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Nuffield Road Medical Centre Requires improvement

Reports


Inspection carried out on 7 August 2019

During a routine inspection

This practice is rated as Requires Improvement overall. At the previous inspection in March 2016 the practice was rated as Good overall.

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Nuffield Road Medical Centre on 7 August 2019 as part of our inspection programme.

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.

At this inspection, the practice was rated as requires improvement for providing safe services because:

  • The practice’s system of recruitment checks was not fully effective. We found one clinical member of staff did not have a DBS check completed. In addition to this, the practice was unable to provide evidence of the immunisation status of staff.
  • We found the practice did not have an effective fire risk assessment completed; we identified fire risks which had not been recorded in the fire risk assessment completed one week before our inspection.
  • Concerns highlighted in an external health and safety risk assessment completed in July 2019 had not been identified during the fire risk assessment and no actions had been completed.
  • The practice did not provide evidence to show equipment had been calibrated.
  • No infection prevention and control audit had been completed in the practice since 2017. We found some areas of concern; for example, a sharps waste bins left on a consultation room floor and paint and plaster coming away from the walls in one treatment room.
  • The practice did not have a system in place for managing the security of prescription papers.

At this inspection, the practice was rated as good for providing effective services to older people and vulnerable people. The practice was rated as requires improvement for providing effective services to people with long-term conditions, families, children and young people, working aged people (including those recently retired and students) and people with poor mental health (including people with dementia) and therefore overall because:

  • The practice’s Quality and Outcomes Framework performance for long-term conditions and mental health was lower than the CCG and England averages. We reviewed submitted but unverified 2018/2019 data and found this performance had continued.
  • The practice’s childhood immunisation uptake rate was lower than the 90% target rate and no action had been taken to improve this.
  • The practice’s cervical screening uptake rate was lower than the 80% target rate and no action had been taken to improve this.
  • The practice did not target quality improvement activity to areas of poor performance.

At this inspection, the practice was rated as good for providing caring and responsive services.

At this inspection, the practice was rated as requires improvement for providing well-led services because:

  • We found the practice did not always have governance structures and systems in place, and where they were in place, these were not always effective.
  • We found that despite the practice identifying a number of risks and performance issues through their internal audit process, these were not always monitored and actions had not been taken.
  • The practice did not have documented records to confirm staff received an annual appraisal, supervision or competency checks. Some staff confirmed they had received an appraisal and had on-going supervision but this was not recorded.

However, we also found that:

  • The practice had implemented a ‘Doctor First’ system and recruited new clinical staff to support patients accessing the practice.
  • The practice completed an annual report for a number of years and allowed the practice to monitor performance and review against previous years. The practice could analyse trends and use the information to assess staffing levels and competencies; however, this didn’t target areas of poor performance.
  • Patients we spoke with told us they were happy to be registered at the practice.
  • We received 27 CQC patient comment cards, all of which were wholly positive.
  • Staff told us morale was high and they felt well supported by the practice management team.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

  • Review and improve the practice’s antibiotic prescribing rate.
  • Review and improve the number of health checks provided.

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

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 17 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Nuffield Road Medical Centre

on 17 March 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • 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.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

  • The practice protected children and families in a way that supported the best outcomes for these patients. A strong partnership approach, appropriate and swift information sharing, alongside meticulous minute taking, ensured that safeguarding issues were both highlighted and followed up. Additional support was made available for families and concerns shared more widely as necessary. There was a strong focus on considering issues relating to domestic violence and substance abuse. The pro-active and responsive management of safeguarding concerns has led to the effective and timely mitigation of risks to children and their families.

The areas where the provider should make improvement are;

Ensure all members of staff are aware of where emergency equipment and medicines are located. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 4 September 2014

During a routine inspection

Nuffield Road Medical Centre provides primary medical services to patients in Cambridge City and the villages of Histon, Impington and Milton. The practice is led by nine general practitioners (GPs) and one managing partner who from the partnership management team. One of the partners is the registered provider of services at the practice.

We spoke with patients during our inspection, who were complimentary about the services they had received from the practice. We also received two comments from patients who had completed comment cards prior to our inspection. Both comments were positive. Patients told us that the practice was accessible and met their needs.

Nuffield Road Medical Centre had been proactive in supporting patients to adopt a healthy lifestyle in order to maintain good mental and physical health. This included referrals to local weight loss schemes, smoking cessation support and nurse led advice for better management of long term conditions. The practice had also set up a walking group with the aim of supporting patients to become more active in a social outdoor environment.

The practice had ensured that patients received the care that met their individual needs by means of effective assessment and treatment.  Clinical audit cycles had been successfully adopted to deliver improved outcomes for patients. Staff had delivered care in a respectful way which took into account the holistic needs of the individual. The practice understood the needs of the population it served and had taken steps to make their service accessible to vulnerable groups. The partnership had fostered a culture of openness and transparency where learning could flourish. Patients fed back that they appreciated the standard of service available to them.