We carried out an announced comprehensive inspection at Crocus Medical Practice on 18 July 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the July 2018 inspection can be found by selecting the ‘all reports’ link for Crocus Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 6 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 18 July 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

Our key findings were as follows:

• Significant improvements had been made since our previous inspection.
• There was now a system to respond, action and review Medicine and Health products Regulatory Agency (MHRA) alerts.
• Medicines were kept safely, including those that required cold storage.
• Patients who were prescribed high risk medicines were receiving appropriate monitoring and review.
• The practice had not carried out an appropriate risk assessment to identify all emergency medicines that it should stock at both locations, although relevant medicines were acquired immediately after our inspection.
• Recruitment checks were effective and sought to ensure that staff were appropriately appointed. This was the case for permanent staff and locum GPs.
• The practice maintained a register of patients with learning disabilities. There were 42 patients on the register. There had been 25 health checks of patients with learning disabilities carried out in the last year. We saw that the remainder of patients were being actively recalled.
• Governance procedures had improved and were effective at identifying and mitigating risks to patients.
• 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.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crocus Medical Practice on 18 July 2017. Overall, the practice is rated as requires improvement.

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

• Whilst there was effective system in place to initially respond to Medicine and Health products Regulatory Agency (MHRA) alerts and identify patients who may be at risk, there was no evidence of ongoing monitoring.
• There were not adequate systems in place to ensure that patients who were prescribed high risk medicines were receiving appropriate monitoring.
• There was an effective system for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety in the practice.
• There was a monthly multi-disciplinary meeting with social workers, the health visitor and midwife to discuss children who may be at risk of abuse. GPs attended child safeguarding conferences wherever possible.
• The practice did not have adequate systems to manage medicines that required cold storage.
• Recruitment checks were not always effective.
• Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.
• Clinical audits demonstrated quality improvement.
• A GP from the practice had been involved in developing voluntary services for patients in the locality. This charity signposted patients to avenues of support within the community.
• The practice had identified 189 patients as carers, which amounted to 1.5% of the practice list.
• The practice had 42 patients on the learning disability register and identified that of these patients, 27 were eligible for a health check. 18 health checks for patients with learning disabilities had been completed in the last year.
• The weekly GP-led visits to care homes enabled GPs to support staff, patients and their families.
• The practice understood its population profile and had used this understanding to meet the access needs of its population.
• There was comprehensive understanding of the performance of the practice. QOF data indicated consistent achievement despite a complex merger of the practices at Saffron Walden and Great Chesterford.
• A programme of clinical and internal audit was used to monitor quality and to make improvements.
• The governance and quality assurance at the practice required strengthening as some risks to patients had not been identified or acted on.

The areas where the provider must make improvement are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvement are:

• Ensure patients with learning disabilities are invited to an annual health check.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice