Newcastle Medical Centre Also known as Dr Neil Daniel Lloyd-Jones

We carried out an announced inspection of this practice on 8 December 2016. The practice was rated as inadequate for providing effective and well-led services, requires improvement for providing safe, caring and responsive services and inadequate overall. The practice was placed in special measures on 28 September 2017.

The full comprehensive report on the December 2016 inspection can be found at: http://www.cqc.org.uk/location/1-3017488527

This comprehensive inspection was undertaken on 6 July 2017. Overall, the practice is rated as inadequate.

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

• The delivery of the high-quality care was not assured by the leadership and governance of the practice. The provider had taken steps to make improvements following the last inspection in December 2016. An action plan was developed by the practice in March 2017 in response to areas of concern highlighted by the inspection. They had developed a clearer vision, strategy and plan to deliver high quality safe care, however, these did not focus on the atypical nature of the practice population. Many of the new arrangements were at an early stage and work was still in progress in many areas.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, minutes of meetings and records of significant events did not consistently detail discussion, actions taken and learning to lead improvements.
• The practice’s system for identifying, capturing and managing issues and risks was not effective.
• Staff were aware of current evidence based guidance. Most staff had received training to provide them with the skills and knowledge required to deliver effective care and treatment.
• Data that showed the practice’s Quality and Outcomes Framework (QOF) achievement for 2016/2017 was 68%. This was 8% lower than their achievement for 2015/2016. The practices clinical exception rate for 2016/2017 was 17%. This was 10% improvement on clinical exception rate for 2015/2016. This data has not yet been verified or published. Action has been initiated by the practice to improve patient outcomes although this was still at an early stage. It is of note that the practice serves a predominantly student population and that practice has a low number of patients with long-term conditions.
• The practice told us that given the atypical nature of the practice’s patient population QOF was not effective as a measure of the practice’s performance despite this, the practice had not monitored their outcomes compared to other similar services.
• From the sample of 13 clinical records we reviewed, we saw that the information recorded in clinical records was not thorough.
• The practice had improved their approach to quality improvement work and clinical audit. We saw that seven single-cycle reviews had been completed or were on-going and that audit meetings had been introduced.
• The practice participated in the CCG practice engagement programme. This included work to improve their prescribing performance and engagement with the CCG. They had performed well, for example, they had low levels of antibiotic prescribing.
• Results from the national GP patient survey showed patients felt they were treated with compassion, dignity and respect. The practice was in line with or above average for its satisfaction scores on consultations with GPs. Satisfaction scores for consultations nurses were generally comparable to local and national averages.
• The practice had developed a small range of information about services that was available to meet the needs of the practices population. For example, as the practice had a high number of patients who spoke Chinese they had recently ensured their patient leaflet was available in Chinese. We saw that the practice planned to introduce a wider range of information for patients in Chinese.
• Most patients we spoke with said they had to use the walk-in surgery to see a GP promptly and that it was difficult to book an appointment to see a named GP if you wanted to be seen in a timely manner. Some patients said there had been an improvement in the last six months. Urgent appointments were available the same day at the walk-in surgery.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clearer leadership structure and staff felt more supported by clinical leadership of the practice than they had when we last inspected this practice. Staff development was a priority and staff felt supported in this area.
• The practice had gathered the views of patients by issuing their own surveys the results of which they acted on. They did not have an active patient participation group (PPG). Members had recently been recruited, however, no meetings had been held at the time of this inspection.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. Specifically, to embed and sustain the systems and processes in place to assess monitor and improve the quality and safety of the service provided which includes addressing the learning and actions from clinical audit improvement work, significant events and complaints to show improvements in patient care. The practice also must ensure that accurate, complete and contemporaneous notes are maintained in respect to each patient.

The areas where the provider should make improvement are:

• Enable the persons employed in the provision of the regulated activity to receive the appropriate support, training, professional development, supervision and appraisal that is necessary to enable them to carry out their duties. Specifically, training in child safeguarding and the use of the clinical system (EMIS).
• Continue to take steps to improve their identification of carers registered at the practice.
• Continue to improve arrangements for the provision of a patient participation group (PPG) to ensure the views of patients are sought and considered by the practice.
• Review how they routinely collect and monitor information about the outcomes of patients care and treatment.

The practice has made some improvements since our last inspection in December 2016. This is reflected in our report that shows the practice is rated as good for providing a safe and caring service. There remain significant shortfalls with regard to effectiveness and leadership. As a result, this practice is rated as being inadequate overall and is in special measures. In line with our enforcement procedures, we have issued a requirement notice. The practice is expected to devise an action plan that addresses the shortcomings identified in the report. The service will be kept under review and if needed we may escalate our enforcement action and this may lead to the cancellation of the practice’s registration as a general practice. Another inspection will be  conducted within six months.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Newcastle Medical Centre on 8 December 2016. Overall, the practice is rated as inadequate.

This inspection follows an earlier announced comprehensive inspection at Newcastle Medical Centre on 13 October 2015 at which time the overall rating for the practice was requires improvement. The practice was rated as requires improvement for providing safe and effective care and good for providing caring, responsive and well-led care. The full comprehensive report on the October 2015 inspection can be found by selecting the ‘all reports’ link for Newcastle Medical Centre on our website at www.cqc.org.uk. Two requirement notes were issued as breaches of regulation were identified during this inspection.

Our key findings were at this inspection were as follows:

• The practice had complied with the requirement notices we set following the last inspection. Care plans were in place and recruitment checks were carried out in line with Schedule 3 of the Health Care Act 2008.
• We saw that the practice had acted to address some of the actions we told them they should take. Staff were fully aware of fire procedures at the practice and the practice held records to demonstrate the maintenance, servicing and calibration of equipment. The practice were not able to demonstrate they had maintained an audit trail for all prescription forms.
• Staff did not always recognise concerns, incidents and near misses and take steps to learn from them. Most understood their responsibilities to raise concerns and report incidents and near misses.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Outcomes for patients were below average for the locality, this included Quality and Outcomes Framework (QOF), childhood immunisation and cervical screening. Action has been initiated by the practice to improve patient outcomes.
• Limited quality improvement work was taking place and there was little evidence that clinical audit was driving improvements in performance to improve patient outcomes. However, quality improvement work has been planned and taken place since the inspection.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Most patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
• Data from the National GP Patient Survey, published in July 2016, showed that patients rated the practice below average for access to care and treatment. For example, of those that responded 58% found it easy to get through to the practice by telephone (CCG average 79%, national average 73%).
• The practice had a walk-in surgery Monday to Friday. Every patient who presented at the practice between 8am and 9am was guaranteed to see a GP the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a documented leadership structure and staff felt supported by management.
• The practice had gathered the views of patients by completing surveys on patient’s overall opinion of the practice and the practice’s appointment system. They did not have a patient participation group (PPG). Action has been taken by the practice to recruit members to a patient participation group, however, no meetings have been held yet.
• The provider was aware of and complied with the requirements of the duty of candour regulation.

There were areas where the provider needs to make improvements.

The provider must:

• Improve the governance arrangements at the practice. Specifically, the systems and processes in place to assess monitor and improve the quality and safety of the service provided.
• Ensure all significant events are reported, recorded and managed by the practice to enable lessons to be learned from these incidents to prevent their reoccurrence and to improve the outcomes for patients.
• Improve the arrangements for clinical audit in order to be able to demonstrate a clear link between audits and quality improvement.
• Ensure medicines are managed safely and appropriately. Specifically, make sure there are systems in place for ensuring that the process to monitor the distribution of blank computer prescriptions is in line with national guidance.
• Ensure that Patient Group Directions (PGD’s) and Patient Specific Directions (PSD’s) are implemented in accordance with national guidance.
• Ensure that complaints including verbal complaints are recorded and managed in line with the practice’s own complaints policy
• Improve their arrangements for the clinical supervision of nursing staff at the practice.

The provider should:

• Record minutes of the GP meetings.
• Review the information displayed for patients in the practice waiting area. Specifically information for non-English speaking patients on the services provided by the practice.
• Improve arrangements for the provision of a patient participation groups (PPG) to ensure the views of patients are acted upon by the practice.
• Take steps to improve their identification of carers registered at the practice.
• Take steps to ensure that all staff are aware of who the safeguarding lead at the practice is.

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration. Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice