• Doctor
  • GP practice

Castletown Medical Centre

Overall: Good read more about inspection ratings

6 The Broadway, Castletown, Sunderland, Tyne And Wear, SR5 3EX (0191) 549 5113

Provided and run by:
Dr Hesham Moustafa Koriem

Important:

We served a warning notice on Dr Hesham Moustafa Koriem on 23 September 2024 for failing to meet the regulation related to management and oversight of governance and quality assurance systems, staffing and recruitment procedures at Castletown Medical Centre.

All Inspections

2 june and 12 june 2023

During a routine inspection

We carried out an announced focused inspection at Castletown Medical Centre on 02 and 12 June 2023. Overall, the practice is rated as good.

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led - Good

Following our previous inspection on 24 February and 1 March 2022, the practice was rated requires improvement overall The conditions were imposed as a result of the May 2021 inspection when we rated the provider as inadequate. We rated the key questions of safe, effective and well-led as requires improvement and caring and responsive as good.

The full reports for previous inspections can be found by selecting the 'all reports' link for Castletown Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up concerns from our previous inspection.

How we carried out the inspection/review

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.

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 had been improvements to the way safe care and treatment was delivered since our previous inspection. The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • There were comprehensive systems in place to keep patients safe, which took into account current best practice. Projects and audits had been carried out to improve the prescribing of medicines.
  • The practice had improved systems that ensured patients received effective care and treatment that met their needs.
  • Complaints were dealt with as per the practice policy and were discussed to help improve practice
  • Staff involved patients in decisions about their care.
  • The leadership governance and culture at the practice had improved. They were developing new ways of working to meet challenges they had identified through their quality improvement systems.
  • Staff were positive about working for the organisation.

At this inspection we also reviewed the conditions we imposed on the providers registration as a result of our inspection in May 2021. The evidence we collected confirmed that all of the conditions had been met, so the conditions will now be removed.

Whilst we found no breaches of regulations, the provider should:

  • The provider should work to understand the results of their National GP Patient Survey where patients have reported they don't feel listened to or treated with care and concern by their healthcare professionals. They should endeavour to make improvements in these areas.
  • Continue to develop systems to ensure all medication reviews are carried out in a timely manner.

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

24 February 2022, 1 March 2022

During a routine inspection

We carried out an announced comprehensive inspection at Castletown Medical Centre on 24 February and 1 March 2022.

We previously inspected the practice on 8 September 2021. This was an urgent focused inspection which did not include an on-site inspection and therefore ratings from our previous inspection were not been reviewed.

We previously inspected the practice on 11 May 2021. Where the practice was rated overall as inadequate and for;

Safe - Inadequate

Effective - Inadequate

Caring - Good

Responsive - Inadequate

Well-led – Inadequate

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Castletown Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive follow-up of issues identified in the inspection of 11 May 2021 when the practice was placed in special measures.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit

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 have rated this practice as requires improvement overall

We rated the practice as requires improvement for providing safe, effective and well led services because:

  • At this inspection we saw some positive improvements to systems were in place to assess monitor and manage risks to patient safety. A great deal of work had been done to make these changes.
  • Although we saw some improvements in the management of high-risk medications, care plans and medication reviews, we identified further improvements which could be made.
  • Since the last inspection the practice had made progress with recruitment of non-clinical staff. However, they had yet to demonstrate these improvements were sustainable. The practice manager was quite new in post, and although interim support arrangements were in place, they were inexperienced in this role and had yet to demonstrate sustainable and effective management of the practice.
  • Some patients had not had a structured and comprehensive medication review of their long-term conditions.
  • There was no forward plan of clinical audits to make improvements to care and treatment.
  • Although we saw a lot of work had been done to try and address issues previously identified, the practice were reactive to the issues we identified in our previous inspection and there was no overall action plan in place to address these issues.
  • We remained concerned that changes to quality and sustainability cannot be fully implemented by the management at the practice, due to the high turnover of administrative staff and the lack oversight at the practice.
  • Although there was evidence of rudimentary governance and assurance processes in place, these were not effective. We had concerns regarding, the organisation and oversight of records, for example significant events, patient safety alerts, clinical coding, staff vaccinations and recruitment records.
  • There was no failsafe systems in place to ensure management of patient’s care and treatment.
  • Staff had received staff training, and this was recorded appropriately.

We rated the practice as good for providing a caring service because:

  • National GP survey results were positive.
  • The practice received good feedback from the NHS friends and families test.
  • The practice had identified carers at the practice.

We rated the practice as good for providing a responsive service because:

  • Patients could access care and treatment in a timely way.
  • Complaints were used to improve the quality of care.

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

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

I am taking this service out of special measures. This recognises the improvements that have been made to the quality of care provided by this service

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

11 May 2021

During a routine inspection

We carried out an announced inspection at Castletown Medical Centre on 11 May 2021. Overall, the practice is rated as inadequate;

Safe - Inadequate

Effective - Inadequate

Caring - Good

Responsive - Inadequate

Well-led - Inadequate

We previously inspected the practice on 5 January 2016, the practice was rated good overall and for effective, caring, responsive and well-led services. The practice were rated requires improvement for providing safe services. Following a further inspection on 15 August 2016, the practice was rated Good overall and for the key question of safe.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Castletown Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection, we have carried out this inspection because we received information of concern relating to insufficient clinical presence at the practice, limited numbers of administration staff suggesting that the practice was neither safe or accessible to patients.

How we carried out the inspection/review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing, on the telephone and face to face
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit

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 have rated this practice as inadequate overall and inadequate for all population groups.

The population groups are rated inadequate overall because there are aspects of the practice that are inadequate which therefore has an impact on all population groups.

We rated the practice as inadequate for providing safe, effective, responsive and well led services because:

  • There were not enough members of staff working at the practice to keep patients safe who were fully trained and in the correct role, with clear accountabilities.
  • Due to the limited experience of the staff in administrative roles and lack of access to information, we were concerned that staff could not identify and respond to the changing risks to patients who used the service, including deteriorating health and well-being or medical emergencies.
  • There was no overall training, the practice were not recording and monitoring staff training to ensure staff had the skills and experience needed to carry out their roles. There was no evidence of staff receiving appraisals.
  • In the clinical notes of four out of five hypertensive patients we looked at we saw that they had been monitored by a non-medical prescribing nurse without the clinical oversight of the GP.
  • There was no clear evidence of effective monitoring for high risk medication. Advice from the medicines and healthcare products regulatory agency (MHRA) was not being followed.
  • The practice did not have a system for the management of patient and drug safety alerts and therefore could not ensure medicines were prescribed safely.
  • Some patients had not had a structured and comprehensive medication review.
  • The lack of some systems and processes meant that patient’s needs were not always identified. For example, there were examples of poor-quality and inaccurate coding of patient records.
  • The practice did not have a system in place to learn and make improvements when things went wrong. There was no clear process for the recording of significant events, some staff we spoke with told us they were fearful of raising significant events and they were not allowed to enter them on the local risk and incident reporting system.
  • We found care and treatment was not always delivered in line with current legislation, standards and evidence-based guidance
  • A review of the mental health register found four patients had not been formally reviewed and they did not have a documented care plan in place.
  • We were concerned that the arrangement for appointments at the practice was unreasonable and unsuitable and left patients at risk of not receiving timely access to appointments.
  • Patients were not encouraged to put their concerns or complaints in writing. The practice thereby lost any opportunity to learn from these concerns or rectify what had happened for patients.
  • We found a lack of leadership capacity and capability to successfully manage challenges and implement and sustain improvements.
  • The practice could not evidence that some risks, issues and performance were managed to ensure that services were safe or that the quality of those services was effectively managed.
  • We were concerned that there was a blame culture in the practice, some staff were fearful of raising concerns and received a lack of support from management.
  • We found a lack of governance and assurance structures and systems which led to serious patient safety concerns identified at this inspection.

We rated the practice as good for providing a caring service because:

  • National GP survey results were positive.
  • The practice received good feedback from the NHS friends and families test.
  • The practice had identified carers at the practice.

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

  • Ensure care and treatment is provided in a safe way to patients
  • Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment

This is in accordance with the fundamental standards of care.

We are currently in the process of undertaking enforcement action against this provider. Once the appeal process has been concluded we will publish a supplementary report detailing the actions taken.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

15 August 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection of this practice on 15 August 2016, to check compliance with requirement notices we had previously issued following our inspection on 5 January 2016. During our inspection on 5 January 2016, continuing breaches of legal requirements were found and we issued requirement notices.

The continuing breaches we identified when we carried out the inspection on 5 January 2016 were in relation to:

  • Regulation 19 HSCA 2008 (Regulated Activities) Regulations 2014 Fit and proper persons employed.

  • Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2014 Care and treatment.

This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Castletown Medical Centre, on our website at www.cqc.org.uk.

Our key findings were as follows:

  • The provider had taken action which demonstrated their intent to comply with the requirement notice we issued, regarding their failure to do what was reasonably practical to ensure that all GPs working in the practice had undergone suitable pre-employment checks.

  • The provider had complied with the requirement notice we issued regarding their failure to provide a supply of oxygen for use in an emergency.

There were also areas of practice where the provider should make improvements:

  • Carry out regular audits of the practice’s infection control arrangements. The practice’s infection control lead should complete additional training to help them carry out this role effectively.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

5 January 2016

During a routine inspection

Letter from the Chief Inspector of General Practice


We carried out an announced comprehensive inspection at the Castletown Medical Centre on 5 January 2016. Overall, the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system for reporting and recording significant events.

  • Overall, risks to patients and staff 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 decisions about their care and treatment. They said they were satisfied with the quality of the care and treatment they received.

  • 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.

  • All staff were actively engaged in monitoring and improving quality and outcomes for patients.

  • Staff consistently supported patients to live healthier lives through a targeted and proactive approach to health promotion.

  • There was a clear leadership structure and staff felt supported by the management team. Good governance arrangements were in place.

  • Staff had a clear vision for the development of the practice and were committed to providing their patients with good quality care.

The areas where the provider must make improvements are:

  • Carry out the required pre-employment checks for GP locum staff employed directly by the practice. Obtain confirmation from NHS England that a DBS check has been carried out for GP locums working at the practice and keep a record of the outcome of each check.

  • Ensure there is a supply of oxygen for use in an emergency.

There were also areas of practice where the provider should make improvements:

  • Continue to take steps to set up a patient participation group.

  • Develop a plan for the practice which clearly sets out how staff will deliver their vision and strategy.

  • Carry out regular audits of the practice’s infection control arrangements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice