Crabbs Cross Surgery

We carried out an announced comprehensive/focused inspection at Crabbs Cross Surgery on 31 August 2022. Overall, the practice is rated as Requires Improvement.

Safe - Good

Effective – Requires Improvement

Well-led – Requires Improvement

Following our previous inspection on 7 February 2017, the practice was rated Good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Crabbs Cross Surgery www.cqc.org.uk

Why we carried out this inspection

This inspection included a comprehensive review of information and a site visit where we inspected safe, effective, responsive and well-led care. Additionally, we reviewed access to the practice via telephone and a patient’s ability to book in with named GP’s.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, considering the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently. Therefore, as part of this inspection we completed clinical searches on the practice’s patient records system and discussed the findings with the provider. This was with consent from the provider and in line with all data protection and information governance requirements.

The inspection also included:

• Requesting and reviewing evidence and information from the service
• A site visit
• Conducting staff interviews
• Reviewing patient records to identify issues and clarify actions taken by the provider

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:

• There were clear responsibilities, roles and systems of accountability to support good governance and management. However, oversight of some systems was not effective.
• The practice had completed some quality improvement activities but did not routinely review the effectiveness of changes made as a response. There was limited monitoring of the outcomes of care and treatment.
• The practice consistently worked with other organisations to deliver effective care and treatment. Patients could be referred to a single point of access for concerns surrounding mental health; they were then signposted to other services.
• The practice was not routinely able to evidence that staff had received training in some areas. However, discussions with staff provided assurance that they had the required skills, knowledge and experience to carry out their roles.
• The practice did not always have effective systems for monitoring the storage of medicines. In particular, we found that some medication stored in vaccination fridges were out of date.
• The practice did not always have effective systems for the appropriate and safe use of medicines as some medication was found to be out of date in the medication fridges, in addition staff did not always have the appropriate authorisations to administer medicines, (including patient group Directions
• The practice had completed quality improvement activities but did not routinely review the effectiveness of changes made as a response. There was limited monitoring of the outcomes of care and treatment.

We found Regulation 17 HSCA (RA) Regulations 2014 Good governance breach of regulations.

The provider must:

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

Whilst we found breaches of regulations, the provider should:

• Take steps to improve the clarity of policies and procedures for staff regarding identified leads in areas such as freedom to speak up guardians.

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 Hospitals and Interim Chief Inspector of Primary Medical Services