The Care Quality Commission
  • Doctor
  • GP practice

Nightingale Medical Centre

Overall: Requires improvement read more about inspection ratings

Damson Drive, Peterborough, PE1 4FS (01733) 615090

Provided and run by:
Welland Medical Practice

Important: This service was previously registered at a different address - see old profile

All Inspections

14 October 2021

During a routine inspection

We carried out an announced inspection at Nightingale Medical Centre on 14 October 2021 . Overall, the practice is rated as requires improvement.

Safe - Good

Effective - Good

Caring - Requires improvement

Responsive – Requires improvement

Well-led - Good

When this service registered with us on January 2020, it inherited the regulatory history and ratings of its predecessor, Welland Medical Practice. The predecessor was the same provider, operating from different premises but providing the same services to the same practice population.

The practice under the previous registration was inspected in April 2016 and rated as good overall and for providing effective, caring, responsive and well-led services and rated as requires improvement for providing safe services. We undertook a desk top review of the safe domain in September 2016 and rated the practice as good for providing safe services.

A comprehensive inspection under the previous registration took place on 29 November 2018. The practice was rated as inadequate for providing safe, effective, responsive and well-led services, and rated as requires improvement for caring services.

A comprehensive inspection under the previous registration was undertaken on 25 June 2019 and the practice was rated as requires improvement. The practice was rated requires improvement for providing safe, caring and well led services. They were rated as good for providing caring services and inadequate for providing responsive services.

A comprehensive inspection under the previous registration was then undertaken on 13 August 2019. The practice was rated as requires improvement for providing safe, caring and well-led services. We rated the service as inadequate for providing responsive services and good for providing effective services.

We previously carried out a comprehensive inspection of Nightingale Medical Centre on 26 March 2020 and the practice was rated requires improvement overall and for providing caring and responsive services. The practice was rated as good for providing safe, effective and well-led services.

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

Why we carried out this inspection

We carried out an announced, comprehensive inspection at the practice to review in detail the actions taken by the provider to improve the quality of care. This inspection included:

  • The key questions of safe, effective, caring, responsive and well-led.
  • The follow up on breaches of regulation and areas where the provider ‘should’ improve identified at our previous inspection.

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 with consent from the provider and in line with all data protection and information governance requirements. This included:

  • Requesting evidence from the provider and reviewing this.
  • 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.
  • Conducting staff interviews using video conferencing.
  • Gaining feedback from staff by using staff questionnaires.
  • Requesting and reviewing feedback from the Patient Participation Group.
  • A short 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 requires improvement overall and for caring and responsive services. We have rated the good for safe, effective and well-led services.

We found that:

  • The practice provided care in a way that kept patient’s safe and protected them from avoidable harm. The practice had made and sustained the improvements required to address the concerns identified in our last inspection relating to clinical oversight.
  • Patients received effective care and treatment that met their needs.
  • The practice had employed a wider skill mix and additional clinical and non-clinical staff. Additional staff training including communication skills and customer service.
  • Although the GP data survey results was still low, the practice in house survey showed positive improvements.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way. However, data from the GP patient survey showed the practice performance in relation to access had declined.
  • We found the practice system and process to ensure all medicines were linked to a diagnosis or particular problem was not always wholly effective.
  • We found the practice system and process did not always ensure information for all patients with potential chronic kidney disease was recorded.
  • The practice told us they were reviewing the quality of their care plans to ensure they were comprehensive and shared with the patients.
  • The practice had agreed plans to address any backlogs such as the reviews for patients with long term conditions.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • Data from the GP patient survey (July 2021) had continued to decrease since our last inspection for both caring and responsive services. Although the practice had an action plan and had made improvements, these improvements had not had sufficient impact to reflect a more positive patient experience.

Whilst we found no breaches of regulations, the provider should:

  • Implement and monitor the action plan to address the backlog of long-term condition reviews.
  • Monitor the system to ensure all patient records are fully summarised, correctly coded, and that medicines are linked to diagnosis or problems within the clinical record.
  • Monitor and embed the systems and processes newly implemented to ensure all patients taking high-risk medicines are monitored appropriately.
  • Continue to improve the system to ensure patient care plans are documented and in a format that is useful to patients and other health professionals.
  • Continue to monitor and encourage patients/guardians to attend their appointments for the baby Measles Mumps and Rubella immunisation and cervical screening.
  • Continue to monitor and improve patient experience in relation to caring services and access to the GP practice.

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

10 February 2020

During a routine inspection

Nightingale Medical Centre was formerly known as Welland Medical Practice.

The practice was previously inspected in April 2016 and rated as good overall and for providing effective, caring, responsive and well led services and rated as requires improvement for providing safe services. We undertook a desk top review of the safe domain in September 2016 and rated the practice as good for providing safe services.

A comprehensive inspection of Welland Medical Practice took place on 29 November 2018. The practice was rated as inadequate for providing safe, effective, responsive and well led services, and rated as requires improvement for caring services. As a result of the findings on the day of the inspection the practice was issued with a warning notice for regulation 12 (Safe care and treatment) and a requirement notice for Regulation 17 (Good governance). We understood a further inspection of the practice was undertaken on 25 June 2019 and the practice was rated as requires improvement. The practice was rated for requires improvement for providing of safe, care and well led services. They were rated as good for providing caring services and inadequate for providing responsive services. The practice remained in special measures.

We carried out a comprehensive inspection of Welland Medical Practice on 13 August 2019. The practice was rated as requires improvement for providing safe, caring and well led services. We rated the service as inadequate for providing responsive services and good for providing effective services. As a result of the findings the practice was issued with a requirement notice for regulation 17 (Good governance). The practice remained in special measures.

You can read our findings from our last inspections by selecting the ‘all reports’ link for Welland Medical practice on our website at .

This report describes our findings from an announced comprehensive inspection at Nightingale Medical Centre on 10 February 2020. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

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 we found:

  • Two weeks prior to our inspection, the practice had moved into the new purpose-built premises and had been successful in recruiting additional staff including GPs, nurses and a practice manager.
  • Due to the closure of a local practice, the Nightingale Medical centre had significantly increased their list size by approximately 1,600 patients.
  • We found the practice had implemented a number of governance structures and systems since our previous inspection.
  • We saw the practice had made improvements including; the completion of a number of medicine reviews and improved medical record coding.
  • Some practice performance had decreased since our last inspection for example; uptake of childhood immunisation and screening rates for cervical cancer.
  • Patients we spoke with told us they had seen improvements in the practice since the previous inspection. In addition to this we received 19 CQC written comment cards, 16 of which were wholly positive about the service.

At this inspection, we have rated the practice as requires improvement overall. The population group of working age people (including those recently retired and students) has been rated as requires improvement for providing effective services. All population groups have been rated as requires improvement for responsive services. As a result of these ratings all population groups are rated as requires improvement overall.

We rated the practice as requires improvement for providing caring services because:

  • At this inspection we found some patient feedback had improved in respect of the care they had received, but data from the GP patient survey published July 2019 showed patient satisfaction had decreased in respect of care patients received. The practice remains rated as requires improvement for providing caring services.

We rated the practice was rated as requires improvement for providing responsive services because:

  • We found the GP patient survey data July 2019 was still below the CCG and national averages. However, we noted since moving into the new premises, the practice had been successful in recruiting more staff including GPs, nurses, and receptionists. In addition, they had introduced a new appointment system, ensuring all patients were seen or spoken to on the day they requested a consultation. Patients we spoke with and comments we received were positive in their feedback. This data affected all population groups; therefore, they are all rated as requires improvement for providing responsive services.

We have rated the practice was rated as good for providing safe, effective and well-led services.

The area 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 embed and monitor the new risk assessments, policies and procedures relating to changes and the health and safety of patients and staff in the practice premises.
  • Take action to improve the recent decline in uptake of childhood immunisations.
  • Continue to review and monitor patient feedback to ensure changes to access and appointments is effective.

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

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