Cromwell Medical Centre Also known as Cromwell and Wormley Medical Centres

Updated 9 December 2016

Cromwell Medical Centre provides primary medical care for approximately 7,650 patients living in Cheshunt and surrounding areas in Hertfordshire.

The practice provides services, including minor surgery, under a General Medical Services (GMS) contract agreed nationally. The practice population is predominantly White British and the area served is less deprived compared to England as a whole.

The practice has four GPs (one male and three females) consisting of one principal GP two salaried GPs and a locum GP. There are two practice nurses including a nurse practitioner and a healthcare assistant. There is a practice manager who is supported by a team of administrative and reception staff.

The practice is open Monday to Friday from 8am to 6.30pm. The practice is closed between 12.30pm and 1.30pm each day and patients can contact a GP through a dedicated telephone line during this time if needed. The practice offers extended opening on a Saturday between 9am and

12.30pm. The practice offers a variety of access routes including telephone appointments, on the day appointments, online appointments and advance pre bookable appointments.

When the practice is closed services are provided by Herts Urgent Care via the 111 service.

Updated 9 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Cromwell Medical Centre on 20 October 2016. This was to check that improvements had been made following the breaches of legal requirements we identified from our comprehensive inspection carried out on 21 April 2016. During our inspection in April 2016 we identified regulatory breaches in the safe care and treatment, staffing and governance at the practice.

This report only covers our findings in relation to the areas requiring improvement as identified on inspection in April 2016. You can read the report from this comprehensive inspection, by selecting the 'all reports' link for Cromwell Medical Centre on our website at www.cqc.org.uk. The areas identified as requiring improvement during our inspection in April 2016 were as follows:

• Maintain accurate records of investigations of safety incidents and complaints.
• Ensure an appropriate system is in place for the safe use and management of medicines including a system for tracking blank prescription forms and pads, having valid and approved Patient Group Directions (PGDs) and Patient Specific Direction (PSDs).
• Carry out a risk assessment to ensure the appropriateness of emergency medicines stocked.
• Ensure that systems designed to assess the risk of and to prevent, detect and control the spread of infection are fully implemented.
• Ensure that all applicable staff receive a criminal records check and that the required information is available in respect of the relevant persons employed.
• Ensure that all staff employed are supported, receive the appropriate supervision and complete the essential training relevant to their roles and accurate records are kept in respect of the relevant persons employed.
• Make available a business continuity plan.
• Ensure a record of meetings held within the practice is kept.
• Review and date practice specific policies so these are reflective of current legislation and guidance.
• Maintain an oversight of the governance system in place to monitor the quality of the service.

Our key findings on this focused inspection across the areas we inspected were as follows:

• The practice had an effective system in place for reporting and recording significant events, including handling complaints and concerns.
• The practice had appropriate systems in place for the safe use and management of medicines, including emergency medicines and prescriptions. The practice had up-to-date Patient Group Directions (PGD’s) and Patient Specific Directions (PSD’s) in place.
• Systems and processes were in place to assess the risk of and to detect, prevent and control the spread of infection. For example, the practice had completed an infection control audit and had taken action to address improvements identified as a result.
• The practice had risk assessed the roles of all non-clinical staff and appropropriate checks had been undertaken through the Disclosure and Barring Service (DBS) check where applicable.
• A process was in place to ensure regular staff appraisals and all staff had completed essential training relevant to their roles.
• Practice policies were specific and up-to-date and reflected current legislation and guidance.
• Steps had been taken to review and make improvements to the disabled patient toilet facilities. For example, an emergency call bell had been installed.
• The practice had a business continuity plan in place.
• Records were maintained of practice meetings and the practice had an overarching governance system in place to monitor the quality of services provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016 we found that the practice offered effective care to patients with long term conditions.

However, breaches of legal requirements were identified and improvements needed to be made to ensure the practice provided safe services and was well-led. During our focused inspection on 20 October 2016 we found the practice had taken action to improve. Consequently the practice is rated as good for the care of people with long-term conditions as they received care that was safe and well-led.

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016 we found that the practice provided a good service to families, children and young people including those children living in disadvantaged circumstances and who were at risk

However, breaches of legal requirements were identified and improvements needed to be made to ensure the practice provided safe services and was well-led. During our focused inspection on 20 October 2016 we found the practice had taken action to improve. Consequently the practice is rated as good for the care of families, children and young people as they received care that was safe and well-led.

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016 we found that the practice offered proactive, personalised care to meet the needs of the older people in its population.

However, breaches of legal requirements were identified and improvements needed to be made to ensure the practice provided safe services and was well-led. During our focused inspection on 20 October 2016 we found the practice had taken action to improve. Consequently the practice is rated as good for the care of older people as they received care that was safe and well-led.

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016 we found that the practice offered a good service to patients of a working age and ensured the needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

However, breaches of legal requirements were identified and improvements needed to be made to ensure the practice provided safe services and was well-led. During our focused inspection on 20 October 2016 we found the practice had taken action to improve. Consequently the practice is rated as good for the care of working age people as they received care that was safe and well-led.

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016 we found that the practice had systems in place to ensure good care for those patients experiencing poor mental health including those patients with dementia.

However, breaches of legal requirements were identified and improvements needed to be made to ensure the practice provided safe services and was well-led. During our focused inspection on 20 October 2016 we found the practice had taken action to improve. Consequently the practice is rated as good for the care of people experiencing poor mental health as they received care that was safe and well-led.

Updated 9 December 2016

At our comprehensive inspection on 21 April 2016 we found that the practice held a register of patients living in vulnerable circumstances including those with a learning disability. The practice informed vulnerable patients about how to access support groups and voluntary organisations and staff knew how to recognise signs of abuse in vulnerable adults and children.

However, breaches of legal requirements were identified and improvements needed to be made to ensure the practice provided safe services and was well-led. During our focused inspection on 20 October 2016 we found the practice had taken action to improve. Consequently the practice is rated as good for the care of people whose circumstances may make them vulnerable as they received care that was safe and well-led.