Modality Lewisham

We carried out an announced comprehensive at Modality Lewisham on 2 August 2023. Overall, the practice is rated as requires improvement.

Safe - requires improvement

Effective - good

Caring - good

Responsive – requires improvement

Well-led – requires improvement

Why we carried out this inspection

We inspected the practice because it was newly registered following the merging of three practices. This inspection was comprehensive and covered the key questions, are services safe, effective, caring, responsive and well-led.

How we carried out the inspection

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. We interviewed staff remotely in the lead up to our on-site inspection and also on 4 August 2023, following our visit. We spoke with Modality HR managers by video conference on 4 August 2023 and arranged a remote interview with the Modality Operations Manager on 10 August 2023.
• Completing clinical searches on the practice’s patient records system on 1 August 2023 (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.
• Three site visits.

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:

• The provider delivered care from three practice locations in buildings managed by NHS Property Services. There were some risks that were not well managed, related to safety risks in the buildings which were managed by another organisation.

• Care and treatment did not always reflect prescribing standards and best practice. Records we reviewed showed a small number of patients had not received monitoring or appropriate follow up, in line with current evidence-based guidance.
• The practice had not met targets for cervical screening and childhood immunisations. However, there were robust recall systems and performance against these targets was continually reviewed and monitored.
• Safety alerts were not always managed effectively to keep patients safe.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• People could not always access care and treatment in a timely way. Although we saw the practice was attempting to improve access, this was not yet reflected in the GP patient survey data or other sources of patient feedback.
• Some recruitment information was unavailable at the time of request, as some staff files were held in multiple locations. Senior HR managers told us staff files were still being migrated from old practice IT systems to the Modality Partnership central staff database.
• Staff provided positive feedback about working at the practice which indicated that there was a good working culture. Learning was shared effectively and used to make improvements.
• Although there were some strong systems and processes to manage risks to patients there were some risks that were not well managed. For example, medicines management processes for monitoring patients with long term conditions, required improvement.

We found two breaches of regulations. The provider must:

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

In addition, the provider should:

• Continue to implement a programme to improve uptake for cervical screening and childhood immunisations.
• Continue to improve processes for collating and storing recruitment and staff files to ensure information is easily accessible to managers.
• Continue to encourage patients to become members of the patient participation group.

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 Health Care