Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cambridge Medical Group on 10 November 2015. Overall the practice is rated as good.

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

• 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 the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.

We saw some areas of outstanding practice including:

Cambridge Medical Group is a well-established training practice for registrars and third year and fifth year medical students. One of the GPs in the practice achieved trainer of the year for registrars for Durham and Tees Valley in 2014.

Training is also given to second year nursing students. One student at a time works at the practice over one or two weeks. These secondments continue over ten weeks in the practice. During this time the student observes the GPs during consultations and similarly with the nurse practitioner. The student then carrys out some nursing tasks under the supervision of the nurse practitioner. An evaluation is completed by the student and those evaluations seen showed that the students had enjoyed their time at the practice and felt they had learnt a lot about general practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cambridge Medical Group on 10 December 2018.

We had previously inspected the practice on 10 November 2015. The overall rating was Good.

Since the previous inspection in 2015 the practice has undergone significant changes in the leadership. This has had an impact on how the practice is performing.

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 rated the practice as inadequate for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe.
• The practice did not have robust systems in place for the recruitment of staff.
• The practice did not have a fire risk assessment on the premises.
• The practice had not carried out an infection prevention and control audit. There was no evidence to show that staff had received training in infection prevention and control.
• The practice could not demonstrate that all confidential information was stored securely.
• The practice could not always demonstrate that the learning from significant events had been shared with all staff.

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

• There was limited monitoring of the outcomes of care and treatment.
• Some performance data was significantly below local and national averages.
• The practice could not demonstrate that sufficient staff training was taking place.

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

• The national GP survey results showed that patients said that last time they had a general practice appointment the clinician was not good at listening to them.
• The healthcare professional was not very good at treating them with care and concern

We rated the practice as inadequate for providing responsive services because:

• The national GP patient survey results showed that patients were not always able to access care and treatment in a timely way.
• The practice could not show that learning from complaints was shared with all staff.

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

• Leaders were not always visible and approachable. They could not show that they had the capacity and skills to deliver high quality, sustainable care.
• The practice could not demonstrate that they had a clear written plan and vision for the future.
• The overall governance arrangements were not always effective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.
• The practice did not have formal full team meetings.

These areas affected all population groups so we rated all population groups as inadequate

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

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.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice