The Care Quality Commission
  • Doctor
  • GP practice

City Way Surgery

Overall: Requires improvement read more about inspection ratings

67 City Way, Rochester, Kent, ME1 2AY (01634) 843351

Provided and run by:
City Way Surgery

Important: We are carrying out a review of quality at City Way Surgery. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

18 April 2023

During a routine inspection

We carried out an announced comprehensive inspection at City Way Surgery on 18 April 2023. Overall, the practice is rated as requires improvement.

The ratings for each key question are:

Safe – requires improvement

Effective – requires improvement

Caring – requires improvement

Responsive – requires improvement

Well-led – requires improvement

Following our inspection on 1 December 2021, the practice was rated inadequate overall and for providing safe and well-led services. The practice was rated as requires improvement for providing effective, caring and responsive services. Warning notices were issued for breaches of regulation found at this inspection and the practice was placed into special measures.

We carried out an announced focussed inspection at City Way Surgery on 8 November 2022 to confirm that the practice had taken action to meet the legal requirements in relation to the breaches in regulations that we identified in our inspection in December 2021. The practice was not rated as a result of this inspection. We found the provider had met the requirements set out in our warning notices. However, we found breaches of regulations and requirement notices were issued.

The full reports for the December 2021 and November 2022 inspections can be found by selecting the ‘all reports’ link for City Way Surgery on our website at www.cqc.org.uk.

Why we carried out this inspection:

We carried out this inspection to follow up on breaches of regulation from our previous inspection.

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:

  • Requesting evidence from the provider.
  • A site visit.
  • Completing clinical searches on the practice’s patient records system in line with all data protection and information governance requirements.
  • Reviewing patient records to identify issues and clarify actions taken by the provider.

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.
  • Information from the provider, patients, the public and other organisations.

We rated the practice as Requires Improvement for providing safe services because;

  • Improvements had been made to the practice’s systems, practices and processes to help keep people safe and safeguarded from abuse. Action had also been taken to address improvements that were ongoing at the time of our inspection in November 2022.
  • Improvements had been made to systems and processes to help maintain appropriate standards of cleanliness and hygiene.
  • Improvements had been maintained to the way risks to patients, staff and visitors were assessed, monitored or managed. Further improvements had taken place but others were ongoing.
  • Improvements were made to systems during and after our inspection to help ensure staff had the information they needed to deliver safe care and treatment.
  • The provider had maintained systems for the appropriate and safe use of medicines, including medicines optimisation.
  • The provider had maintained improvements to the way significant events as well as safety alerts were managed and demonstrated an effective system that reported, investigated and shared learning from significant events.

We rated the practice as Requires Improvement for providing effective services because:

  • Improvements had continued to be made to the way patients’ needs were assessed, and the way care as well as treatment were delivered, to help ensure they were in line with current legislation, standards and evidence-based guidance.
  • The provider had a programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided. However, improvements remained ongoing for some patients with long-term conditions, some patients with potential missed diagnoses and some patients prescribed certain medicines.
  • The provider was continuing to take action to improve uptake of childhood immunisations.
  • Action taken by the provider had resulted in performance related to cancer indicators, such as cervical screening, meeting required targets.
  • Further improvements to complaints management had been made. Complaints were listened to and used to improve the quality of care.
  • Staff had the skills, knowledge as well as experience to carry out their roles and had received relevant appraisals.
  • Staff worked together and with other organisations to deliver effective care and treatment.
  • Staff were consistent and proactive in helping patients to live healthier lives.
  • The practice continued to obtain consent to care and treatment in line with legislation and guidance.

We rated the practice as Requires Improvement for providing caring services because:

  • Staff continued to treat patients with kindness, respect and compassion.
  • Improvements to the practice’s system for coordinating care for patients who required palliative care had been maintained by the provider.
  • Feedback about the practice from the national GP patient survey published in July 2022 was either in line with or below local and England averages. There was now a formal action plan to help improve patient satisfaction scores. However, this was in the process of being implemented.
  • Staff continued to help patients to be involved in decisions about care and treatment.
  • The provider had increased the number of patients who had been identified as being carers from 113 (1% of the practice population) at the time of our December 2021 inspection to 286 (2% of the practice population) currently.
  • The practice continued to respect patients’ privacy and dignity.

We rated the practice as Requires Improvement for providing responsive services because:

  • The practice continued to organise and deliver services to help meet patients’ needs.
  • Patient feedback indicated people were not always able to access care and treatment in a timely way. The provider had taken some action to address this but some actions were ongoing.
  • The provider had developed an action plan to help improve patient satisfaction scores. Some actions had been implemented but others were ongoing. The provider was not yet able to demonstrate the impact of actions that had been implemented.

We rated the practice as Requires Improvement for providing well-led services because:

  • Improvements to quality and sustainability found at our last inspection in November 2022 had been maintained. Action had continued to be taken to address many of the remaining issues relating to quality and sustainability.
  • The provider had maintained improvements so that the practice culture continued to support delivery of high-quality sustainable care.
  • There were processes and systems to support good governance and management. Improvements had been made to the system that helped keep governance documents up to date and practice specific.
  • The provider had maintained improvements to processes for managing risks, issues and performance. Further action had been taken but some improvements remained ongoing.
  • The practice involved the public, staff and external partners to help ensure they delivered high-quality and sustainable care. Formal plans to improve patient satisfaction scores regarding services provided by City Way Surgery had been developed. However, the provider was not yet able to demonstrate the impact of actions that had been implemented.
  • Improvements to the practice’s systems and processes for learning, continuous improvement and innovation had been maintained.

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.

The areas where the provider should make improvements are:

  • Continue to seek occupational health advice and manage risks for staff who do not respond to vaccinations.
  • Continue with plans for a fire risk assessment to be carried out and ensure action is taken to address any findings.
  • Continue with plans to replace clinical wash-hand basins that are not compliant with Department of Health guidance as well as dirty light pull cords.
  • Continue with plans to deliver basic life support training to staff who are not up to date with this training.
  • Revise management so that all emergency medicines that are required to be kept are available at all times in the practice for use in an emergency.
  • Continue to monitor the use of Patient Group Directions to help ensure they are completed correctly and fully.
  • Continue to implement actions, and monitor results, to help encourage uptake of childhood immunisations

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

Please refer to the detailed report and the evidence tables for further information.

8 November 2022

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at City Way Surgery on 1 December 2021. The overall rating for the practice was Inadequate. Warning Notices were issued for breaches of regulation found at this inspection and the practice was placed into Special Measures.

The full version of the report for the December 2021 inspection can be found by selecting the ‘all reports’ link for City Way Surgery on our website at www.cqc.org.uk.

Why we carried out this inspection:

We carried out an announced focussed inspection at City Way Surgery on 8 November 2022 to confirm that the practice had taken action to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in December 2021. The practice was not rated as a result of this inspection. This report covers findings in relation to those requirements.

How we carried out the inspection:

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was in line with all data protection and information governance requirements.

This included:

  • Requesting evidence from the provider.
  • A short site visit.

Our judgement of the quality of care at this service is based 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.

Our findings:

  • Improvements had been made to the practice’s systems, practices and processes to help keep people safe and safeguarded from abuse. However, some improvements were ongoing and other improvements were still required.
  • Action had been taken but some improvements were ongoing to systems and processes to help maintain appropriate standards of cleanliness and hygiene.
  • Some improvements had been made to the way risks to patients, staff and visitors were assessed, monitored and managed. However, further improvements were ongoing.
  • Improvements had been made to the arrangements for managing medicines that helped keep patients safe.
  • The provider had made improvements to the way significant events as well as safety alerts were managed and demonstrated an effective system that reported, investigated and learned from significant events.
  • Improvements had been made to the way patients’ needs were assessed, and the way care as well as treatment were delivered, to help ensure they were in line with current legislation, standards and evidence-based guidance. However, these were ongoing for reviews of patients with asthma and hypothyroidism.
  • The practice had a programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided. However, improvements were ongoing for some patients with long-term conditions, some patients with potential missed diagnoses and some patients prescribed certain medicines.
  • Staff had the skills, knowledge and experience to carry out their roles. However, some staff were not up to date with basic life support training and some staff were overdue an appraisal.
  • Staff worked together and with other organisations to deliver effective care and treatment.
  • Staff were consistent and proactive in helping patients to live healthier lives.
  • The practice obtained consent to care and treatment in line with legislation and guidance.
  • Improvements had been made to the practice’s system for coordinating care for patients who required palliative care.
  • Patient feedback indicated people were not always able to access care and treatment in a timely way.
  • Feedback about the practice from the national GP patient survey published in July 2022 varied from being in line with or tending towards variation negative to variation negative or significant variation negative when compared with local and England averages. Staff told us there was no formal action plan to help improve patient satisfaction scores.
  • Improvements had been made to complaints management. Complaints were listened to and used to improve the quality of care.
  • Action had been taken to address many of the issues relating to quality and sustainability found at our last inspection. Action was also ongoing but not all plans had been formally recorded and some did not have projected dates for completion.
  • The provider had made improvements so that the practice culture supported delivery of high-quality sustainable care.
  • There were processes and systems to support good governance and management. However, improvements were required to the system that helped keep governance documents up to date and practice specific.
  • The provider had made improvements to processes for managing risks, issues and performance. However, some improvements were still required, and some were ongoing.
  • The practice involved the public, staff and external partners to help ensure they delivered high-quality and sustainable care. However, there were no formal plans to improve patient satisfaction scores regarding services provided by City Way Surgery.
  • Improvements had been made to the practice’s systems and processes for learning, continuous improvement and innovation.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Continue with plans for relevant staff to attend basic life support training on 23 November 2022.
  • Revise complaints management to help ensure complainants receive a written acknowledgement in line with the complaints policy.
  • Continue to make relevant changes to their registration with the Care Quality Commission.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

Please refer to the detailed report and the evidence tables for further information.

01 December 2021

During a routine inspection

We carried out an announced inspection at City Way Surgery on 1 December 2021. Overall, the practice is rated as inadequate.

Safe - Inadequate.

Effective – Requires improvement.

Caring – Requires improvement.

Responsive – Requires improvement.

Well-led – Inadequate.

Following our previous inspection on 23 June 2015 the practice was rated Good overall and for all key questions.

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

Why we carried out this inspection

This inspection was a comprehensive inspection.

The focus of the inspection included:

  • Are services safe?
  • Are services effective?
  • Are services caring?
  • Are services responsive?
  • Are services well-led?

How we carried out the inspection/review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A site visit

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 have rated this practice as Inadequate overall and for safe, responsive and well-led. We have rated the practice as requires improvement for effective and caring.

We found that:

  • The practice did not always provide care in a way that kept patients safe and protected them from avoidable harm.
  • Not all patients on high risk medicines were appropriately monitored and safety alerts had not always been acted on.
  • Risks to patients, staff and visitors were not always assessed, monitored or managed in an effective manner.
  • Patients did not always receive effective care and treatment that met their needs. Follow up of vulnerable patients after discharge from hospital was inconsistent.
  • Arrangements to support patients at the end of life had not always been effective.
  • Uptake of cervical screening was below target and two of the childhood immunisation indicators were below the minimum target.
  • The way the practice was led and managed did not promote the delivery of high-quality, person-centred care.
  • The governance systems had failed to ensure patients prescribed high risk medicines had appropriate monitoring or that all safety alerts had been acted on within appropriate timescales.
  • Systems for learning and improvement when things went wrong were not effective.
  • Staff dealt with patients with kindness and respect but did not sufficiently address patient concerns that fell below expected standards. They did not consistently involve patients in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. However, patients expressed concerns they could not access care and treatment in a timely way and these were not sufficiently addressed by the practice to ensure improvements.

We found two breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

  • Improve the uptake of cervical screening.
  • Improve the uptake of childhood immunisations.
  • Work to identify patients who are also carers and promote support available to them.

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 cancer the provider’s registration.

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

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

23 June 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of City Way Surgery 23 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services.

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patient’s needs were assessed and care was planned and delivered in line with current legislation. Staff had received training appropriate to their roles.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information to help patients understand the services available was easy to understand. Staff treated patients with kindness and respect, and maintained confidentiality.
  • Patients said they experienced few difficulties when making appointments and urgent appointments were available the same day.
  • There was a leadership structure and staff felt supported by management. The practice took into account the views of patients and those close to them as well as engaging with staff when planning and delivering services.

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

The provider should;

  • Ensure that all documents used to govern activity are up to date and contain relevant contact details.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

29 and 31 October 2014

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced focussed inspection on 29 and 31 October 2014. The inspection was carried out over two days as one of our inspection team became unwell during the inspection visit on 29 October 2014. There was therefore insufficient time for the remaining staff to establish enough information in one day which is why we returned on a second day. During the inspection we gathered information from a variety of sources. For example, we spoke with patients, interviewed staff of all levels and checked that the correct systems and processes were in place.

City Way Surgery has not received a rating as this was a focussed inspection.

Our key findings were as follows:

  • City Way Surgery had systems to monitor, maintain and improve safety and demonstrated learning from significant events. The practice had policies to safeguard vulnerable adults and children who used services. There was enough equipment, including equipment for use in an emergency, to enable staff to care for patients. Staff were trained and the practice had plans to deal with foreseeable emergencies. However, the practice did not have a system to adequately monitor on-going safety and had not always responded to identified risks. Patients’ records and blank prescription forms were not always held securely. Insufficient numbers of staff with the skills and experience required to meet patients’ needs were employed. Some records such as significant event records were incomplete.
  • Staff at the City Way Surgery followed best practice guidance and had systems to monitor, maintain and improve patient care. There was a process to recruit, support and manage staff. Equipment and facilities were monitored and kept up to date to support staff to deliver effective services to patients. The practice worked with other services to deliver effective care and had a proactive approach to health promotion and prevention.
  • Patients were satisfied with the care provided by City Way Surgery and were treated with respect. Staff were careful to keep patients’ confidential information private and maintained patients’ dignity at all times. Patients were supported to make informed choices about the care they wished to receive and most patients said they felt listened to. The practice provided opportunities for patients to manage their own health, care and wellbeing and maximised their independence.
  • The practice was responsive to patients’ individual needs such as language requirements, some mobility issues as well as cultural and religious customs and beliefs. However, access to services for all patients was limited.
  • Although City Way Surgery had a vision statement to provide high quality care and best practice to its patients, none of the staff we spoke with were aware of it. The practice had dedicated lead GPs for certain issues such as safeguarding. However, there was a lack of clear leadership structure. The practice used a variety of policies and other documents to govern activity and there were regular governance meetings. However, there was not an effective system to help ensure all governance documents were kept up to date. There were systems to monitor as well as improve quality and the practice was able to demonstrate clinical audit activity. The practice did not always take into account the views of patients and those close to them when planning and delivering services. The practice valued learning but did not always share learning outside of the partners’ practice meetings. Systems to identify and reduce risk were not always employed effectively.

The areas where the provider must make improvements are:

  • Review its arrangements for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs as well as improve access to primary medical services for all patients.
  • Review its system to manage and record significant events as well as ensure that patients’ records are held securely at all times.
  • Address its leadership issues and review its system of monitoring safety and responding to risk.
  • Address its response to patients’ comments and suggestions received through the patient participation group meetings, complaints received, reviews left on the NHS Choices website and patient survey results.
  • Improve its policy review system and clinical audit activity to comply with its own governance policies.

In addition the provider should:

  • Review its system to manage National Patient Safety Alerts as well as the information available in its whistleblowing policy.
  • Ensure that relevant information is shared with all staff members.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice