Background to this inspection
Updated
15 April 2019
Market Quarter Medical Practice is part of the Coventry and Rugby Clinical Commissioning Group (CCG) and provides services to approximately 8,000 patients living in the town centre and surrounding areas of Rugby under the terms of a general medical services (GMS) contract which is nationally negotiated.
The provider is registered with CQC to deliver five Regulated Activities; diagnostic and screening procedures, maternity and midwifery services, treatment of disease, disorder or injury, surgical procedures and family planning.
The practice operates from a modern purpose built, two storey building with disabled access and parking. The reception area is spacious and allows easy access for patients using mobility aids including a lift. The building is shared with another GP practice and accommodates other community services such as Improving Access to Psychological Therapies (IAPT), Social Prescribing, a psychologist, Abdominal Aortic Aneurysm (AAA) screening and retinal screening. The practice is also a hub for the local Coventry & Rugby GP Alliance extended hours service which provides all patients in the area with access to a GP or nurse appointment from Monday to Friday from 6.30pm until 9.30pm and every Saturday morning from 9am until 12pm. There is also an option to be seen in a Coventry hub on Sunday mornings from 10am until 1pm.
The practice population has a higher than average number of patients aged 15-64 years. National data indicates that the area is one that does not experience overall high levels of deprivation, although there are pockets of deprivation where patients experience high unemployment, drug and alcohol problems. The practice population is predominantly made up of white British patients with some Eastern European and Asian ethnic minority groups.
There are two GP partners, one male and one female and two salaried female GPs. The practice employs three practice nurses, a health care assistant, practice manager and assistant practice manager who are supported by a team of administration and reception staff. It is a training practice which teaches medical students from Warwick Medical School as well as GP registrars who are qualified doctors carrying out additional training to become GPs. At the time of our inspection there was one trainee GP actively in training at the practice.
The practice offers a range of services including, minor surgery, long term condition monitoring, cervical cytology and child health services.
The practice is open from Monday to Friday from 8am until 6.30pm. The practice offers their own extended hours appointments on one Saturday each month from 9am until 12pm for their own patients for pre-booked appointments only. When the practice is closed services are provided by the local out of hours provider by Care UK accessed via the NHS 111 service.
Updated
15 April 2019
We carried out an announced comprehensive inspection at Market Quarter Medical Practice (previously known as Dr Leach & partners) on 14 February 2019. This was to follow up from a previous inspection carried out on 10 January 2018, when the practice had been rated as requires improvement in the areas of providing safe and responsive care which had made the overall rating requires improvement.
At our inspection on 10 January 2018 we found there had been a breach of Regulation 19 HSCA Regulations 2014 Fit and proper persons employed. They had not ensured that all the information specified in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was available for each person employed. We also noted that the practice should make improvements in the following areas:
- Ensure complaints are a standard agenda item at meetings to ensure shared learning.
- Routinely offer health checks to all carers.
- Record any actions taken when a child on the risk register does not attend a hospital appointment.
- Continue to monitor the uptake of cervical screening.
- Continue to improve telephone access and monitor patient satisfaction.
More information regarding that report can be found at: https://www.cqc.org.uk/location/1-569239314
During our inspection on 14 February 2019 we found that the provider had addressed all areas identified although we did not have evidence of the impact of changes implemented regarding access to appointments and getting through on the phone.
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 good overall.
We rated the practice as requires improvement for providing responsive services because:
- The practice has had ongoing issues experiencing negative responses from patients regarding telephone access and have made changes to the appointment system. They monitor and review this weekly with the aim of delivering services to meet patients’ needs and plan to continue with this. The practice intended to carry out their own patient survey in March 2019 but at the time of our inspection there was no evidence that the changes had had a significant impact on patients’ access to appointments and getting through on the phone.
- The issue identified affects all population groups, which have therefore also been rated as requires improvement for providing responsive services.
We rated the practice as good for providing safe, effective, caring and well-led services because:
- The practice provided care in a way that kept patients safe and protected them from avoidable harm. They had established systems which all staff were aware of to ensure the safety of patients and staff was maintained.
- We saw that the GPs monitored clinical care via audits and reviews to determine its effectiveness. This ensured patients received effective care and treatment that met their needs and was evident both in the practice’s clinical achievement as well as from patients’ reported satisfaction with the care they received.
- There were systems to support effective governance and staff had allocated roles and responsibilities which they were all aware of and had been appropriately trained to carry out.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care. This was reported by patients on the day of inspection and we observed staff assisting patients with their queries and appointments.
- The management team worked closely together, although formal regular minuted meetings had been less frequent over the last year due to clinical staff changes. However, we noted they had maintained effective communication to promote the delivery of high-quality, person-centred care.
- Staff reported feeling well supported in their work and were encouraged to develop within the practice.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
The areas where the provider should make improvements are:
- Continue to carry out plans to monitor and increase the uptake of cervical screening.
- Continue to monitor telephone access and access to appointments.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care