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Inspection Report | The New City Medical Group | December 2013 www.cqc.org.uk 1
Inspection Report
We are the regulator:
Our job is to check whether hospitals, care homes and care
services are meeting essential standards.
The New City Medical Group
The New City Medical Centre, Tatham Street,
Sunderland, SR1 2QB
Tel: 01915675571
Date of Inspection: 14 November 2013 Date of Publication:
December 2013
We inspected the following standards as part of a routine inspection. This is what we
found:
Respecting and involving people who use
services
Met this standard
Care and welfare of people who use services
Met this standard
Cleanliness and infection control
Met this standard
Supporting workers
Met this standard
Assessing and monitoring the quality of service
provision
Met this standard
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Details about this location
Registered Provider Dr Sarah Schofield
Registered Manager Dr. Sarah Schofield
Overview of the
service
New City Medical Croup is a General Medical Service
practice with two full time partners. Additional appointments
are provided the Nurse Practitioner and practice nurses. The
surgery is in a purpose built surgery with consulting rooms
on both the ground and first floor. There is a lift to give
access to all areas of the building. It has good access to
public transport and is within walking distance of the centre
of Sunderland.
Type of services Doctors consultation service
Doctors treatment service
Regulated activities Diagnostic and screening procedures
Family planning
Maternity and midwifery services
Surgical procedures
Treatment of disease, disorder or injury
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Contents
When you read this report, you may find it useful to read the sections towards the back
called ‘About CQC inspections’ and ‘How we define our judgements’.
Page
Summary of this inspection:
Why we carried out this inspection 4
How we carried out this inspection 4
What people told us and what we found 4
More information about the provider 5
Our judgements for each standard inspected:
Respecting and involving people who use services 6
Care and welfare of people who use services 8
Cleanliness and infection control 10
Supporting workers 12
Assessing and monitoring the quality of service provision 14
About CQC Inspections
16
How we define our judgements
17
Glossary of terms we use in this report
19
Contact us
21
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Summary of this inspection
Why we carried out this inspection
This was a routine inspection to check that essential standards of quality and safety
referred to on the front page were being met. We sometimes describe this as a scheduled
inspection.
This was an unannounced inspection.
How we carried out this inspection
We looked at the personal care or treatment records of people who use the service,
carried out a visit on 14 November 2013, observed how people were being cared for and
checked how people were cared for at each stage of their treatment and care. We talked
with people who use the service, talked with carers and / or family members, talked with
staff and reviewed information given to us by the provider. We reviewed information sent
to us by commissioners of services, reviewed information sent to us by other authorities,
talked with commissioners of services and talked with other authorities.
What people told us and what we found
We spent time during our visit observing how the practice worked and speaking to
patients, staff and stakeholders. Patients told us they felt their needs were met by the
practice and we saw positive exchanges between patients and staff. One person said,
“They always give me a good service,” Another said “Staff are really nice, including the
receptionists”.
Patients we spoke with told us they could always get an appointment when they needed
one and emergency slots were available if they needed to see a GP or nurse urgently.
One told us the doctors were “Excellent, they always explain what is wrong and what
treatment is available.”
Care and treatment was planned and delivered in a way that was intended to ensure
people’s safety and welfare. We saw the general practitioners followed national guidance
as well as local Clinical Commissioning Group (CCG) guidelines to make sure they were
following best practice.
We saw the practice was up to date with infection control policies and procedures and
when we spoke with staff they had a clear understanding how to reduce the risk of cross
infection. The surgery was clean and well maintained.
Staff were provided with support, guidance and training to make sure they were able to
carry out their role safely and their performance was monitored to maintain the standards.
The provider had an effective system in place to identify, assess and manage risks to the
health, safety and welfare of people who use the service and others.
You can see our judgements on the front page of this report.
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More information about the provider
Please see our website www.cqc.org.uk for more information, including our most recent
judgements against the essential standards. You can contact us using the telephone
number on the back of the report if you have additional questions.
There is a glossary at the back of this report which has definitions for words and phrases
we use in the report.
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Our judgements for each standard inspected
Respecting and involving people who use services
Met this standard
People should be treated with respect, involved in discussions about their care
and treatment and able to influence how the service is run
Our judgement
The provider was meeting this standard.
People’s views and experiences were taken into account in the way the service was
provided and delivered in relation to their care.
Reasons for our judgement
The practice manager confirmed that the information about the practice was on the NHS
choices website which also included a variety of patient information such as appointment
times and the specialist clinics and support available.
People were given information both about the practice and general health issues. We saw
a range of general health information and practice publicity in the waiting room on the
ground floor and in the small waiting room on the first floor. The small area on the first floor
close to the consulting rooms had a large range of targeted practice leaflets and
information which were season and theme specific, for example advice regarding flu
vaccines.
The practice staff were aware of the availability and access to the interpreting service,
should this be needed, and information was available to tell staff how to access it. The
practice manager was aware of the constraints for privacy in the waiting room and so they
had made available a booth type reception desk next to the main desk. She also gave
examples of private spaces which would be used where patients wanted to discuss
matters in private.
The surgery had a chaperone policy by which the practice nurse would act as chaperone,
however if not available the reception staff would provide the role. The availability of a
chaperone was made known to the patients through the practice leaflet and a notice in the
waiting area.
We saw that bookable appointments for all clinicians were generally available within 24
hours which suggested people could access the service. Patients told us they had not
experienced any problems getting appointments when they needed one. Urgent
appointments were also made available as necessary. Appointments were made available
at different times of day and the practice operated evening surgeries until 6pm Monday to
Friday.
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The practice used “Choose and Book”. The information we looked at confirmed that
patients were routinely given the choice of hospitals, although we were told most would
choose the local hospitals or take their advice regarding regional services.
The practice manager showed us leaflets, publicity and letters which the practice used as
part of the ‘Choose Well’ scheme to raise awareness of different NHS services and to
encourage patients to make the most appropriate use of these.
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Care and welfare of people who use services
Met this standard
People should get safe and appropriate care that meets their needs and supports
their rights
Our judgement
The provider was meeting this standard.
Care and treatment was planned and delivered in a way that was intended to ensure
people’s safety and welfare.
Reasons for our judgement
Care and treatment was planned and delivered in a way that was intended to ensure
people’s safety and welfare. We saw that the general practitioner followed national
guidance as well as local Clinical Commissioning Group guidelines for areas of care such
as hernia, urinary incontinence and rectal issues to ensure appropriate referrals. The
surgery used the national systems for patient information leaflets.
We spoke with six patients and without exception, they told us they were satisfied with the
standard of care they received at the practice. One person said, “I have always seen Dr
Partington, but the one I have seen recently is really good as well” and another said “I had
to be referred to the hospital and they sorted it out for me, I was really happy, all staff are
really good”.
Patients we spoke with said their appointments were sometimes delayed but never for
very long and that they were kept informed of any delay. They told us they were given the
time they needed with the doctor to discuss their health issues or concerns. We observed
people using the touch screen technology to register their arrival in the practice; the usual
reception desk checking in system was also available.
The practice had equipment for managing emergencies with medication and other
resuscitation equipment. All items including drugs were within the expiry date and regular
equipment checks were undertaken. We saw all the staff had access to the information
they needed about clinical protocols on line.
The computer system included an alert which appeared on the screen when a patient is
seen, for example people on special medication or one who is overdue for a monitoring
visit for a chronic condition. Also children who are on an “at risk register” are identified in
the “problem page” of the patient computerised record.
We looked at how the surgery managed certain conditions, including asthma, and
diabetes. We saw clear treatment plans were in place for people, dependent on the
medical condition and these were managed by the particular member of staff identified.
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The administration staff had specific roles in the management of chronic disease
management and this was overseen by the practice manager.
The practice had recently achieved the Palliative Care award and had reviewed the way
they met the needs of people requiring this service including their medication and clinical
information about their care. We were told about specific meetings held with members of
the primary health care team these included palliative care meetings and meetings
regarding children at risk.
Health promotion information, such as diet and exercise advice was available in the
waiting room on the electronic display board; there was also a large selection of pamphlets
and leaflets in the waiting room. One patient told us, “They make sure we have the right
information for us to choose a healthy lifestyle”.
The doctor and nursing staff continued to maintain their skills and competencies as part of
their on-going professional registration. This is checked by the practice manager to ensure
that the registration remains current.
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Cleanliness and infection control
Met this standard
People should be cared for in a clean environment and protected from the risk of
infection
Our judgement
The provider was meeting this standard.
People were protected from the risk of infection because appropriate guidance had been
followed and people were cared for in a clean, hygienic environment.
Reasons for our judgement
We spent time with the staff on duty during the visit and asked them about their
understanding of how they assessed the risk, detected, prevented and controlled the
spread of health care associated infections.
We spoke with the Nurse Practitioner who took responsibility for infection control. She told
us that disposable equipment was used for specific clinical procedures such as cervical
smears. We saw how this equipment was stored and managed, for example aprons and
disposable gloves available in all of the clinical areas. She told us disposable items were
used and disposed of in line with best practice guidelines. There was a system for labelling
and disposing of clinical waste which was carried out by the contractor responsible for
removal of the waste.
We saw there were separate hand wash sinks available for people to clean their hands.
Not all of the hand washing areas had advice displayed to give people appropriate
guidance on good hand wash technique. We were told by the practice manager that this
had been addressed following our visit. Hand wash gel was available from dispensers in
the entrance to the clinical areas. This meant that patients and staff were being support to
maintain good hand hygiene practices.
The clinical areas were clean, tidy and well organised. We saw effective systems in place
to ensure that unused (clean) and used (dirty) equipment were stored appropriately. We
reviewed files which contained guidance to support staff to ensure they were following
good practice guidelines, for example personal protective equipment such as gloves.
We saw that the practice had a domestic cleaner employed directly by the practice. This
meant they could monitor the standards and make any amendments to the cleaning
schedule if necessary. The practice was clean and well maintained.
We spoke with several patients during or after the inspection and they told us they were
happy with the standard of cleanliness. Comments included: “The surgery is clean and
well organised” and “I’ve never given it a thought which probably means it’s always clean.”
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Most of the furnishings and floor coverings in the surgery, including those fitted in the
consulting rooms were washable. We noted the use of some pillows used on the
examination couches needed new covers to make them water proof. Plans were in place
to address these issues.
A policy, with the relevant contact details was available to enable the staff to respond
appropriately in the event of an outbreak of a communicable disease. An infection control
policy was also in place which was reviewed annually.
There were effective systems in place to reduce the risk and spread of infection.
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Supporting workers
Met this standard
Staff should be properly trained and supervised, and have the chance to develop
and improve their skills
Our judgement
The provider was meeting this standard.
People were cared for by staff who were supported to deliver care and treatment safely
and to an appropriate standard.
Reasons for our judgement
The practice manager was responsible for ensuring all staff were up to date with the
training they needed to carry out their role. She did not have an overview of all of the
mandatory training staff required to carry out their role. The provider may find it useful to
note that introducing this would give her the opportunity to identify what staff training to
organise and which staff needed to be updated.
We spoke with the Nurse Practitioner who showed us the records of the training she had
completed. She had undertaken all of the training she required to carry out her role safely
and maintained her competence by undertaking updates of the training in line with relevant
guidance. For example she had recently attended updates on cervical screening and
holiday vaccinations. She had also identified, as part of her professional development, that
she would like to develop her knowledge in sexual heath so that she could provide a more
extensive service to the patients in the practice. This training had recently been arranged.
We reviewed the training with the practice manager and found that some additional
training, or updates of the training was required. A receptionist told us she had received
the training she needed to carry out her role, for example read code training and training
for the new IT system. She also told us she had received training in first aid and fire
prevention and evacuation. Another receptionist confirmed she had also had received the
mandatory training and we saw their certificates which they held in their own training
records.
We saw records which showed that staff had received training in safeguarding, health and
safety and resuscitation, however there were gaps in statutory staff training for fire training
and adult protection training. Also training in dealing with complaints would have been
helpful for staff. The practice manager confirmed following the visit that training had been
identified and arranged for those staff who needed updates. The provider may find it useful
to note that this training must be maintained to make sure staff were safe and to maintain
the safety of others.
We spoke with the doctor who told us they maintained their own training in line with the
registration requirements. We checked the registration status of the doctors working in the
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practice, they were appropriately licensed. This means that they were subject to
revalidation of their ability to practice which included maintaining their training and having
regular appraisals.
The staff we spoke with told us they had annual appraisals with the practice manager we
saw the records of these and they were up to date. The new practice manager had carried
out an appraisal with each of the staff in 2013. When we spoke with the staff they told us
these gave them an opportunity to their further training and development needs. Staff told
us they could speak with the practice manager and the doctors if they had any concerns or
they thought things could be done differently or better.
The staff we spoke to said they felt supported to carry out their role. For example, the
practice nurse told us she could attend practice nurse groups locally and received informal
clinical support from the doctor and practice nurses who were co-located in the health
centre. She also told us she could speak to other nurses in the health centre and that the
doctor was “Very approachable”.
We noted there were sufficient numbers of staff on the day, which was the normal staffing
complement, to provide effective levels of support and care to the patients using the
service which meant that the staff could carry out their role effectively.
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Assessing and monitoring the quality of service
provision
Met this standard
The service should have quality checking systems to manage risks and assure
the health, welfare and safety of people who receive care
Our judgement
The provider was meeting this standard.
The provider had an effective system to regularly assess and monitor the quality of service
that people receive.
Reasons for our judgement
We looked at the way the practice made sure patients received safe quality care,
treatment and support, due to effective decision making and the management of risk to
their health welfare and safety.
Records of significant events were kept in line with the practice policies and they contained
a date when they had been reviewed. All incidents were reported on the ‘Datax’ database.
For example there was an event in which the security of the medication cupboard had
been compromised. Action was taken immediately and a plan was put in place to prevent it
reoccurring.
During the visit we saw patient records stored in unlocked filing cabinets (and some on top
in open boxes) in a room which was not locked or secured. They could be accessed by
people using a meeting room and an adjoining room used by patients during surgery
times. The practice manager told us that these rooms were never accessed by people
unless accompanied by a member of staff but agreed that this could not be guaranteed as
they were on a shared corridor. We were given evidence following the visit that this had
been addressed by the addition of key pad locks to these rooms. This meant that patient
records could be kept safe and patient confidentiality could be ensured.
The surgery had a first aid book and risk and Incident forms, a copy of these would be sent
to clinical commissioning group as necessary and one copy kept on file at the practice.
The practice manager told us she reviewed the surgery risk assessments and was aware
of the elements required to ensure it was complete and up to date.
We looked at the quality and outcome framework (QOF) GP practice results. This showed
the practice was continuing to review its activity for chronic disease management, for
example, asthma, diabetes, hypertension, and mental health.
There was a practice complaints procedure which was implemented by the practice
manager. She told us she would handle any concerns, as was identified in the practice
leaflet.
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The practice manager described the practice system for dealing with mail and read coding,
which is detailed clinical coding of multiple patient information, such as social
circumstances, clinical signs, laboratory tests and results, diagnosis etc. This showed that
at each stage of the process there was an audit trail. The secretaries also had
responsibility of reviewing new patient records and adding relevant read codes.
The practice held formal internal meetings which meant that they kept staff up to date with
relevant information during these meetings and during informal discussions. There were
also weekly clinical meetings. This meant staff were receiving the information they
required to give them the opportunity to participate in the running of the practice and
discuss clinical issues.
The following audits had been carried out recently: waiting times for cancer patients,
erectile disfunction management and referrals and statin prescribing patterns.
The practice had a patient participation (PPI) group arranged and led by the practice
manager. We saw that recent changes had been made to the patient registration form
which included information about the PPI group and an invitation to take part. There was
also a practice newsletter which was available in the waiting rooms and was going to be
added to the website.
There was an identified safeguarding lead and all staff we spoke with were aware of this.
They confirmed they had received training at the relevant level for their role although
updates were needed.
There was an up to date fire plan and evacuation procedure and the practice had a
business continuity plan. The provider had an effective system in place to identify, assess
and manage risks to the health, safety and welfare of people using the service and others.
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About CQC inspections
We are the regulator of health and social care in England.
All providers of regulated health and social care services have a legal responsibility to
make sure they are meeting essential standards of quality and safety. These are the
standards everyone should be able to expect when they receive care.
The essential standards are described in the Health and Social Care Act 2008 (Regulated
Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations
2009. We regulate against these standards, which we sometimes describe as “government
standards”.
We carry out unannounced inspections of all care homes, acute hospitals and domiciliary
care services in England at least once a year to judge whether or not the essential
standards are being met. We carry out inspections of other services less often. All of our
inspections are unannounced unless there is a good reason to let the provider know we
are coming.
There are 16 essential standards that relate most directly to the quality and safety of care
and these are grouped into five key areas. When we inspect we could check all or part of
any of the 16 standards at any time depending on the individual circumstances of the
service. Because of this we often check different standards at different times.
When we inspect, we always visit and we do things like observe how people are cared for,
and we talk to people who use the service, to their carers and to staff. We also review
information we have gathered about the provider, check the service’s records and check
whether the right systems and processes are in place.
We focus on whether or not the provider is meeting the standards and we are guided by
whether people are experiencing the outcomes they should be able to expect when the
standards are being met. By outcomes we mean the impact care has on the health, safety
and welfare of people who use the service, and the experience they have whilst receiving
it.
Our inspectors judge if any action is required by the provider of the service to improve the
standard of care being provided. Where providers are non-compliant with the regulations,
we take enforcement action against them. If we require a service to take action, or if we
take enforcement action, we re-inspect it before its next routine inspection was due. This
could mean we re-inspect a service several times in one year. We also might decide to reinspect
a service if new concerns emerge about it before the next routine inspection.
In between inspections we continually monitor information we have about providers. The
information comes from the public, the provider, other organisations, and from care
workers.
You can tell us about your experience of this provider on our website.
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How we define our judgements
The following pages show our findings and regulatory judgement for each essential
standard or part of the standard that we inspected. Our judgements are based on the
ongoing review and analysis of the information gathered by CQC about this provider and
the evidence collected during this inspection.
We reach one of the following judgements for each essential standard inspected.
Met this standard
This means that the standard was being met in that the
provider was compliant with the regulation. If we find that
standards were met, we take no regulatory action but we
may make comments that may be useful to the provider and
to the public about minor improvements that could be made.
Action needed
This means that the standard was not being met in that the
provider was non-compliant with the regulation.
We may have set a compliance action requiring the provider
to produce a report setting out how and by when changes
will be made to make sure they comply with the standard.
We monitor the implementation of action plans in these
reports and, if necessary, take further action.
We may have identified a breach of a regulation which is
more serious, and we will make sure action is taken. We will
report on this when it is complete.
Enforcement
action taken
If the breach of the regulation was more serious, or there
have been several or continual breaches, we have a range of
actions we take using the criminal and/or civil procedures in
the Health and Social Care Act 2008 and relevant
regulations. These enforcement powers include issuing a
warning notice; restricting or suspending the services a
provider can offer, or the number of people it can care for;
issuing fines and formal cautions; in extreme cases,
cancelling a provider or managers registration or prosecuting
a manager or provider. These enforcement powers are set
out in law and mean that we can take swift, targeted action
where services are failing people.
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How we define our judgements (continued)
Where we find non-compliance with a regulation (or part of a regulation), we state which
part of the regulation has been breached. Only where there is non compliance with one or
more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a
judgement about the level of impact on people who use the service (and others, if
appropriate to the regulation). This could be a minor, moderate or major impact.
Minor impact –
people who use the service experienced poor care that had an impact on
their health, safety or welfare or there was a risk of this happening. The impact was not
significant and the matter could be managed or resolved quickly.
Moderate impact –
people who use the service experienced poor care that had a
significant effect on their health, safety or welfare or there was a risk of this happening.
The matter may need to be resolved quickly.
Major impact –
people who use the service experienced poor care that had a serious
current or long term impact on their health, safety and welfare, or there was a risk of this
happening. The matter needs to be resolved quickly
We decide the most appropriate action to take to ensure that the necessary changes are
made. We always follow up to check whether action has been taken to meet the
standards.
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Glossary of terms we use in this report
Essential standard
The essential standards of quality and safety are described in our
Guidance about
compliance: Essential standards of quality and safety
. They consist of a significant number
of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the
Care Quality Commission (Registration) Regulations 2009. These regulations describe the
essential standards of quality and safety that people who use health and adult social care
services have a right to expect. A full list of the standards can be found within the
Guidance about compliance
. The 16 essential standards are:
Respecting and involving people who use services – Outcome 1 (Regulation 17)
Consent to care and treatment – Outcome 2 (Regulation 18)
Care and welfare of people who use services – Outcome 4 (Regulation 9)
Meeting Nutritional Needs – Outcome 5 (Regulation 14)
Cooperating with other providers – Outcome 6 (Regulation 24)
Safeguarding people who use services from abuse – Outcome 7 (Regulation 11)
Cleanliness and infection control – Outcome 8 (Regulation 12)
Management of medicines – Outcome 9 (Regulation 13)
Safety and suitability of premises – Outcome 10 (Regulation 15)
Safety, availability and suitability of equipment – Outcome 11 (Regulation 16)
Requirements relating to workers – Outcome 12 (Regulation 21)
Staffing – Outcome 13 (Regulation 22)
Supporting Staff – Outcome 14 (Regulation 23)
Assessing and monitoring the quality of service provision – Outcome 16 (Regulation 10)
Complaints – Outcome 17 (Regulation 19)
Records – Outcome 21 (Regulation 20)
Regulated activity
These are prescribed activities related to care and treatment that require registration with
CQC. These are set out in legislation, and reflect the services provided.
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Glossary of terms we use in this report (continued)
(Registered) Provider
There are several legal terms relating to the providers of services. These include
registered person, service provider and registered manager. The term ‘provider’ means
anyone with a legal responsibility for ensuring that the requirements of the law are carried
out. On our website we often refer to providers as a ‘service’.
Regulations
We regulate against the Health and Social Care Act 2008 (Regulated Activities)
Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009.
Responsive inspection
This is carried out at any time in relation to identified concerns.
Routine inspection
This is planned and could occur at any time. We sometimes describe this as a scheduled
inspection.
Themed inspection
This is targeted to look at specific standards, sectors or types of care.
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Contact us
Phone: 03000 616161
Email: enquiries@cqc.org.uk
Write to us
at:
Care Quality Commission
Citygate
Gallowgate
Newcastle upon Tyne
NE1 4PA
Website: www.cqc.org.uk
Copyright Copyright © (2011) Care Quality Commission (CQC). This publication may
be reproduced in whole or in part, free of charge, in any format or medium provided
that it is not used for commercial gain. This consent is subject to the material being
reproduced accurately and on proviso that it is not used in a derogatory manner or
misleading context. The material should be acknowledged as CQC copyright, with the
title and date of publication of the document specified.
