- GP practice
Newington Road Surgery Limited Also known as Newington Road Surgery
Important:
We are carrying out a review of quality at Newington Road Surgery Limited. We will publish a report when our review is complete. Find out more about our inspection reports.
All Inspections
17 November 2022
During a routine inspection
We carried out an announced comprehensive inspection at Newington Road Surgery Limited between 14 and 17 November 2022. Overall, the practice is rated as requires improvement.
Safe- good
Effective - good
Caring - good
Responsive - requires improvement
Well-led - requires improvement
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Newington Road Surgery Limited 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.
Following our previous inspection in February 2022 the practice was rated inadequate and placed into special measures. We took enforcement action against the provider. We issued two warning notes for breaches of Regulation 12: Safe care and treatment, and Regulation 17: Good governance.
This inspection was comprehensive inspection and we included all key lines of enquiry.
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:
- Conducting staff interviews using video conferencing facilities.
- Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
- Reviewing patient records to identify issues and clarify actions taken by the provider.
- Requesting evidence from the provider.
- 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 found that:
- There had been significant improvements to the practice since the previous inspection.
- The practice provided care in a way that kept patients safe and protected them from avoidable harm.
- However, there were some issues with the frequency of monitoring of emergency equipment and vaccines’ fridge monitoring. These issues were rectified during the course of the inspection.
- Our clinical searches indicated that patients received effective care and treatment that met their needs.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- Staff reported a positive culture and they felt able to raise concerns.
- Improvements to leadership resources and governance had led to better processes for delivering services.
- Patient feedback was poor regarding accessing services and appointments.
- Staff received training. However, appraisals were still in the process of being completed and there were some staff whose training uptake was not assured by the practice (staff who were not directly employed by the practice).
- The premises were well maintained and safe for patients and staff.
We found one breach of regulations. The provider must:
- Ensure systems and processes of governance are established and operated effectively.
In addition the provider should:
- Complete appraisals where required by staff.
- Continue to identify potential means of improving cervical screening and child immunisations uptake.
Due to the improvements since our last inspection in February 2022, I am removing this practice from Special Measures.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA
Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services
18 and 21 February 2022
During a routine inspection
We carried out an announced inspection of Newington Road Surgery on 18 and 21 February 2022. Overall, the practice is rated as Inadequate.
Safe - Inadequate
Effective – Requires Improvement
Well-led – Inadequate
Following our previous inspection on 8 September 2020, the practice was rated Good overall, but Requires Improvement for the provision of well-led services.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Newington Road Surgery on our website at www.cqc.org.uk
Why we carried out this inspection
This inspection was a focused inspection to follow up on our previous inspection to ensure:
- Are services safe?
- Are services effective?
- Are services well-led?
CQC undertook this inspection at the same time as we inspected a range of urgent and emergency care services in Kent and Medway. To understand the experience of GP providers and people who use GP services, we asked a range of questions in relation to urgent and emergency care. The responses we received have been used to inform and support system-wide feedback.
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:
- Conducting staff interviews using video conferencing facilities,
- 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
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.
- Uptake of cervical screening was below target and three 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 the management of safe care and treatment in relation to high-risk medicines monitoring, safety alerts and risk management practices.
- There were gaps in systems for reporting incidents and complaints, therefore learning and improvement when things went wrong were not effective.
- The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. However, arrangements for access did not fully consider the needs of the vulnerable, in particular those who may be digitally excluded, as the door to the surgery was kept locked.
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 standard of care.
The provider should:
- Work towards registered staff including nurses completing level three safeguarding training for both adults and children.
- Improve the uptake of cervical screening.
- Improve the uptake of childhood immunisations.
- Develop a programme of quality improvement activity.
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 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 cancel 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
14 December 2020
During an inspection looking at part of the service
We carried out an announced follow up inspection at Newington Road Surgery on 14 December 2020. We followed up on concerns found during our inspection conducted on 20 October 2020 in relation to the management of medicines. Following the inspection an enforcement notice was issued on 27 October 2020 and required the practice to be compliant by 30 November 2020.
This report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the practice.
We found that the practice had made improvements. We found:
- The practice met the requirements of the enforcement notice.
- The practice had ensured the safe management of high-risk medicines. Patients had been appropriately advised of risks and these were documented within their clinical record.
- We found the practice had confirmed the identity of patients in consultations, recorded clear patient histories and had conducted appropriate management plans based on current accepted evidence.
- We found the practice had repeatedly sought to encourage and engage patients in the management of their care.
We also found improvements were required with governance systems, in relation to their management of medicines. We found;
- We found the practice had prescribed a high dose of an antidepressant medicine contrary to guidance for patients over 65years of age. This was discussed with the practice who agreed to review patient care.
- We found inconsistent management of some patients on medicines, for example, some medication reviews were overdue, had not been scheduled, a patient had been placed on repeat prescriptions without a medication review and some clinical records lacked narrative entries to support the completion of their medication reviews.
The areas where the provider must make improvements are:
- Establish effective systems and processes to ensure good governance of medicines in accordance with the fundamental standards of care.
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
08/09/2020
During an inspection looking at part of the service
We carried out an announced follow up inspection at Newington Road Surgery on 20 October 2020. We followed up on safeguarding concerns identified during the inspection conducted on 21 May 2019 and to assess improvements required in respect of governance systems found on 12 June 2018.
This report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the practice.
We found that the practice had made some improvements. We found:
- The practice had a policy on vulnerable adults and children who were at risk, or in need who failed to attend clinical appointments with primary or secondary care.
- The practice safeguarding policy had been revised and addressed the disclosure of physical or sexual abuse. However, it did not reflect current General Medical Council guidance on the recording of risk assessments relating to children under 18 years who are sexually active.
- The practice had appointed an administrative member of staff to support the safeguarding lead clinician to collate, review and manage risks to the patients.
- The practice had introduced regular and structured team meetings, but the meeting minutes lacked details of discussion, actions and resolution of tasks.
- The practice had not ensured all patients were appraised of potential risks relating to their medicines and that they were appropriately monitored.
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.
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
During an inspection looking at part of the service
We carried out an announced follow up inspection at Newington Road Surgery on 21 May 2019 to follow up on concerns identified during our comprehensive inspection on 12 June 2018. During the initial inspection of the surgery we found the practice to be good overall with requires improvement in well-led as they needed to improve their governance systems.
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
This inspection was not rated as we did not review all elements of the well led domain.
We found that sufficient improvements had not been made to improve the rating of the service in the well-led domain, because:
- The practice had introduced team meetings but these were not yet well established or effective.
- On receipt of medicine alert information, the practice had not conducted appropriate checks on their clinical system and mitigated the risks to patients.
- The practice had not maintained accurate information regarding children who were at risk or in need.
- The practice had not followed up on children who were at risk, or in need who failed to attend clinical appointments with primary or secondary care.
- The practice safeguarding policy did not address the disclosure of physical or sexual abuse.
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 patients are protected from abuse and improper treatment
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
12 Jan 2018
During a routine inspection
This practice is rated as good overall. (Previous inspection 17/03/2015 – Good)
The key questions are rated as:
Are services safe? – good
Are services effective? – good
Are services caring? – good
Are services responsive? – good
Are services well-led? – requires improvement
We carried out an announced comprehensive inspection at Newington Road Surgery Limited on 12 June 2018. The practice was last inspected in 2015 and therefore was scheduled for inspection under the five-year inspection programme.
At this inspection we found:
- The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
- The practice had a strong clinical performance.
- Patients told us they were treated with compassion, kindness, dignity and respect.
- Patients found the appointment system easy to use and reported that they could access care when they needed it.
- The leadership at the practice was not cohesive and all partners did not subscribe to the same vision for the future.
The areas where the provider must make improvements as they are in breach of regulations are:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
17 March 2015
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Newington Road Surgery Limited on 17 March 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. It was also good for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including dementia).
Our key findings across all the areas we inspected 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, appropriately reviewed and addressed.
- Risks to patients were assessed and well managed.
- Patients’ needs were assessed and care was planned and delivered following best practice guidance.
- Staff had received training appropriate to their roles, with the exception of safeguarding training for administration staff. Further training needs had been identified and the training planned.
- 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.
However there were some areas of practice where the provider needs to make improvements.
Importantly the provider should:
- Review the training arrangements for administrative staff in relation to safeguarding children.
- Review the process used by all GPs to monitor follow-up appointments / non-attendance of patients following abnormal blood test results.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
24 July 2013
During a routine inspection
We found that a touch screen facility for booking in for an appointment was available for people as well as reporting to reception so that staff knew they were there. People told us the staff treated them respectfully and were helpful. We saw that staff spoke politely to people and consultations were carried out in private treatment rooms.
Appropriate pre employment checks had been carried out and we found evidence that staff had received regular training, supervisions and appraisals. We found that the service had effective systems in place to monitor and assess the quality of the service that people received.