City Square Medical Group

Updated 1 February 2024

City Square Medical Group is an NHS GP practice partnership located in a purpose-built building at 14 Deancross Street, London E1 2QA; and a branch site at 445 Cable Street, London E1W 3DP.

The City Square Medical Group delivers primary medical care to approximately 11,800 patients in the Stepney area of east London, on behalf of NHS Northeast London integrated care board (ICB). An integrated care board (or ICB) is a statutory NHS organisation which is responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in a geographical area. The practice is also part of Primary Care Network (PCN) and works with other local practices to improve the quality of healthcare for the local populations.

The provider registered with the CQC on 3 May 2023 following a merger of two smaller practices and is registered to undertake the following regulated activities: treatment of disease, disorder or injury diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures. One of the GP Partners is the CQC Registered Manager that is also the Clinical Lead of the PCN. A registered manager is a person who is registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The practice holds a general medical services contract (GMS) with NHS England (A GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities). Services provided include minor surgery (injections only), phlebotomy and a range of nurse led clinics such as antenatal, diabetes and sexual health, and primary medical services to a local care home.

There are 3 GP partners (2 male and 1 female) and a salaried GP. There is a part time female Nurse Practitioner, a full-time practice nurse, , 2 part time pharmacists, a part time physiotherapist, full time care co-ordinator, part time mental health worker, three part time health care assistants, practice manager, receptionist supervisor, and 8 reception/administration staff. There is currently no employed practice nurse, and this is being provided by agency nurses. The practice is a teaching practice for medical students.

Opening hours at the Deancross Street (main site) are Monday 8am to 8pm and Tuesday to Friday 8am to 6.30pm. Appointment times are Monday 8:30am to 12:30pm and 2:30pm to 8pm, and Tuesday to Friday 8:30am to 12:30pm and 2:30pm to 6.30pm. Opening hours at Cable Street (branch site) are Monday to Friday 9am to 6pm; and appointment times are Monday to Friday 9am to 6pm.

Extended hours are offered Monday from 6:30pm to 8pm and appointments are available via the local hub on weekdays from 6:30pm to 8pm, and at weekends from 8am to 8pm. In addition to pre bookable appointments that can be booked up to two weeks in advance. There are in-person same day appointments and urgent same day telephone consultations are also available for people that need them. Out of hour’s service are delivered by a separate provider that is accessed by calling the surgery telephone number.

Information published by Office for Health Improvement and Disparities shows that deprivation within the practice population group is in the fourth lowest decile (4 of 10). The lower the decile, the more deprived the practice population is relative to others.

According to the latest available data, the ethnic make-up of the practice area is 52% Asian, 37% White, 5% Black, 3% Mixed, and 3% Other.

Updated 1 February 2024

At a previous inspection on 9 May 2017 when the practice was registered at a different location, it was rated good in all key questions and overall, and there were with no regulatory breaches.

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

Why we carried out this inspection

We carried out a comprehensive unannounced inspection of the City Square Medical Group on 24 May 2023, 7 and 23 June 2023 (on site), and 12 and 21 July 2023 (remote evidence review), to follow up concerns reported to us.

Overall, the practice is rated as inadequate. The key questions are rated as:

Safe - inadequate

Effective - inadequate

Caring - requires improvement.

Responsive - requires improvement.

Well-led - inadequate,

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.
• 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.
• 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:

• Clinical staff were working outside the scope of their role and competence which exposed patients to a risk of harm.
• Examples of unsafe clinical care included treatment relating to regarding long term conditions, childhood immunisations, contraceptive pill checks and cervical screening.
• The practice had not ensured effective medicines management which exposed service users to the risk of harm, including emergency medicines, prescriptions security and refrigerated medicines.
• Staff had administered injectable medicines, including a controlled drugs outside required legal frameworks. There were no effective arrangements for the oversight of clinical care.
• Arrangements for the prevention and control of infections were ineffective and standards of cleanliness were not met.
• Patients did not always receive effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care, but their privacy and dignity were not always sustained.
• Patients could access care and treatment in a timely way, but patients’ complaints and feedback were not gathered and acted upon to improve services.
• Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care, including the Registered Manager.
• The practice culture did not effectively support high quality sustainable care due to ineffective significant events and other risk identification and management processes.
• There was high staff turnover that resulted in staff shortages.
• There were gaps in staff training and no evidence of inductions for new staff members.
• There were no clear responsibilities, roles and systems of accountability to support good governance and management.
• The overall governance and accountability arrangements were ineffective. For example, HR information was incomplete and unclear.
• The practice did not have clear and effective processes for managing risks, issues and performance. Serious and extensive concerns that were raised by more than a year prior to our inspection had not been resolved.
• There was no effective process for identification, management and oversight of risk such as provider self-audits to evaluate quality and safety, including no PPG, patient satisfaction surveys or leadership oversight of risks and staff feedback.
• The provider explained that following the merger the practice population list had grown significantly by approximately 33% and this and the merger had put strain on the practice and prevented them from focus on establishing the new practice. Following our inspection, the practice developed a action plan in July 2023 and updated in December 2023 which demonstrated that the provider was making improvements and responding to our findings.

We found breaches of regulations. The provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure that any complaint received is investigated and any proportionate action is taken in response to any failure identified by the complaint or investigation.
• 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.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Ensure specified information is available regarding each person employed.
• Ensure where appropriate, persons employed are registered with the relevant professional body.

Whilst also found the provider should:

• Improve arrangements to ensure communications made to patients via text message are appropriate.
• Take steps to check and improve the premises decoration, such as painting.
• Improve arrangements to ensure patients are aware of the availability of translation services, and sources of support for patients that are carers or are bereaved.
• Improve arrangements to ensure patients’ privacy in the reception area.
• Evaluate newly improved arrangements for urgent referrals under the two weeks wait system follow through, to ensure those improvements are sustained.
• Take action to improve breast, bowel and cervical cancer screening, and uptake of childhood immunisations.

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

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 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 varying the terms of their registration within six months if they do not improve.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care