This practice is rated as Good overall. (Previous rating: 07 December 2017 – Requires improvement)

We carried out an announced comprehensive inspection at Civic Medical Centre on 5 September 2017. The overall rating for the practice was requires improvement. The service had been removed from special measures following an earlier inspection on 19 January 2017. The full comprehensive reports on the January 2017 and September 2017 inspections can be found by selecting the ‘all reports’ link for Civic Medical Centre on our website at cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 20 June 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 5 September 2017.

This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Overall the practice is now rated as Good.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. Some areas of risk management required improvement.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• The practice worked proactively in collaboration with the hospital to improve bowel cancer screening uptake. There was an increase from 30% to 62%, becoming one of the highest achievers in the locality.
• Staff roles were developed and non-clinical staff were known as Healthcare Navigators (HCNs) and were involved in clinical meetings.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. Since the previous inspection, the practice had sought support from several support organisations to deliver improvement to 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 for patients.

The areas where the provider should make improvements are:

• Consider an updated DBS certificate for the Enhanced Nurse Practitioner that reflects the current registered body.  
• Maintain appropriate staff induction records.
• Take action to carry out and review prescribing audits.
• Monitor and improve the child immunisation uptake.
• Continue to monitor and improve patient satisfaction with regards to GP consultations.
• Take action to ensure patients complaint response letters clearly state how to escalate complaints.

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 Civic Medical Centre on 19 January 2017. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Civic Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 5 September 2017. Overall the practice is now rated as requires improvement.

Our key findings were as follows:

• The practice had addressed the matters that led to breaches in regulations at our last inspection, with the exception of addressing infection prevention and control risks.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

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

• Feedback about patient experiences, from national GP patient survey, suggested the practice performance had improved from the previous year in many areas

• Information about services and how to complain was available and easy to understand.

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

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Explore ways of improving the accessibility of the practice premises

In addition the provider should:

• Ensure they complete the remedial actions identified in their most recent infection prevention and control audit
• Continue to explore ways to improve the identification of a greater proportion of patients with caring responsibilities so they can provide and signpost them to appropriate support
• Explore ways of improving access to appointments

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

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 Civic Medical Centre on 19 January 2017. Overall the practice is rated as inadequate.

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

• The practice had a system in place for reporting and recording significant events. However, the lead GP was unaware that there was a formal process in place and we saw one significant event which had not been dealt with under the practice procedure.
• Risks to patients were not always assessed or managed appropriately. For example, the practice did not have adequate equipment to enable them to respond effectively in an emergency, there were infection control risks which had not been addressed and none of the nursing staff had professional indemnity insurance at the time of our inspection. In addition the practice was not regularly assessing fire safety risks.
• Overall, staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with clinical skills, knowledge and experience to deliver effective care and treatment. However, we found that some essential training was missing for some staff, that exception reporting was higher in a number of clinical areas and that there was a low uptake of breast and bowel cancer screening among the patient population.
• Patients’ feedback from the comment cards completed and from those we spoke with on the day of the inspection said that they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However, National GP Patient Survey scores showed the practice was rated below local and national averages in respect of the level of compassion shown to patients.
• Information about services was available and easy to understand. The practice complaint policy was available upon request but not easily accessible in the patient waiting area. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke to on the day and feedback from comment cards showed that patients found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. However, feedback from the patient survey showed the practice rated below local and national average for access to appointments.
• In most areas, leadership and areas of responsibility were clear; however, there was not an effective lead in place for infection control. All staff spoken to felt supported by management though GPs did not receive a practice appraisal. The practice proactively sought feedback from staff and patients, which it acted on; however, they were not aware of the National GP Patient Survey.
• The provider was aware of and complied with the requirements of the duty of candour.
• The provider was not registered for the regulated activity of family planning or maternity and midwifery services. We told the practice to take the necessary steps to ensure that their registration was correct.

The areas where the provider must make improvement are:

• Ensure that care and treatment are provided in a safe way and that all risks to the health and safety of service users are mitigate by; having adequate arrangements in place to respond effectively to emergencies and disaster and mitigating risks associated with infection control, legionella and fire safety.

• Have systems which effectively identify, record and learn from significant events and mechanisms to improve quality to ensure that risks are mitigated and the quality of service improves.

• Ensure that records, inclusive of comprehensive recruitment checks, are maintained for each staff member in order to mitigate against risks associated with staffing.

• Ensure all staff regularly receive training in accordance with current legislation and guidance which enables them to effectively carry out the duties they are employed to perform.

The areas where the provider should make improvement are:

• Review the number of GP sessions provided, ensuring that there are sufficient numbers of suitably qualified, competent, skilled and experienced staff available provide safe care and treatment.

• Work to improve patient satisfaction with care, treatment and involvement in decisions.

• Review clinical areas where exception reporting is higher than local and national averages to ensure that exception reporting is appropriate

• Review information in the patient waiting area which advises patients what to do in the event of an emergency.

• Consider ways to ensure that patient dignity is respected in the practice’s minor surgery room.

• Take action to improve the identification of patients with caring responsibilities to be able to provide appropriate support and signposting

• Advertise translation services, ensure the complaints policy is visible to patients and that responses comply with current legislation and guidance.

• Consider introducing mechanisms to regularly review performance against practice aims and strategic objectives.

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.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice