Background to this inspection
Updated
1 February 2021
Queens Bower Surgery is registered with the CQC to carry out the following regulated activities: diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury.
Queens Bower Surgery is located in the NHS Nottingham City Clinical Commissioning Group (CCG) area and is contracted to provide General Medical Services (GMS) to approximately 4,000 registered patients. The practice is owned by an individual GP who holds the overall financial and managerial responsibility for the practice.
The practice has an above-average number of patients who have a long-standing health condition. The practice also has a lower average of patients who are in paid work or full-time education. The locality has a higher than average deprivation level. The National General Practice Profile describes the practice ethnicity as being 15% black and minority ethnic background.
The practice employs four permanent receptionists on a part-time basis. The practice uses regular locum GPs and part-time locum nurses. The practice is open Monday to Friday from 8:00am until 6:30pm. Extended hours appointments are available to patients via the extended access service (GP+) in Nottingham city centre run by Nottingham City GP Alliance. This opens from 4pm to 8pm Monday to Friday, and 9am to 1pm at the weekends. There is also an urgent care centre in Nottingham which is open every day from 7am until 9pm.
The practice has opted out of providing GP services to patients out of hours. During these times services are provided by Nottingham Emergency Medical Services (NEMS).
Updated
1 February 2021
We carried out a comprehensive inspection at Queens Bower Surgery on 1 December 2020. Due to the impact of the COVID-19 pandemic, the majority of evidence was reviewed and staff interviews were undertaken remotely in advance of the site visit on 1 December 2020.
The practice had previously received a comprehensive inspection in January 2018 (the inspection report was published in May 2018). The practice was rated as requires improvement overall, with the safe and well-led domains rated as requires improvement. As a result, the practice was issued with requirement notices for Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).
A follow up comprehensive inspection was carried out in April 2019 when the practice first received an overall rating of inadequate with ratings of inadequate for safe and well-led services, requires improvement for effective and caring services and good for responsive services. We issued the provider with two warning notices, one for Regulation 12 (Safe care and treatment) and the other for Regulation 17 (Good governance).
We carried out an announced focussed inspection in July 2019. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and confirmed that the practice was meeting the legal requirements as detailed in the warning notices issued on 30 April 2019.
A further announced comprehensive inspection was carried at Queens Bower Surgery on 10 December 2019, as the practice had been rated inadequate and placed into special measures following their last comprehensive inspection in April 2019. The practice remained rated as inadequate overall, although the practice was rated as requires improvement for safe services and as good for caring and responsive services.
You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Queens Bower Surgery on our website at www.cqc.org.uk
We undertook this comprehensive inspection in December 2020 to check that the provider had completed the action plan they had provided to address the areas identified as inadequate and requiring improvement. This was to determine if they had made sufficient improvements to be taken out of special measures.
The practice remains rated as inadequate overall, and is now rated inadequate for safe, effective, responsive and well-led services. It is rated as requires improvement for providing caring services.
The practice is now rated as inadequate for all population groups: older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).
The service is now rated as inadequate for providing safe services because:
- The practice did not have fully effective systems, practices and processes to keep people safe and safeguarded from abuse.
- There were gaps in systems to assess, monitor and manage risks to patient safety.
- The practice did not have fully effective systems for the appropriate and safe use of medicines, including medicines optimization. The practice did not always learn and make improvements when things went wrong.
The service is now rated as inadequate for providing effective services because:
- Patients’ needs were not always assessed, and care and treatment were not always delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
- The practice did not have a fully comprehensive programme of quality improvement activity which routinely reviewed the effectiveness and appropriateness of the care provided.
- Staff were not always consistent and proactive in helping patients to live healthier lives.
-
The service is now rated as requires improvement for providing caring services because:
- Staff did not always treat patients with kindness, respect and compassion. However, feedback from patients was positive about the way staff treated people.
- The practice had not made improvements to ensure information available to patients via the practice website was presented in a way that was easy for patients to understand.
The service is now rated as inadequate for providing responsive services because:
- The practice did not always organise and deliver services to meet patients’ needs.
- People were not able to access care and treatment in a timely way.
The service is now rated as inadequate for providing well-led services because:
- Leaders could not fully demonstrate that they had the capacity and skills to deliver high quality sustainable care.
- The practice had a clear vision, but it was not supported by a strategy and fully effective processes to provide high quality sustainable care.
- There were defined responsibilities, roles and systems of accountability to support good governance and management, however, we found these not to be fully effective.
- The practice did not have fully clear and effective processes for managing risks, issues and performance.
- The practice did not fully involve the public, staff and external partners to sustain high quality and sustainable care.
- There were some evidence of systems and processes for learning, continuous improvement and innovation, however, they could be further improved.
This service has been in special measures since April 2019. We found the provider had not sustained improvements and uncovered further serious risks to patient safety, which prompted us to begin urgent enforcement action to cancel the provider’s registration to protect patients.
Since the inspection, the provider voluntarily cancelled their registration voluntarily on 4 December 2020 and factual accuracy responses were received. The service is continuing to run in the interim under caretaker arrangements put in place by the local Clinical Commissioning Group.
Details of our findings and the evidence supporting our ratings are set out in the evidence table.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care