Newington Road Surgery Limited Also known as Newington Road Surgery

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed all 6 quality statements from this key question. We found staff involved people in decisions about their care and treatment and provided them advice and support. Improvements had been made following our last inspection. However, at this assessment we found care and treatment sometimes did not adhere to current legislation, standards and evidence-based guidance. Furthermore, the provider was unable to demonstrate quality improvement through clinical audits.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most of the patient feedback CQC received reflected negatively on the care and treatment provided. Specific concerns included delays in processing prescriptions, challenges in obtaining a prescription after an urgent referral from 111, and difficulties booking appointments. There was also feedback regarding the increased reliance on locum doctors, with reports of uncontrolled asthma and blood pressure management. Additionally, some patients highlighted issues with staff compassion and poor communication. One patient reported that their medication had been stopped multiple times without prior consultation. The recent GP patient survey results showed 85% of respondents were confident and had trust in the healthcare professional they spoke to, 82% said their needs were met, 84% said they were involved as much as they wanted to be in decisions about their care and treatment, 78% said the professional was good at listening to them and 77% said the healthcare professional was good at treating them with care and concern. 56% of respondents said their overall experience of the GP practice was good.

Staff were knowledgeable about the local community’s needs. Reception staff used digital flags in the care records system to identify specific requirements, such as extended appointment times or the need for a translator. Staff identified the need for menopause clinics which prompted staff to receive relevant training. As a result, the practice has specialists in menopause care, allowing them to better meet the needs of their population. Staff told us the practice had systems to assess and address the immediate and ongoing needs of patients, ensuring continuous care management. Key measures include recall systems and regular multidisciplinary meetings. Staff highlighted significant challenges encountered within the practice as well as issues faced by the patient population. For example, high frequency of missed appointments and the transition from the previous ownership of the practice. Leaders told us they inherited operational and administrative challenges which required considerable effort to address. Staff told us they had worked diligently to rectify the inherited challenges, including restructuring workflows and improving practice systems. Staff told us that despite initial difficulties, the practice has entered a more stable phase. While some challenges remain, staff expressed confidence in the progress made and the foundation established for further improvement in patient care and practice management.

The provider assessed the needs of is population to ensure patients received the best possible outcomes. For example, the provider gathered data on call waiting times and adjusted staffing levels accordingly to better meet demand. Patients were told when they needed to seek further help and what to do if their condition deteriorated. Triage systems were in place with the reception and nursing team with escalation systems in place for people presenting with immediate needs. Where possible, staff tried to book people in advance. Patient records were accordingly flagged to alert staff to individuals needs and preferences. This enabled staff to identify vulnerable groups and proactively invite them for health checks, such as carers The provider continued to implement and embed the governance processes we saw at the last inspection. A key initiative was the “Model Day” programme which encompassed all aspects of day-to-day service delivery. This programme enabled senior leaders to maintain oversight of critical operational tasks, ensuring essential activities were completed in a timely and organised manner.

Feedback from patients raised no concerns about delivering evidence-based care and treatment.

The practice completed annual reviews for patients with learning disabilities. Staff at the practice met with the palliative care team when required to discuss patients receiving end-of-life care. Patients received safety netting advice in case their condition deteriorated. Feedback from leaders showed they worked to ensure all clinical correspondence and tasks were up to date. Patients were encouraged to be involved in monitoring and managing their own health and were referred to additional services if needed.

We conducted a series of searches on the practice’s clinical records system to review if care and treatment was delivered in line with best practice. We reviewed the records of 5 patients that had been identified by the clinical search as having a potential missed diagnosis of diabetes and found 3 required additional review, however this had not happened. We identified instances where follow up tasks were marked as completed and closed without any action being taken. We saw the provider shared this feedback with all staff and new protocols were put in place to prevent reoccurrence. We also found the practice did not consistently adhere to the guidelines for repeating blood glucose tests, which recommend that the test be repeated within 2 to 12 weeks after the initial test. We reviewed the records of 3 patients with asthma who were prescribed 2 or more courses of rescue steroids in the past 12 months. For 1 patient, we identified that improvements were needed in record-keeping. For example, there was no documentation of face-to-face observations or safety netting information that had been communicated. The provider reviewed all patients identified in the search and took necessary actions. We reviewed the records of 5 patients with diabetes whose latest blood glucose level was more than 75mmol/l. We found 4 patients were overdue a blood pressure check; 2 of which were also overdue a diabetic and medicines review. We also found some tests/evaluations were not recorded for 1 patient. Furthermore, we saw one instance where tasks were completed without action taking place. After the assessment, the provider contacted the patients and took necessary action. For example, arranged appointments or completed blood tests according to best practice guidance.

Most of the patient feedback CQC received reflected negatively on the care and treatment provided. Specific concerns included delays in processing prescriptions, challenges in obtaining a prescription after an urgent referral from 111, and difficulties booking appointments. There was also feedback regarding the increased reliance on locum doctors, with reports of uncontrolled asthma and blood pressure management. Additionally, some patients highlighted issues with staff compassion and poor communication. One patient reported that their medication had been stopped multiple times without prior consultation. The recent GP patient survey results showed 85% of respondents were confident and had trust in the healthcare professional they spoke to, 82% said their needs were met, 84% said they were involved as much as they wanted to be in decisions about their care and treatment, 78% said the professional was good at listening to them and 77% said the healthcare professional was good at treating them with care and concern. 56% of respondents said their overall experience of the GP practice was good.

Leaders held regular meetings with staff to discuss daily processes, share learning and discuss ideas for improvement. Additionally, clinicians participated in frequent multidisciplinary meetings to address safeguarding concerns, discuss palliative care patients and cancer care coordination.

Following our last inspection, the commissioners of the service, NHS Kent and Medway integrated care board (ICB) collaborated with the provider to address and enhance the areas identified for improvement. The provider demonstrated good engagement although there were instances where follow up was required.

There were processes to ensure information was shared with other agencies. Care was delivered and reviewed in a coordinated way when different teams, services or organisations were involved. The provider continued to implement and embed the governance processes we saw at the last inspection. A key initiative was the “Model Day” programme which encompassed all aspects of day-to-day service delivery. This programme enabled senior leaders to maintain oversight of critical operational tasks, ensuring essential activities are completed in a timely and organised manner. Key areas of oversight included completion of referrals for example ensuring 2 week wait referrals were completed within 24 hours, processing of pathology results and timely authorisation of prescriptions.

Most of the patient feedback CQC received reflected negatively on the care and treatment provided. Specific concerns included delays in processing prescriptions, challenges in obtaining a prescription after an urgent referral from 111, and difficulties booking appointments. There was also feedback regarding the increased reliance on locum doctors, with reports of uncontrolled asthma and blood pressure management. Additionally, some patients highlighted issues with staff compassion and poor communication. One patient reported that their medication had been stopped multiple times without prior consultation. The recent GP patient survey results showed 85% of respondents were confident and had trust in the healthcare professional they spoke to, 82% said their needs were met, 84% said they were involved as much as they wanted to be in decisions about their care and treatment, 78% said the professional was good at listening to them and 77% said the healthcare professional was good at treating them with care and concern. 56% of respondents said their overall experience of the GP practice was good.

Improvements had been made following our last inspection. Patients with a learning disability were invited to attend for annual health assessments. This was a face-to-face appointment; patients could be accompanied by a carer or family member if they wished. The provider worked together with 4 other GP practices within Ramsgate Primary Care Network and linked with social prescribers.

There were leaflets in the reception area with information on smoking cessation, dressing clinics and local organisations who could offer healthy living advice.

Most of the patient feedback CQC received reflected negatively on the care and treatment provided. Specific concerns included delays in processing prescriptions, challenges in obtaining a prescription after an urgent referral from 111, and difficulties booking appointments. There was also feedback regarding the increased reliance on locum doctors, with reports of uncontrolled asthma and blood pressure management. Additionally, some patients highlighted issues with staff compassion and poor communication. One patient reported that their medication had been stopped multiple times without prior consultation. The recent GP patient survey results showed 85% of respondents were confident and had trust in the healthcare professional they spoke to, 82% said their needs were met, 84% said they were involved as much as they wanted to be in decisions about their care and treatment, 78% said the professional was good at listening to them and 77% said the healthcare professional was good at treating them with care and concern. 56% of respondents said their overall experience of the GP practice was good.

Staff told us they had conducted regular audits to identify children who required their immunisations; sent texts/letters to the parent/guardian to remind them of the need to book an appointment for their child’s immunisations and had taken the opportunity to talk with the parent/guardian when they attended the practice with their child for other matters. Staff also told us they tried to increase uptake for cervical cancer screening by regularly reviewing the updated figures and sent recall letters/text messages to remind patients of the need to book an appointment; offered a range of appointments during the day; and took the opportunity to speak to the patient when they attended the practice for other matters.

Childhood immunisations were carried out in line with the national childhood vaccination programme. There were processes to monitor and contact patients requiring immunisations or screening tests. There was a dedicated member of staff who reviewed the patients due for cervical cancer screening. Patients were sent 3 separate invites throughout the year to encourage them to attend the practice for their cervical screening. If patients did not attend or missed appointments, the provider would follow up by sending a text message, a telephone call or a letter. The practice’s procedures were such that each person would be contacted 3 times using different methods. There was also a dedicated member of staff that conducted an audit every 2 weeks to identify patients due for their childhood immunisations. The staff member would call the parent/guardian, explained which immunisations were needed and provided them the opportunity to ask any questions. The appointment was scheduled during the call. If the parent/guardian could not be reached, a text message with a link to self-book the appointment or a letter was sent. If no appointment was made, the staff member followed up with a phone call or letter. Parents/guardians also had the option to speak to a GP if they had concerns about childhood immunisations. There was no targeted quality improvement program in place. Staff explained that this was due to the reliance on locum GPs, which made it challenging to implement such initiatives. However, permanent GP staff have recently been employed, and plans were in place to conduct clinical audits and use the data on care and treatment to drive improvements. The provider was working on a clinical audit related to B12 injections.

NHS England results between April 2022 and March 2023 showed uptake rates were below the 95% World Health Organisation (WHO) target for all 5 indicators; 2 of these indicators were below the 90% minimum target (children aged 5 who had 2 doses of MMR at 83.3% and children aged 1 who had completed three doses of Diptheria, Tetanus, Polio, Pertussis, Haemophilus influenza type b and Hepatitis B at 88.1%). Three indicators had met the 90% minimum target: children aged 2 who received their immunisation for Haemophilus influenza type b and Meningitis C (90.9%), children aged 2 who had one dose of MMR (90.9%) and children aged 2 who received their booster immunisation for pneumococcal infection (90.9%). Published results showed the provider’s uptake for cervical cancer was below the 80% target for the national screening programme. Data from June 2023 showed uptake at 69%. Although performance had decreased overall since 2020, data showed a small increase in uptake between December 2022 and June 2023. The provider shared unverified data which showed uptakes rates had improved and met the target (unverified data refers to data that has been provided by the practice and has not been published; therefore, has not been verified by the data owner, for example, UK Health Security Agency, NHS Digital, NHS England and Improvement). Unverified data showed that to date; 80% persons aged between 25 to 49 that were eligible for cervical cancer screening were screened adequately within a specified period and 89% persons aged between 50 to 64 that were eligible for cervical cancer screening were screened adequately within a specified period. Published results showed that the number of new cancer cases that had been identified and referred in a timely manner were above the national average.

We did not receive any concerns or identify specific feedback about consent.

Clinicians understood the requirements of legislation and guidance when considering consent and decision making.

Clinicians supported patients to make decisions. Where appropriate, they assessed and recorded a patient’s mental capacity to make a decision. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were made in line with relevant legislation and were appropriate.