The Care Quality Commission (CQC) has downgraded the rating for Cricklade Surgery in Swindon, Wiltshire, from good to inadequate and placed the service into special measures to protect people, following an inspection in December.
Cricklade Surgery provides GP services to around 3,400 people and CQC carried out this inspection after receiving concerns about the quality of care being delivered.
Inspectors found the surgery was in breach of four legal regulations around providing safe care and treatment, staffing, employing fit and proper people and how the service is being managed.
CQC has served three warning notices to the service and requested an action plan.
Following this inspection, inspectors downgraded safe from good to inadequate and downgraded well led from requires improvement to inadequate. Effective dropped from good to requires improvement. Caring and responsive weren’t looked at and remain rated as good from a previous inspection.
CQC has placed the service in special measures which involves close monitoring to ensure people are safe while they make improvements. Special measures also provides a structured timeframe so services understand when they need to make improvements by, and what action CQC will take if this doesn’t happen.
Victoria Oecken, deputy director of primary care and community services in the South West, said:
“When we inspected Cricklade Surgery, we found people were being put at risk by poor leadership and ineffective systems. Although people were positive about the care and treatment they received, our inspection identified multiple areas where the service wasn’t meeting required standards.
“Leaders didn’t have effective systems and processes in place to manage medicines safely, monitor long-term conditions, or deal with test results appropriately. They’d allowed a backlog to build up of test results waiting to be reviewed, some dating back months. For example, there were 232 pathology test results awaiting review, including both normal and abnormal results. This means people may not have received timely diagnoses or treatment.
“We found significant issues with how leaders were managing medicines at the surgery. Some people were recorded as having had a medication review when they hadn’t, and staff told us they helped dispense prescribed medicines, despite having no training to do so. This means people may not have been receiving their medicines safely, putting them at risk of harm.
“It was clear the service wasn’t providing staff with enough training or support to deliver safe, effective care. For example, there were times when there weren’t any clinicians present at the surgery, but leaders hadn’t ensured staff had the required skills or training to respond if there was a clinical emergency during those times. Only one of the ten staff had basic life support training and in one worrying example, someone experiencing chest pain presented at the surgery and was told to make their own way to the local A&E.
“We have told leaders exactly where we expect to see rapid improvements and we will continue to monitor the service closely to keep people safe during this time.”
Inspectors found:
- The service wasn’t always following national guidance when it came to managing long-term conditions. For example, records showed 70 people may have had a missed diagnosis of chronic kidney disease.
- Reception staff were responsible for triaging appointment requests, but leaders hadn’t provided them with training or triage tools to support them to do this. This means people who need urgent appointments may not be prioritised.
- The service didn’t provide adequate support or supervision to staff. They failed to ensure appraisals were completed and didn’t maintain regular one-to-one supervision. This put people at risk of unsafe care as the work of staff wasn’t being monitored for safety and effectiveness.
- Although the premises were clean and well maintained, leaders didn’t ensure health and safety or fire risks were mitigated. For example, there weren’t any appropriately trained fire marshals, which means people were at risk of delays or unsafe evacuation.
- Leaders didn’t ensure incidents were reported, recorded or investigated which meant lessons weren’t being learned.