All inspections: Gardiner Crescent Surgery

We carried out an announced comprehensive at Gardiner Crescent Surgery on 27 June and 5 July 2023. Overall, the practice is rated as requires improvement.

Safe - requires improvement.
Effective - requires improvement.
Caring – good.
Responsive – requires Improvement.
Well-led – requires Improvement.

Following our previous inspection on 20 September 2022, the practice was rated inadequate overall and for all key questions apart from caring which was rated as requires improvement. The practice was placed into special measures as a result of an earlier inspection in May 2022 and remained as special measures following our inspection in September 2022. We took enforcement action at our previous inspections and this inspection was to check if the provider had made sufficient improvements.

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

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection and check on any improvements made.

We inspected:

All key questions
We checked progress with improvement against the following breaches of regulation found during previous inspections including, good governance (regulation 17); staffing (regulation 18); fit and proper persons employed (regulation 19); safe care and treatment (regulation 12); receiving and acting on complaints (regulation 16).

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 (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.
Sending out a questionnaire to staff.

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:

At this inspection in June/July 2023, we found compliance with Regulation 12 safe care and treatment and Regulation 19 Fit and proper persons employed. However, we found continued non-compliance with Regulation 16 Complaints, Regulation 17 Good governance and Regulation 18 Staffing. The practice is therefore rated as requires improvement overall. There was clear evidence of the provider taking action to improve the quality and safety of the service following the last CQC inspection. However, this has been reactive to those issues reported via the CQC inspection process or via commissioners. Improvement is still required.

We rated the practice as requires improvement for providing safe services because:

There were gaps in systems to assess, monitor and manage risks to patient safety.
The practice did not have an effective system to learn and make improvements when things went wrong.

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

Whilst staff had the skills, knowledge, and experience to carry out their roles and were supported, the systems in place did not support mangers to have oversight of staff training levels for either mandatory or specialist training.
A programme of targeted quality improvement was not in place.

We rated the practice as good for providing caring services because:

Staff treated patients with kindness, respect, and compassion.
Staff helped patients to be involved in decisions about care and treatment.
The practice respected respect patients’ privacy and dignity.

We rated the practice as requires improvement for providing responsive services because:

We found that those areas previously regarded as inadequate had improved but there were still some gaps and areas for improvement identified.
The practice took some steps to organise and deliver services to meet patients’ needs. However, delivery of such services was impacted by reduced clinical staffing levels meaning services did not always meet patients’ needs.
The provider was now responding to the needs of patients with long term conditions and addressing health inequalities. Translation and interpretation services were available.
The practice had put in place some measures to address gaps in access, but these measures were not sustainable in the long term.
The practice had improved complaint handling processes, but this required more time to be fully embedded.

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

Leaders could not demonstrate that in isolation they had the capacity and skills to deliver high quality sustainable care.
There was no clear strategy in place but there was a commitment to improve and provide high quality care.
The overall governance and management arrangements were not always effective.
There were gaps in the systems and processes for managing risks, issues, and performance.
There was some involvement of the public, staff, and external partners to sustain high quality and sustainable care.
There was some evidence of systems and processes for learning and continuous improvement. Innovation was not demonstrated.

We found 3 breaches of regulations. The provider must:

Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.

The provider should:

Implement the remaining actions from the infection prevention and control audit.
Reduce the risk of antibacterial resistance by continuing to monitor and reduce the inappropriate prescribing and overuse of antibiotics.
Improve information about support groups on the practice website.
Take action to ensure all staff are aware of who the Freedom to Speak Up Guardian is.

This service was placed in special measures in July 2022. Following a further inspection in September 2022 where we found insufficient improvements we took action in line with our enforcement procedures to begin the process of preventing the provider from operating the service.

In this third inspection we found that sufficient improvements have now been made. I am taking this service out of special measures. This recognises the 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 Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

We previously carried out an announced inspection at Gardiner Crescent Surgery on 24 and 26 May 2022. The provider was rated as inadequate and placed into special measures. We issued warning notices in respect of non-compliance with five Regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014:

Regulation 12 Safe care and treatment
Regulation 16 Receiving and acting on complaints
Regulation 17 Good governance
Regulation 18 Staffing
Regulation 19 Fit and proper persons employed

We told the provider they needed to be compliant with the Regulations 12, 16, 18 and 19 by 01 August 2022; and by 31 October 2022 for Regulation 17.

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

This inspection was an announced focused (unrated) inspection, carried out on 15 and 20 September 2022.

Overall, the practice rating remains as inadequate.

Why we carried out this inspection

The purpose of this inspection was to review actions taken by the provider in response to the warning notices for non-compliance with the following Regulations:

Regulation 12 Safe care and treatment
Regulation 16 Receiving and acting on complaints
Regulation 18 Staffing
Regulation 19 Fit and proper persons employed

The focus of this inspection was to:

Review the response of the provider to the concerns raised.
Review the quality of care currently provided by the provider

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:

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 site visit.
Reviewing concerns that were highlighted to us.
Requesting staff to complete feedback 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.

At this inspection we found that:

The provider did not provide safe care and treatment for patients.
The provider had failed to establish policies, systems and processes which operated effectively to assess, monitor and improve the quality and safety of care.
The staff team had undertaken mandatory training, and this was up to date.
Systems to assess, monitor and manage risks to patient safety were inadequate.
The provider did not establish or operate an effective system for the identifying, receiving, recording, handling or responding to significant events or complaints.
The provider did not have a formal process of clinical supervision in place to assess competencies or review prescribing data.
The provider did not have oversight of staff recruitment. The procedures in place did not operate effectively to ensure only fit and proper persons were employed.

We found 3 breaches of regulations. The provider must:

Ensure care and treatment is provided in a safe way to patients.
Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
Ensure that any complaint received is investigated and necessary and proportionate action taken in response to any failures identified in accordance with the fundamental standards of care.

In addition, the provider should:

Improve the arrangements in place for patients to have the choice to see a male or female GP.

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

A final version of this report, which we will publish in due course, will include full information about our regulatory response to the concerns we have described.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

We carried out an announced inspection at Gardiner Crescent Surgery on 24 and 26 May 2022. Overall, the practice is rated as Inadequate.

We rated the practice in each key question as:

Safe - Inadequate

Effective - Inadequate

Caring – Requires Improvement

Responsive - Inadequate

Well-led - Inadequate

Following an inspection on 23 and 24 August 2018 the provider was rated as good for providing caring and responsive services but rated as requires improvement for providing safe, effective and well-led services. Therefore, we rated the provider as requires improvement overall. At the follow up inspection on 19 August 2019, the practice was rated as good overall and for all key questions.

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

Why we carried out this inspection.

This inspection was a comprehensive inspection to respond to risk and follow up on concerns that were raised with us.

The focus of this inspection was to:

Review and respond to the concerns highlighted to the Care Quality Commission
Review the quality of care provided in each key question
Review the ‘shoulds’ identified in the previous inspection of August 2019.

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 to identify issues and clarify actions taken by the provider
Requesting evidence from the provider
A site visit
Reviewing concerns that were highlighted to us.

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

We found that:

The provider did not provide safe care and treatment for patients.
The provider had failed to establish policies, systems and processes which operated effectively to assess, monitor and improve the quality and safety of care.
Systems to assess, monitor and manage risks to patient safety were inadequate.
The provider did not establish or operate an effective system for the identifying, receiving, recording, handling or responding to significant events or complaints.
The provider did not ensure that there were sufficient numbers of suitably qualified, competent, skilled and experienced persons employed or ensure that staff received the appropriate support, training, professional development, supervision and appraisal, necessary to enable them to carry out the duties.
The provider did not have oversight of staff training or ensure that recruitment procedures were established and operated effectively to ensure only fit and proper persons were employed.
Outcomes from the National GP Patient survey were positive, and we observed staff speaking to patients in a kind and professional manner.

We found five breaches of regulations. The provider must:

Ensure care and treatment is provided in a safe way to patients.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment
Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
Ensure that any complaint received is investigated and necessary and proportionate action taken in response to any failures identified in accordance with the fundamental standards of care.

In addition, the provider should:

Improve the arrangements in place for patients to have the choice to see a male or female GP.

Following the inspection, we wrote to the provider on 27 May 2022 and requested that urgent action was taken to review the electrical safety of the premises managed by the provider. This included the installation of CCTV, a review of the use of overloaded extension leads, a socket covered in blue tape and a patient couch. The provider responded to our concerns and we were sent documented evidence on 30 May 2022 that these specific issues had been addressed.

We shared our concerns regarding the management of fire safety at the practice with the fire and rescue service.

We also shared our concerns regarding this provider with key stakeholders including County Durham Clinical Commissioning Group (CCG).

Meetings were held between CQC and the CCG post inspection. The CCG provided immediate support to the practice to enable them to meet fundamental standards of care, this was accepted by the provider.

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

We carried out an announced comprehensive inspection at Gardiner Crescent Surgery on 22 August 2019 as part of our inspection programme and to check that improvements had been made (previous rating August 2018 – requires improvement).

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.

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 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.

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

Take steps to make sure that infection control policies and procedures are easily accessible for all staff.
Continue the work currently in progress to ensure antibiotics are appropriately prescribed.
Carry out a risk assessment to determine the range of emergency medicines to store.
Continue to develop arrangements for ensuring only appropriate patients are excepted from the Quality and Outcomes Framework.
Complete the work to offer the meningitis vaccination to eligible patients.
Continue to seek ways to engage with patients and establish a patient participation group.

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

This practice is rated as Requires Improvement overall. (Previous rating under former provider 01 2017 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Gardiner Crescent Surgery on 22 and 23 August 2018 as part of our inspection programme.

At this inspection we found:

Staff demonstrated a very caring approach to their patients and it was clear they treated them with compassion, kindness, dignity and respect.
The practice scored well in the National GP Patient Survey across all areas.
Clinicians assessed patients’ needs and delivered person-focussed care and treatment.
The practice had some systems in place to manage risk, so that safety incidents were less likely to happen. When incidents did happen, the practice learned improved processes to keep patients safe. However, the practice’s arrangements for responding to safety alerts was not sufficient. There were some gaps in the practice’s arrangements for identifying, assessing and managing risk.
Staff demonstrated they were committed to making improvements and there was some evidence of this in the quality improvement activity they undertook. However, there was no programme of continuous clinical audit to monitor quality.
There were gaps in some staff’s training.
Appropriate recruitment checks had not been carried out for some staff who worked at the practice.
Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
There was some evidence the practice engaged with their patients. However, this was limited and the practice did not have an active patient participation group.

The areas where the provider must make improvements as they are in breach of regulations are:

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 to enable them to carry out their duties.
Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

Review the process for prescribing antibiotics to conform with best practice.
Consider increasing the support provided to carers.
Review arrangements for offering the meningitis vaccine to students.
Continue to take steps to encourage uptake of annual checks for patients with learning disabilities.
Review and improve patient engagement.
Reduce those exception reporting rates which are higher than the local clinical commissioning group and England averages.
Continue to provide support to ensure the practice management team have the relevant skills to fulfil their roles.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Gardiner Crescent Surgery

All Inspections

27 June 2023 and 5 July 2023

During a routine inspection

20 September 2022

During an inspection looking at part of the service

26 May 2022

During a routine inspection

22 August 2019

During a routine inspection

22 to 23 August 2018

During a routine inspection