We carried out an announced comprehensive inspection at Caradoc Surgery on 29 August 2017. The overall rating for the practice was requires improvement. The full comprehensive report on this inspection can be found by selecting the ‘all reports’ link for Caradoc Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 06 November 2018 as part of our inspection programme and to follow up on breaches of regulations found at our previous inspection in August 2017. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

The provider of this location is Anglian Community Enterprise, they have four GP practice locations registered with the Care Quality Commission.

Overall the practice remains rated as requires improvement

The key questions at this inspection are rated as:

Are services safe? – Good

Are service effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services Well-led – Requires Improvement

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• They had improved the system to act on patient safety and medicine alerts (MHRA) to ensure patient safety.
• Data for the year 2017/18 reflected poor achievement of clinical performance for patients with long term conditions and with poor mental health. Unverified data available on the practice computer system showed some improvement in some indicators. Improvements were below local and national averages.
• The system to monitor repeat prescriptions was effective. Prescribers reviewed patient’s diagnostic tests before issuing prescriptions.
• Recording, and the system to identify patients that were carers registered at the practice had improved. Further support was offered to assist carers.
• The practice had carried out their own patient survey to understand their patient’s level of satisfaction for their service and had acted on the findings. We saw actions taken on a plan to improve patient satisfaction. However, data from the national GP patient survey 2018 reflected low patient satisfaction in many areas.
• Leaders had the capacity and skills to deliver high-quality, sustainable care.
• Staff told us they felt supported, valued and that management listened to their opinions.
• The practice had a realistic strategy and supporting business plans to achieve their priorities.
• Staff involved with treating patients showed compassion, kindness, dignity and respect.
• Patients found it difficult to get an appointment and reported the new phone system to be problematic and it often took a long time to get answered.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• 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.

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

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Caradoc Surgery on 29 August 2017. Overall, the practice is rated as required improvement.

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

• Staff members knew how to raise concerns, and report safety incidents.
• Safety information was appropriately recorded and learning was identified and shared with all staff.
• The infection control policy met national guidance.
• Risks to patients and staff were assessed, documented and acted on appropriately.
• The practice had arrangements and processes to keep adults and children safe and safeguarded from abuse.
• Staff assessed patient care in line with current evidence based guidance.
• The practice had an effective system to act on patient safety and Medicines and Healthcare products Regulatory Agency (MHRA) alerts.
• Staff showed they had the skills, knowledge, and experience to deliver effective care and treatment.
• There were five clinical audits undertaken and we saw two completed cycles enabling improvements to be measured.
• The emergency medicines were stored in a treatment room that was above the safe temperature limits for medicine.
• The emergency equipment checking processes were ineffective, and had not identified the defibrillator pads were out of date.
• The system to monitor patients repeat prescriptions was not effective.
• Patients said they were treated with compassion, dignity, respect, and involved in their care and treatment decisions.
• Information about the practice services and how to complain was available in the waiting room, and on the practice website in easy to understand formats.
• The practice was aware of and complied with the requirements of the duty of candour when dealing with complaints and significant events in an open and honest manner.
• Patient satisfaction results published in the July 2017 national GP patient survey showed that patients were not satisfied with the practice across many of the areas measured.
• The practice facilities, and equipment was appropriate to treat and meet patient’s needs.
• There was a clear leadership structure and in addition, staff members felt supported by the practice clinical and management team.
• The practice had identified a low number of carers.

The areas where the provider must make improvements are:

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

The areas where the provider should make improvements are:

• Improve the identification and recording of carers so support and guidance can be offered.
• Improve the system for monitoring expiry dates of emergency equipment in use at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice