We carried out an announced comprehensive inspection at Lakeside Healthcare at Cedar House Surgery on 28 November 2018 as part of our inspection of the provider (Lakeside Healthcare Partnership). Our inspection team was led by a CQC inspector and included a GP and a nurse specialist advisor. The team also included a second CQC inspector.

Our judgement of the quality of care at this service is based 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.

I have rated this practice as good for safe, effective, caring and responsive (and good) overall because:

• People were protected from avoidable harm and abuse and that legal requirements were met.
• At the time of the visit the GP records were not fully updated with all available monitoring information in relation to the management of patients on high risk medicines. However, the practice were able to demonstrate​, once data had been updated, that prescribing for high risk medicine was safe.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• People’s needs were met by the way in which services were organised and delivered.

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

• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care. However, the system or process for the management of high risk medicines with appropriate monitoring and clinical review prior to prescribing required improvement.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes (in relation to the management of patients on high risk medicines) to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Ensure emergency medicines are kept secure
• Consider a formal process to document quality assurance process for the clinical practice of the advanced nurse practitioners and the paramedic.
• Continue to improve the identification of carers to enable this group of patients to access the care and support they require.

• 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