21 August 2023
During a routine inspection
We carried out an announced comprehensive inspection) at Thurmaston Health Centre on 21 August 2023. Overall, the practice is rated as requires improvement.
Safe - requires improvement.
Effective - good.
Caring - requires improvement.
Responsive - requires improvement.
Well-led - good.
We previously inspected the location under its previous provider on 17 December 2020, the practice was rated requires improvement overall and for all key questions. The practice changed provider and inherited the regulated history and ratings of the predecessor. The new provider registered with the Care Quality Commission (CQC) in May 2022.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Thurmaston Health Centre on our website at www.cqc.org.uk
Why we carried out this inspection
We carried out this comprehensive inspection to provide a rating of the location under the new provider and in line with our inspection priorities.
This was a comprehensive inspection and therefore we have reported on all key questions; 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.
- Staff questionnaires.
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.
- There system for monitoring patients’ health in relation to the use of medicines including high risk medicines needed strengthening as did the system for monitoring patients effected by safety alerts.
- 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.
- GP patient survey data was below ICB and national averages, and the practice had not completed patient their own patient feedback exercises to fully understand patients experiences.
- The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
Whilst we found no breaches of regulations, the provider should:
- Continue to improve the uptake of cervical screening.
- Continue to identify, contact and assess patients who are eligible for NHS health checks including patients with learning disabilities.
- Continue to monitor and further improve the systems and processes in place to link diagnosis with medicines prescribed.
- Review and improve the system and processes to identify patients effected by safety alerts.
- Continue to monitor and review backlog of summarising medical notes.
- Engage in patient feedback exercises to further improve and measure improvements to services.
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 Health Care