The Care Quality Commission
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  • GP practice

Forge Medical Practice

Overall: Good read more about inspection ratings

Pallion Park, Pallion, Sunderland, Tyne and Wear, SR4 6QE (0191) 510 9393

Provided and run by:
Forge Medical Practice

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Forge Medical Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Forge Medical Practice, you can give feedback on this service.

21 and 24 November 2022

During an inspection looking at part of the service

We carried out an announced focused inspection at Forge Medical Practice on 21 and 24 November 2022. Overall, the practice is rated as good.

Safe - Good

Effective – Good

Caring - not inspected, rating of good carried forward from previous inspection

Responsive - not inspected, rating of good carried forward from previous inspection

Well-led – Good

Following our previous inspection on 10 September 2021, the practice was rated requires improvement overall. We rated the key questions of safe and effective as requires improvement and caring, responsive and well-led as good.

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

Why we carried out this inspection

We carried out this inspection to follow up concerns from our previous inspection.

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.
  • A short site visit.

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:

  • There had been improvements to the way care and treatment was delivered since our previous inspection. The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • There were comprehensive systems in place to keep patients safe, which took into account current best practice. Projects and audits had been carried out to improve the prescribing of medicines.
  • Patients received effective care and treatment that met their needs.
  • There was a proactive approach to anticipating and managing risks. Innovation was encouraged to achieve sustained improvements.
  • 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.
  • The leadership governance and culture at the practice were improving the delivery of high-quality, community focused, person-centred care.
  • Staff were positive about working for the organisation. They said they felt supported by the management. Feedback and suggestions from them were taken on board and acted upon.
  • There was a proactive approach to seeking new ways to provide care and treatment.

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

  • Deliver their plans so that all staff receive an appraisal in a timely way.

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

10 September 2021

During a routine inspection

We carried out an announced inspection at Forge Medical Practice on 10 September 2021. Overall, the practice is rated Requires Improvement.

The key question ratings were as follows:

Safe - Requires Improvement

Effective – Requires Improvement

Well-led - Good

We last carried out a comprehensive inspection of Forge Medical Practice on 2 December 2016, when the overall rating for the practice was good, but requires improvement for providing responsive services. We carried out a focused inspection on 3 January 2018 to follow up on this aspect; found the practice had improved; and, rated them as good for providing responsive services.

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

Why we carried out this inspection

This was a focused inspection in response to concerns raised with us. We inspected the three key questions, Safe, Effective and Well Led as part of our new methodology to carry out more focused inspections for those practices rated as good overall. All other ratings were carried forward from the December 2016 and January 2018 inspections.

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 short site visit.
  • Asking staff to complete a questionnaire to gather their views.

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 requires improvement overall, and for being safe and effective; and for the populations groups, people with long-term conditions and people experiencing poor mental health. We rated the practice as good for being well-led

We rated the practice as requires improvement for being safe and effective and for the population groups, people with long-term conditions and people experiencing poor mental health, because:

  • Patients’ needs were not always being assessed, and care and treatment was always not delivered in line with current legislation, standards and evidence-based guidance.
  • The arrangements around prescribing warfarin (a high risk medicine) were not always effective and placed patients at risk.
  • The review processes for patients with long term conditions were not always effective at supporting patients to manage their conditions and improve their health and wellbeing.

We also found:

  • There were systems and processes in place to safeguard patients and protect them from abuse.
  • The practice learned and made improvements when things went wrong.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic.
  • The practice was aware of the areas that needed improvement and had a plan in place to address them. They were still in the process of implementing some of these plans.
  • There was evidence the culture of the practice had started to change to support continual and sustained improvement.
  • There was a clear vision and strategy within the practice and a strong emphasis on quality improvement amongst staff.

We found a breach of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients

Also, the practice should:

  • Carry out formal reviews of significant events to check for themes and repeated events.
  • Review the plan for cervical screening and put effective arrangements in place to increase uptake.

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 January 2018

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Forge Medical Practice on 2 December 2016. The overall rating for the practice was good but requires improvement for providing responsive care. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Forge Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 3 January 2018 to review in detail the actions taken by the practice to improve the quality of care. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

The practice is now rated as good for providing responsive services, and overall the practice is rated as good.

Our key findings were as follows:

  • At our previous inspection on 2 December 2016, we told the provider that they should make improvements in some areas. These included the arrangements for fire safety, quality improvement and access to services. We saw at this inspection that some improvements had been made.
  • The practice had ensured that staff knew what to do in the event of a fire by carrying out a fire drill.
  • The practice had taken steps to improve their cervical screening uptake rate. They had reviewed the letter they sent to patients who had not responded to invitations to attend for a screening test; they had also started to write to women aged 25 when they became eligible for the screening programme. However, these steps had not yet been successful. Data for 2016/2017 showed the practice had achieved 71%, which was a decrease of 2% since we last inspected the practice.
  • The practice had taken action to address concerns raised by patients about access to services, for example, additional clinical staff had been employed. They continued to monitor patient satisfaction in this area to determine if the changes they had made since data was collected for the July 2017 National GP Patient Survey have resulted in increased patient satisfaction with access to services.
  • The practice had continued to improve their performance relating to patients diagnosed with cancer being offered reviews within appropriate timescales. Data for 2016/2017 showed the practice had achieved 89%; an improvement of 16% since we last inspected the practice. The practice showed us data which indicated they would achieve a similar standard for 2017/2018.

There was one area of practice where the provider should make improvements.

  • Continue in their efforts to increase the uptake for cervical screening programme.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

2 December 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a previous inspection of this practice on 21 April 2015 and found a number of concerns. We rated the practice as inadequate overall and placed the practice into special measures. We carried out another inspection on 14 January 2016. The practice had made some improvements, but there were still some areas of concern. We rated the practice as requires improvement overall and as recognition for the improvements made we removed the practice from special measures.

We undertook this comprehensive inspection on 2 December 2016 to check that the practice had improved since the previous inspections; they had followed their plan to improve; and, to confirm that they now met legal requirements. You can read the reports from our previous comprehensive inspections by selecting the ‘all reports’ link for The Old Forge Surgery on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at The Old Forge Surgery on 2 December 2016. Overall, the practice had improved and is rated as good.

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

  • The practice had made improvements across several areas of concern identified at the inspection in January 2016. This included improved governance arrangements. The practice had since merged with another local practice, and evidence demonstrated this was successful. We found a harmonious team working together to provide good quality service and care to patients.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Results from the National GP Patient Survey (July 2016) showed mixed views on patient satisfaction, but they were generally in line with comparators in terms of being treated with compassion, dignity and respect.
  • The practice had made improvements to the process for recording and handling complaints. Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Indicators from the National GP Patient Survey relating to patient satisfaction levels on how they access care and treatment were mostly lower than comparators. Patients told us they were normally able to make appointments when they needed them in an emergency. However, they told us they had to wait for a routine appointment.
  • 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 provider was aware of and complied with the requirements of the duty of candour.

At the last inspection, in January 2016, we told the practice they should make improvements in some areas. The practice had addressed these as follows:

  • Staff had undertaken training in the safeguarding of vulnerable adults.
  • The practice now had in place arrangements to ensure a clean and hygienic environment and monitored compliance with this.
  • All Patient Group Directions were now appropriately authorised and in line with national guidelines.
  • There were arrangements in place to ensure learning from significant events was shared with relevant staff.
  • The practice had developed a protocol for repeat prescribing of medicines. This informed staff how to issue a repeat prescription, including what action to take when a patient was overdue a medicines review.
  • The practice had continued to develop their approach to clinical audit. There was an on-going audit programme where they showed they have made continuous improvements to patient care in a range of clinical areas as a result of clinical audit.
  • Performance relating to patients diagnosed with cancer offered reviews within appropriate timescales had improved significantly. However, performance was still lower than local and national comparators.

However, the practice results from the National GP Patient Survey, particularly in relation to waiting times were still below local and national comparators.

The areas where the provider should make improvements are:

  • Check staff are supported to know what to do in the event of a fire, by carrying out a fire drill as planned.
  • Consider how they can increase the uptake for cervical screening programme to bring them in line with comparators.
  • Review the results from the National GP Survey, specifically in relation to waiting times at the surgery, and take action to improve patients’ experience.
  • Continue to improve performance relating to patients diagnosed with cancer offered reviews within appropriate timescales, to bring performance on this indicator in line with local and national comparators.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

14 January 2016

During a routine inspection

We carried out an announced comprehensive inspection at The Old Forge Surgery on 14 January 2016. Overall the practice is rated as requires improvement.

We found that improvements had been made since the previous inspection of April 2015 when the practice had been rated as inadequate and was placed into Special Measures.

Our key findings were as follows:

  • The practice had received support from the local clinical commissioning group (CCG) and had taken steps to make improvements following the last inspection; some of the new arrangements were at an early stage and not fully embedded into the practice.
  • There was a new leadership structure in place and the partnership arrangements in the practice had changed. Two of the three partners had retired and two former salaried GPs had joined the partnership. The third partner was absent from the practice on a long-term basis.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, although arrangements to share learning with relevant staff were at an early stage
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day. However, the National GP Patient Survey (July 2015) showed that waiting times at the surgery were below average.
  • Information about how to complain was available and easy to understand. However, the arrangements for recording and handling complaints were ineffective.
  • Since the last inspection the practice had taken steps to implement a system for clinical audit, although further improvements were required.

However, there were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Implement effective arrangements to ensure that all complaints are recorded and handled appropriately.

In addition the provider should:

  • Take steps to ensure staff working within the practice have the appropriate level of competencies in relation to adult safeguarding.
  • Complete the updated cleaning schedules to allow for the monitoring of cleaning standards and maintain records to demonstrate when clinical equipment has been cleaned.
  • Review Patient Group Directions and ensure all are appropriately authorised, in line with national guidelines.
  • Make sure that learning from significant events is shared with relevant staff.
  • Review the results from the National GP Survey, specifically in relation to waiting times at the surgery, and take action to improve patients’ experience.
  • Develop a formal protocol for the repeat prescribing of medicines for staff to follow.
  • Continue to develop their approach to clinical audit. The practice should aim to demonstrate an on-going audit programme where they can show that they have made continuous improvements to patient care in a range of clinical areas as a result of clinical audit.
  • Put plans in place to ensure patients diagnosed with cancer are offered reviews within appropriate timescales.

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.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

21 April 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of The Old Forge Surgery on 21 April 2015.

Overall, we rated the practice as inadequate. Specifically, we found that the practice was inadequate for providing safe, effective and well led services, but was good for providing caring services. The practice needed to make improvements to ensure that services were responsive to the needs of its population.

Our key findings were as follows:

  • Patients’ needs were assessed but care was not always delivered following best practice guidance;
  • The outcomes of patients’ care and treatment were not regularly monitored;
  • The practice did not have a clear vision or strategy. Although the practice had a management team, there was a lack of effective leadership;
  • When things went wrong, reviews and investigations were not sufficiently thorough and lessons learned were not communicated widely enough to support improvement;
  • There were ineffective systems in place for infection control and monitoring patients’ medicines;
  • Staff had not received the training necessary to carry out their roles effectively
  • Feedback from patients was generally positive; they told us that staff treated them with respect and kindness;
  • Patients generally reported good access to the practice, with urgent appointments available the same day, although we observed some patients waited a long time once they arrived for their appointment;
  • Staff felt supported by the management team.

There were several areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure that there are formal governance arrangements in place, including systems for assessing and monitoring the quality of the service provision. Staff must have appropriate policies and guidance to carry out their roles in a safe and effective manner.
  • Ensure that audits of practice are undertaken, including completed clinical audit cycles.
  • Take action to ensure that effective infection control systems are in place.
  • Ensure relevant checks are carried out on staff, in relation to recruitment of new staff and the professional registrations of existing staff.
  • Implement systems to ensure that patients’ medicines are effectively monitored and take action to ensure that blank prescription forms are handled safely.
  • Provide appropriate training for all staff, including training on fire safety and information governance.

It has come to my attention also that two of the three GP partners are on sick leave, so I am asking the provider to supply us with information through a section 64 letter about how the practice will cover the appointments needed to meet the needs of its patient population during this time.

On the basis of the ratings given to this practice at this inspection, and the continual breaches of regulations identified at two previous inspections, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

17, 24, 25 June 2014

During an inspection looking at part of the service

At the previous inspection in October 2013 we found that staff were not supported to undertake their roles as they had not received appropriate training, supervision and appraisal support.

The provider sent us an action plan which had been completed following our inspection. This included the actions they were going to take to meet the regulation and the timescale within which this would be achieved. We returned to the practice on 17 and 24 June to speak with the Practice Manager and Deputy Practice Manager and on 25 June 2014 to speak with the practice nurse, to review whether the provider had made improvements. We found some progress had been made to provide training and support to staff. However, there were still some areas where further improvements were needed.

The practice did not have sufficient arrangements in place to ensure staff were aware of the health and safety risks within the practice, and what action they needed to take to reduce the risk for themselves, patients or visitors.

17 October 2013

During a routine inspection

We spent time observing the way the practice worked and spoke to patients and staff. We spoke with four patients who spoke highly of the service they received from The Old Forge Surgery.

One person told us the practice was 'Absolutely brilliant'. Another person said 'Nice clean surgery and people are polite and friendly'. One person said 'I haven't got a bad word to say about this surgery, In fact I would recommend it'.

We saw the provider had taken reasonable steps to identify the possibility of abuse from happening. The practice was clean and had the appropriate standards of cleanliness. There were systems in place to identify, monitor and manage risks to those using, working in or visiting the service.

We found that the provider had no effective system in place to monitor when training was needed or was due for renewal. Staff were not properly supported through basic training or appraisals to perform their roles.