City Way Surgery

Updated 14 June 2023

The registered provider is City Way Surgery.

City Way Surgery is located at 67 City Way, Rochester, Kent, ME1 2AY. The practice is situated within the NHS Kent and Medway Integrated Care Board (ICB) and has a general medical services contract with NHS England for delivering primary care services to the local community.

As part of our inspection we visited City Way Surgery, 67 City Way, Rochester, Kent, ME1 2AY only, where the provider delivers registered activities. City Way Surgery has a registered patient population of approximately 12,510 patients. The practice is located in an area with an average deprivation score.

There are arrangements with other providers to deliver services to patients outside of the practice’s working hours.

The practice staff consists of 3 GP partners, 1 salaried GP, 3 advanced nurse practitioners, 3 practice nurses, 1 paramedic practitioner, 1 physician’s associate, 1 healthcare assistant, 1 phlebotomist, 1 clinical assistant, 1 practice manager, 1 assistant practice manager, 1 operations manager, as well as reception and administration staff. The practice also employs locum staff directly including a locum practice manager and locum GPs as well as a locum healthcare assistant via an agency.

City Way Surgery is a training practice: they are involved in the supervision and training of GP registrars.

City Way Surgery is registered with the Care Quality Commission (CQC) to deliver the following regulated activities: diagnostic and screening procedures; maternity and midwifery services; family planning; surgical procedures; and treatment of disease, disorder or injury.

Updated 14 June 2023

We carried out an announced comprehensive inspection at City Way Surgery on 18 April 2023. Overall, the practice is rated as requires improvement.

The ratings for each key question are:

Safe – requires improvement

Effective – requires improvement

Caring – requires improvement

Responsive – requires improvement

Well-led – requires improvement

Following our inspection on 1 December 2021, the practice was rated inadequate overall and for providing safe and well-led services. The practice was rated as requires improvement for providing effective, caring and responsive services. Warning notices were issued for breaches of regulation found at this inspection and the practice was placed into special measures.

We carried out an announced focussed inspection at City Way Surgery on 8 November 2022 to confirm that the practice had taken action to meet the legal requirements in relation to the breaches in regulations that we identified in our inspection in December 2021. The practice was not rated as a result of this inspection. We found the provider had met the requirements set out in our warning notices. However, we found breaches of regulations and requirement notices were issued.

The full reports for the December 2021 and November 2022 inspections can be found by selecting the ‘all reports’ link for City Way Surgery 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.

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:

• Requesting evidence from the provider.
• A site visit.
• Completing clinical searches on the practice’s patient records system in line with all data protection and information governance requirements.
• Reviewing patient records to identify issues and clarify actions taken by the provider.

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.
• Information from the provider, patients, the public and other organisations.

We rated the practice as Requires Improvement for providing safe services because;

• Improvements had been made to the practice’s systems, practices and processes to help keep people safe and safeguarded from abuse. Action had also been taken to address improvements that were ongoing at the time of our inspection in November 2022.
• Improvements had been made to systems and processes to help maintain appropriate standards of cleanliness and hygiene.
• Improvements had been maintained to the way risks to patients, staff and visitors were assessed, monitored or managed. Further improvements had taken place but others were ongoing.
• Improvements were made to systems during and after our inspection to help ensure staff had the information they needed to deliver safe care and treatment.
• The provider had maintained systems for the appropriate and safe use of medicines, including medicines optimisation.
• The provider had maintained improvements to the way significant events as well as safety alerts were managed and demonstrated an effective system that reported, investigated and shared learning from significant events.

We rated the practice as Requires Improvement for providing effective services because:

• Improvements had continued to be made to the way patients’ needs were assessed, and the way care as well as treatment were delivered, to help ensure they were in line with current legislation, standards and evidence-based guidance.
• The provider had a programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided. However, improvements remained ongoing for some patients with long-term conditions, some patients with potential missed diagnoses and some patients prescribed certain medicines.
• The provider was continuing to take action to improve uptake of childhood immunisations.
• Action taken by the provider had resulted in performance related to cancer indicators, such as cervical screening, meeting required targets.
• Further improvements to complaints management had been made. Complaints were listened to and used to improve the quality of care.
• Staff had the skills, knowledge as well as experience to carry out their roles and had received relevant appraisals.
• Staff worked together and with other organisations to deliver effective care and treatment.
• Staff were consistent and proactive in helping patients to live healthier lives.
• The practice continued to obtain consent to care and treatment in line with legislation and guidance.

We rated the practice as Requires Improvement for providing caring services because:

• Staff continued to treat patients with kindness, respect and compassion.
• Improvements to the practice’s system for coordinating care for patients who required palliative care had been maintained by the provider.
• Feedback about the practice from the national GP patient survey published in July 2022 was either in line with or below local and England averages. There was now a formal action plan to help improve patient satisfaction scores. However, this was in the process of being implemented.
• Staff continued to help patients to be involved in decisions about care and treatment.
• The provider had increased the number of patients who had been identified as being carers from 113 (1% of the practice population) at the time of our December 2021 inspection to 286 (2% of the practice population) currently.
• The practice continued to respect patients’ privacy and dignity.

We rated the practice as Requires Improvement for providing responsive services because:

• The practice continued to organise and deliver services to help meet patients’ needs.
• Patient feedback indicated people were not always able to access care and treatment in a timely way. The provider had taken some action to address this but some actions were ongoing.
• The provider had developed an action plan to help improve patient satisfaction scores. Some actions had been implemented but others were ongoing. The provider was not yet able to demonstrate the impact of actions that had been implemented.

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

• Improvements to quality and sustainability found at our last inspection in November 2022 had been maintained. Action had continued to be taken to address many of the remaining issues relating to quality and sustainability.
• The provider had maintained improvements so that the practice culture continued to support delivery of high-quality sustainable care.
• There were processes and systems to support good governance and management. Improvements had been made to the system that helped keep governance documents up to date and practice specific.
• The provider had maintained improvements to processes for managing risks, issues and performance. Further action had been taken but some improvements remained ongoing.
• The practice involved the public, staff and external partners to help ensure they delivered high-quality and sustainable care. Formal plans to improve patient satisfaction scores regarding services provided by City Way Surgery had been developed. However, the provider was not yet able to demonstrate the impact of actions that had been implemented.
• Improvements to the practice’s systems and processes for learning, continuous improvement and innovation had been maintained.

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.

The areas where the provider should make improvements are:

• Continue to seek occupational health advice and manage risks for staff who do not respond to vaccinations.
• Continue with plans for a fire risk assessment to be carried out and ensure action is taken to address any findings.
• Continue with plans to replace clinical wash-hand basins that are not compliant with Department of Health guidance as well as dirty light pull cords.
• Continue with plans to deliver basic life support training to staff who are not up to date with this training.
• Revise management so that all emergency medicines that are required to be kept are available at all times in the practice for use in an emergency.
• Continue to monitor the use of Patient Group Directions to help ensure they are completed correctly and fully.
• Continue to implement actions, and monitor results, to help encourage uptake of childhood immunisations

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

Please refer to the detailed report and the evidence tables for further information.