The Care Quality Commission
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  • GP practice

Archived: City Road Medical Centre

Overall: Requires improvement read more about inspection ratings

5 City Road, Edgbaston, Birmingham, West Midlands, B16 0HH (0121) 456 3322

Provided and run by:
City Road Medical Centre

Important: The provider of this service changed. See new profile

All Inspections

7 October 2021

During a routine inspection

We carried out an unannounced inspection at City Road Medical Centre on 7 October 2021. Overall, the practice is rated as Requires Improvement.

The ratings for each key question were as follows:

Safe - Requires Improvement

Effective – Requires Improvement

Caring – Good

Responsive – Requires Improvement

Well-led – Requires Improvement

Following our previous inspection on 2 February 2021, the practice was rated inadequate overall and for all key questions, except for providing caring and responsive services which was rated as good. The practice was placed into special measures.

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

Why we carried out this inspection

This inspection was a comprehensive inspection to follow up on any breaches of regulations and ‘shoulds’ identified in the previous inspection.

How we carried out the inspection/review

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:

  • 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 found that:

  • Infection control processes required strengthening. On reviewing the risk assessment that had been completed by the practice, we found it failed to demonstrate an accurate review had taken place.
  • Some risk management processes had improved and we found risk assessments had been completed, however some actions that had been identified had not been acted on.
  • On reviewing a random sample of patients records we found some of the clinical consultations lacked sufficient information and safety netting.
  • On reviewing the emergency equipment we found the practice had no paediatric pulse oximeter in place to enable them to carry out an assessment of patients with presumed sepsis.
  • The practice had some systems to keep clinicians up to date with current evidence-based guidance, however, we found the process to determine the severity of a patients’ condition, was not clearly demonstrated by all clinical staff.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. This included individual risk assessments for staff and the use of Personal Protective Equipment (PPE). However, we found not all staff followed the practice requirements in the wearing of face masks.
  • Since the previous inspection the leadership team had reviewed the practice procedures and implemented effective processes to ensure staff training was monitored and staff completed training relevant to their role.
  • Processes had been implemented to ensure safeguarding registers were monitored and contained all the relevant information. Regular reviews of the registers was carried out and multi-disciplinary meetings had been implemented to ensure information was shared effectively to protect patients from avoidable harm.
  • We found significant improvements in the management of patients’ care and treatment on high risk medicines.
  • Governance arrangements had been strengthened to ensure risks to patients were considered, managed and mitigated appropriately.

We found breaches of regulations. The provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

  • Develop processes to encourage patients to attend cervical screening appointments.
  • Improve the emergency equipment available for assessing patients with presumed sepsis.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

2 February 2021

During a routine inspection

We carried out an announced comprehensive inspection at City Road Medical Centre on 2 February 2021 as part of our inspection programme.

We decided to undertake an inspection of this service to gain assurances, following concerns that were raised about the safety of the practice. This inspection looked at the following key questions

  • Safe
  • Effective
  • Caring
  • Responsive
  • Well Led

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 rated the practice as inadequate for providing safe services because:

  • The practice did not have clear systems and processes to keep patients safe.
  • The practice did not have appropriate systems in place for the safe management of medicines.
  • The practice had ineffective systems in place to ensure risks were mitigated.
  • Systems in place for the monitoring and review of patients with safeguarding concerns were inadequate.
  • Recruitment systems needed strengthening to ensure the appropriate checks had been completed prior to employment.
  • The practice did not learn and make improvements when things went wrong.
  • There was limited evidence to demonstrate the practice had effective systems in place to review safety information. This included safety alerts and recommended guidance updates.

We rated the practice as inadequate for providing effective services because:

  • On reviewing a sample of patients’ records we found that monitoring and reviews had not always been undertaken in line with the relevant guidance.
  • There was limited monitoring of the outcomes of care and treatment.
  • The practice was unable to show that some staff had the skills, knowledge and experience to carry out their roles.
  • The processes in place to ensure care and treatment was in line with evidence based guidance needed strengthening.
  • Some patients had not received effective co-ordination of their medical conditions due to clinical coding errors.

We rated the practice as inadequate for providing well-led services because:

  • Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
  • The practice culture did not effectively support high quality sustainable care.
  • The overall governance arrangements were ineffective.
  • The practice did not have clear and effective processes for managing risks, issues and performance.
  • The practice did not always act on appropriate and accurate information.
  • We saw little evidence of systems and processes for learning, continuous improvement and innovation.

We rated the practice as good for providing caring and responsive services because:

  • The practice had visited patients who were unable to attend the practice to administer the Covid-19 vaccine.
  • A system was in place to gather patient feedback on the services provided.
  • The practice was aware of support groups within the area and signposted their patients to these accordingly.

These areas affected all population groups so we rated all population groups as inadequate.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Continue taking action to improve the uptake of national screening programmes such as cervical screening.
  • Continue to monitor patients with long term conditions to ensure they are receiving the appropriate monitoring and reviews.
  • Continue to proactively identify carers in order to offer them support where appropriate.

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 population group, 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

9 February 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This was a follow up desk-based review carried out on 9 February 2017, to confirm the practice had met the areas for improvement that we identified on our previous inspection on 23 February 2016 and 25 May 2016. The full comprehensive report can be found by selecting the ‘all reports’ link for City Road Medical Centre on our website at www.cqc.org.uk.

This report covers our findings in relation to those improvements.

Overall the practice is now rated as Good.

Our key findings were as follows:

  • The practice had undertaken disclosure and barring service (DBS) checks for staff members who chaperoned. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

  • The practice was able to demonstrate that they had formally considered the risks for not having oxygen on the premises.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

23 February 2016 and 25 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at City Road Medical Centre on 23 February 2016 and 25 May 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and managed. However, risk assessment related to the availability of medical oxygen in the practice needed to be updated and formalised.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice operated walk-in clinics most mornings and patients said they found it easy to see their GP. There was one regular GP which allowed for continuity of care, with urgent appointments available the same day.
  • The practice did not have a nurse and the GP carried out cervical cytology. This was explored with patients when they first joined the practice in view to organising an alternative arrangement.
  • All staff were longstanding including the practice manager. However, some governance processes needed strengthening to ensure appropriate risks were identified and minimised in the absence of the practice manager.

The areas where the provider must make improvement are:

  • Risk assessments must be robust to support decision not to carry out a DBS check for clinical staff.

The areas where the provider should make improvement are:

  • Ensure a formal risk assessment is in place on regards to availability of medical oxygen in the practice.

  • Ensure audit standards are set with completed cycles.

  • All policies should be reviewed regularly and minutes of meetings should be formally recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

19 August 2014

During an inspection looking at part of the service

We previously inspected City Road Medical Practice on 12 February 2014. At the time we found one area of non-compliance which we judged had a moderate impact on patients who used the service. We found that there were no procedures in place for dealing with medical emergencies which are reasonably expected to arise from time to time. We set compliance actions and told the provider to improve.

We gave short notice of this inspection so that any disruption to people's care and treatment were minimised. We spoke with the registered manager. We found that the provider had made the necessary improvements.

We saw that additional systems had been put in place to ensure that medication management practices were robust.

12 February 2014

During a routine inspection

On the day of the inspection we spoke with two reception staff who also worked as healthcare assistants (HCAs). We also spoke with the assistant practice manager and the GP. The practice manager was away on leave at the time of our inspection visit. We also spoke with four patients, all the patients were positive about their experience at the surgery. One patient said, 'The best, I can't praise it enough.' Another patient said, 'The GP has an enormous amount of equality, he sticks up for the underdog.' All the patients also told us that other staff at the surgery were polite, helpful and respectful.

Most patients felt they were involved in their care because the GP had taken time to explain things to them. However, we found that the surgery did not have appropriate arrangements in place for dealing with medical emergencies. This meant that the surgery did not ensure the needs of patients would be met during an emergency.

Staff members had received training in safeguarding and were aware of the appropriate agencies to refer safeguarding concerns to. This ensured that patients were protected from harm.

We found that staff had received appropriate training for the roles they carried out. They also had regular appraisals. This meant that they had been adequately assessed as being competent.

The provider had some systems in place for monitoring the quality of service provision. The provider demonstrated learning from accidents and incidents.