We carried out an announced comprehensive inspection at The New City Medical Group on 28 February 2019. This was as part of our inspection programme, and to follow up on breaches of regulations.
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.
At the previous comprehensive inspection on 13 September 2016, the practice was rated overall good, but requires improvement for the ‘effective’ key question, with one breach of regulation concerning staff training. This led to a follow up inspection of the effective key question on 21 November 2017. Although some improvements had been made the practice was still found to have a breach concerning staff training, and was still rated requires improvement for the effective key question. A further follow up inspection of the effective key question on 7 June 2018 found the original breach for staff training largely completed, although the practice had a new breach around monitoring activity for clinical audit and staff training, and needed to work on the practice development plan. Therefore the practice remained as requires improvement for effective, although good overall.
At this inspection, we found that the provider had satisfactorily addressed the areas previously rated as requires improvement.
We have rated this practice as good overall, except for providing safe services, which we rated as requires improvement. The practice was rated as good for all population groups except long term conditions, which was rated as requires improvement.
We rated the practice as requires improvement for providing safe services because:
- The provider had failed to ensure the proper and safe management of medicines; specifically those administered under Patient Specific Directions (PSD’s).
We rated the population group of long term conditions as requires improvement because:
- There had been insufficient arrangements for timely recall and review of some long-term conditions patients. Although the practice had identified this, it had caused a delay to some reviews, particularly for housebound patients, and the subsequent catch-up programme was having an effect on nursing availability.
Other findings at this inspection were as follows:
- The practice provided care in a way that kept patients safe and protected them from avoidable harm.
- Apart from reviews of long term conditions, patients received effective care and treatment that met their needs.
- Staff involved and treated patients with compassion, kindness, dignity and respect. There was a strong, visible, patient-centred culture, and staff were proud to be able to give multiple examples of helping patients to understand and access timely treatment and support.
- The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
- The provider was prioritising the development of a clear vision and strategy for how they wanted the practice to develop. They had carefully considered the challenges the practice faced, and were involving staff in the process through planned away days and targeted key areas for improvement.
The areas where the provider must make improvements are:
- Ensure healthcare assistants administer medications only under appropriately completed and monitored Patient Specific Directions (PSD’s).
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- In addition to carrying out a written annual comprehensive infection control audit, document all regular ongoing checks to produce a clear audit trail.
- Record serial numbers of prescriptions as they are taken out of the box for use to create a full audit trail.
- Continue to explore ways to improve the annual review uptake for mental health patients.
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