screening of newly recruited staff through the Disclosure and Barring Service (DBS).
- The practice did not always take effective action when risks were identified. For example, we found that an action plan developed further to a fire risk assessment had not been reviewed almost two years after being issued.
- We found that there had been a significant improvement in the culture of the practice. At our previous inspection, some staff had raised concerns about how they were treated and did not feel that they received adequate support. Consequently, there had been a large turnover of staff which had disrupted the continuity of the service. However, we found the situation had improved and the appointment of a new practice manager was driving improvements to address many long-standing difficulties.
- The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Most patients found the appointment system easy to use and reported that they were able to access care when they needed it. Feedback from the GP national survey was mostly in line with averages, although feedback received in CQC patient comment cards and other sources, such as NHS Choices, did not always support this view.
- There had been improvement in the handling of complaints within the practice.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure care and treatment is provided in a safe way to patients in accordance with the fundamental standards of care. For details, please refer to the requirement notice at the end of this report.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For details, please refer to the requirement notice at the end of this report.
The areas where the provider should make improvements are:
- Review the practice’s recall systems to improve patients’ attendance for review of long term conditions.
- Continue to review and improve access arrangements
Where a service is rated as inadequate for one of the five key questions or one of the six population groups, it will be re-inspected no longer than six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.
Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice