We carried out an announced focused inspection of Dr Cakebread and Partners on 17 April 2019. This inspection was undertaken to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation set out in warning notices we issued to the provider for Regulation 12 Safe care and treatment.

The practice received an overall rating of requires improvement at our inspection on 23 January 2019 and this will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the initial report.

The full comprehensive report from the January 2019 inspection can be found by selecting the ‘all reports’ link for Dr Cakebread and Partners on our website at .

Our key findings were as follows:

• The practice had complied with the warning notices we issued and had taken the action needed to comply with the legal requirements.
• The practice had reviewed the system to manage pathology results and this was safe and effective.
• The practice had an effective process to disseminate safety alerts and recent guidelines and ensured appropriate actions were taken.
• The practice had effective and thorough clinical policies.
• The cold-chain was appropriately monitored and vaccination fridge temperatures were monitored daily.
• Patient Specific Directions to enable healthcare assistants to give vaccinations were appropriately signed and stored.
• A complete record of staff immunisations was held.
• Competence of non-medical prescribers was assessed and practice was monitored and audited.
• Patients who were vulnerable were followed up if they did not collect their prescriptions.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Dr Cakebread and Partners on 23 January 2019 in response to concerns regarding poor care. These concerns were raised to the Parliamentary and Health Ombudsmen and not upheld. The practice were aware of the reason for our inspection. Our inspection team was led by a CQC inspector and included a GP specialist advisor and a practice nurse specialist advisor.

At the last inspection in June 2016 we rated the practice as good overall.

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.

The practice is rated as requires improvement overall.

We rated the practice as requires improvement for providing safe services because:

• The system to manage pathology results was ineffective. Shortly following the inspection, we received a policy which detailed how to manage these more safely.
• A complete record of staff immunisations was not held.
• Patient specific directions to allow vaccinations to be given by health care assistants were not always signed by a prescriber.
• There was no audit or competency assessments for non-medical prescribers however, appraisals were completed for these staff.
• We found breaks in the cold chain to safely store vaccinations that had not been appropriately escalated. Shortly after the inspection, we were provided evidence that this had been managed.
• There were adequate safeguarding systems in place.
• There were adequate recruitment systems in place.

We rated the practice as inadequate for providing effective services because:

• There were no systems in place to ensure action had been taken in regard to the most recent guidance or safety alerts. We found that not all patients were receiving the correct treatment for example patients suffering from asthma or respiratory diseases.
• There was not an effective system in place to follow up patients with mental health conditions who did not attend for repeat medicines.

We rated the practice as good for providing caring services because:

• Patients were supported, treated with dignity and respect and were involved as partners in their care.

We rated the practice as good for providing responsive services because:

• The practice offered flexible appointments that could be booked online.
• Patients told us that they could make an appointment when they needed however, it was sometimes difficult to contact the surgery by telephone.
• The practice listened to patient feedback and complaints and acted on it appropriately.

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

• There was a lack of clinical oversight and systems were not always effective. However, the leadership, governance and culture of the practice aimed for delivery of high quality person-centred care.
• Clinical policies were not always followed by all staff.
• Staff felt proud to work at the service and felt comfortable to raise concerns to the management team.

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

• Ensure care and treatment is provided in a safe way to patients.

There were areas where the provider should make improvements are:

• Continue to monitor patient satisfaction scores and improve telephone access to the practice.
• Continue to identify and support carers.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Cakebread and Partners on 16 February 2016. Overall the practice is rated as good.

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were available the same day and there was an extended hours service. Appointments could be booked over the telephone or online.
• Patients were also offered telephone consultation appointments.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

The areas that the provider should make improvement are:

• Ensure that a robust and continuous process of appraisals is in place and that appraisals for all staff are carried out annually.
• Ensure process is implemented to identify and support carers

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice