We carried out an announced comprehensive inspection at Croft Medical Centre on 11 February 2019 as part of our inspection programme. The practice was previously inspected in 2016 and rated good.

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 have rated this practice as good overall.

We rated the practice as requires improvement for providing safe services as at the time of the inspection the key to the controlled drugs cabinet was not kept in a secure place during the day. As a result, there was a significant risk that controlled drugs could have been accessed by unauthorised people. Following the inspection, the practice took appropriate measures to keep the key securely.

We rated the practice as outstanding for providing responsive services and for people with long-term conditions and people whose circumstances may make them vulnerable because:

•The practice has taken an active role in social prescribing since 2016. They demonstrated the positive impact this had on patients including fewer hospital attendances.

•The practice had an above average prevalence of patients with diabetes and reached out to different communities to raise awareness of the risks associated with diabetes, for example by attending events at a temple.

•The practice carried out a monthly “hot clinic” for many patients with poorly controlled diabetes (HbA1c levels over 90) who needed specialist support. HbA1c indicates the level of sugar levels in the blood. By involving the GP, Consultant, practice nurse and community diabetic nurse, a significant improvement in HbA1c was demonstrated in 33 patients.

We also rated the practice as good for providing effective, caring and well-led services and for older people, families, children and young people, working age people and people experiencing poor mental health because

•The practice provided care in a way that kept patients safe and protected them from avoidable harm.

•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.

•The feedback we received from the care homes was very positive about the practice.

•The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

•The practice had a focus on learning and improvement.

•The way the practice was led and managed promoted the delivery of high-quality, person-centred care.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

•Review the security of keys in the dispensary.

•Review confidentiality in the reception area and the dispensary.

•Continue to review the appointment system and telephone access for patients to improve patient satisfaction.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Croft Medical Centre on 20 September 2016. Overall the practice is rated as good.

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

• People were protected by a strong, comprehensive safety system and a focus on openness, transparency and learning when things went wrong. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Risks to patients were comprehensively assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• The practice had recruited a clinical pharmacist who had carried out medicines reviews and worked with one of the practice nurses and outside agencies to implement a range of improvements. This included carrying out detailed reviews for 39 patients in a six-month period, resulting in patients using less medicines and significant cost savings for the practice.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• The provider was aware of and complied with the requirements of the duty of candour.

  We saw one area of outstanding practice:

• The practice had set up a social prescribing project which aimed to address social and economic isolation.Patients were referred to a community development worker who met with patients in a setting suitable for them, including weekly surgeries at the practice. The project had referred 37 patients to local services during a six month period in 2016 and we saw examples of improved outcomes for vulnerable patients.

There was an area where the practice should make improvements:

• The practice should continue to monitor and review the appointment system and telephone access for patients to improve patient satisfaction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Croft Medical Centre provides primary medical services to people in Leamington Spa and the surrounding areas, with a branch surgery serving people in and around Bishop’s Tachbrook. The branch surgery has a dispensary on site to issue prescribed medications to patients. Both surgeries offer consultations on site but doctors also visit patients at home if they need it.At the time of this inspection there were around 11,000 people registered with Croft Medical Centre.

We found that the practice was safe, effective, caring, well led, and responsive. The practice had adequate arrangements to provide healthcare services for older people aged over 75; people with long-term conditions; mothers, babies, children and young people; the working age population and those recently retired (aged up to 74); people in vulnerable circumstances who may have poor access to primary care; and people experiencing a mental health problem.

We spoke with 11 patients during our inspection. They told us that they had positive experiences of the care they had received. Concerns raised were mostly related to the appointment system and access to appointments on the same day. The practice was working with the Patient Participation Group (PPG) to address this issue.

The practice has been recently re-established and financed under new management. The practice management structure ensured the smooth running of the services provided. Staff told us that they felt supported and valued by their managers. There was a systematic approach that identified relevant legislation, latest best practice and evidence-based guidelines and standards, which contributed to effective patient care. The practice had carried out audits to check the quality of clinical care provided and acted on the findings but had not audited again to ensure the improvements made were being sustained.