24 May 2023
During a routine inspection
We carried out an announced comprehensive inspection at Churchtown Medical Centre on 22 and 24 May 2023. Overall, the practice is rated as good.
Safe - good
Effective - good
Caring - good
Responsive – requires improvement
Well-led - good
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Churchtown Medical Centre on our website at www.cqc.org.uk
Why we carried out this inspection
We carried out this inspection in line with our inspection priorities.
We inspected the key questions of:
Safe, effective, caring, responsive and well led.
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.
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:
- 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 way the practice was led and managed promoted the delivery of high-quality, person-centre care.
Responsive is rated requires improvement because:
- Patients reported less satisfaction with access to the practice in the National GP Patient Survey, directly to CQC and the practice. As a result, the provider had an action plan to improve the appointment system. The changes made were yet to be evaluated over time and sustained.
Whilst we found no breaches of regulations, the provider should:
- Take more timely action in response to all safety alerts.
- Improve documentation in patient records including medication reviews and information provided to patients during consultations.
- Take action to address monitoring and follow up action required for patients with long term conditions.
- Improve uptake for cervical screening.
- Continue to take action to improve patient satisfaction regarding access to the 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 Hospitals and Interim Chief Inspector of Primary Medical Services