City Square Medical Group

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 found the practice had made improvements following the previous inspection in May to July 2023. For example, patients were regularly assessed, and care and treatment were delivered in line with current legislation and evidence-based guidelines. The leaders monitored patients care and outcomes monthly to ensure they were met.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The national GP patient survey carried out from January to March 2023 had 115 responses. This found 82% of patients stated the healthcare professional was good at listening to them, and 82% of patients stated they were involved as much as they wanted to be in decisions about their care and treatment. In addition, 88% of patients had confidence and trust in the health care professional they saw or spoke to and 87% of patients said their needs were met. When asked about accessing the practice, 51% stated the experience of making an appointment was very or fairly good. The practice submitted their friends and family test responses from July 2023 to present time, out of 487 patient’s responses 431 stated their experience of the practice was either very good or good. CQC received 18 complaints from July 2023 to February 2024, 4 were regarding their care and treatment. CQC did not speak to patients on the days of the assessment.

Leaders attended a monthly quality and safety group, which reviewed and submitted the practice’s performance to the local Integrated Care System. The practices performance for the year ending in March 2024 demonstrated the practice had met 16 of the 20 targets in the previous year. The areas that required improvements were care plans for adult patients with asthma and the monitoring of diabetes. Leaders explained how patients’ immediate and ongoing needs were fully assessed and patients’ treatment was regularly reviewed and updated. This included their clinical needs and their mental and physical wellbeing. In addition, how patients presenting with symptoms which could indicate serious illness were followed up in a timely and appropriate way. Staff explained they had a call and recall policy for patients who required chronic disease management, cervical screening tests, childhood immunisations, or those who took certain medicines requiring regular blood tests. Leaders and staff explained that all abnormal blood tests were followed up and they had a protocol for workflow, emails, post and test results in place. Leaders explained patients were told when they needed to seek further help and what to do if their condition deteriorated.

As part of the assessment a number of set clinical record searches were undertaken by a CQC GP specialist advisor. A sample of the records of patients with long term health conditions were checked to ensure the required monitoring was taking place. We also reviewed a sample of patients records who may have an undiagnosed long-term condition. A search for patients diagnosed with asthma who had 2 or more courses of steroids in the last 12 months, to check if they had been followed up correctly, identified 442 patients with asthma and 15 who had received the 2 or more courses, we reviewed a sample of 5 patients and found all but one had been followed up. The search for patients with the possible diagnosis of kidney disease following a blood test result, identified all patients had been diagnosed. We sampled 5 patient records to check this and found no concerns. A search for patients with hypothyroidism, identified 1 out of 223 who may not have had the correct monitoring, we reviewed them and found medication continued to be prescribed although the patient had not responded to requests to attend the practice. We sampled 5 patients who had retinopathy with a blood result which may indicate a risk and found no issues with monitoring. Any issues found during the assessment were immediately followed up by the practice. The practice submitted evidence to demonstrate they reviewed the uptake of childhood immunisations and cervical screening and took steps to improve their uptake at the monthly quality and safety group. They provided unverified data from 1 April 2023 to 31 March 2024 to show had achieved over 80% uptake in three of the childhood immunisations, and one below at 77%, these were similar to the results in 2022/2023. (The world health targets are 90%). Cervical screening unverified data from March 2024 showed they had achieved a 69% uptake for cervical screening, this demonstrated an improvement from June 2023 which was 54%. (The national target is 80%)

The national GP patient survey carried out from January to March 2023 had 115 responses, 88% of patients had confidence and trust in the health care professional they saw or spoke to and 87% stated their needs were being met. The practice submitted their friends and family test responses from July 2023 to present time, out of 487 patient’s responses 431 stated their experience of the practice was either very good or good. CQC received 18 complaints from July 2023 to February 2024, there were no specific complaints regarding evidence-based care and treatment, but 4 referred to their own personal care and treatment. CQC did not speak to patients on the days of the assessment.

Leaders and staff told us the practice had systems and processes to keep clinicians up to date with current evidence-based practice. Staff had access to the National Institute for Health and Care Excellence guidelines, monthly clinical meetings and supervision where new care pathways were discussed. In addition, staff had protected time to attend training. Any face-to-face training was shared with other clinicians by a text group or at clinical meetings.

Staff discussed patient care at monthly clinical, safeguarding and integrated care team meetings. A review of a sample of patients’ clinical records demonstrated they had received evidence-based care. Staff had completed some clinical audits to ensure they were meeting clinical guidelines. The quality and safety group monitored the practices clinical performance monthly.

We could not collect the evidence to score this evidence category.

The leaders explained that when people received care from a range of different staff, teams or services, it was coordinated, and staff worked collaboratively to understand and meet the range and complexity of people's needs. Shared care agreements were made with secondary care providers regarding the prescribing and monitoring of patient medication. The leaders explained that they provided the care and treatment for an older people’s residential home, a GP would visit the home weekly to review peoples care and treatment. The practice held monthly quality and safety meetings where they reviewed their performance. In addition, the practice had care coordinators who helped patients who struggled booking appointments for different services and provided support and social prescribing. Also, when a patient was discharged from secondary care into primary care with complex needs the practice would try to visit as soon as possible to review and identify if other services were needed.

Leaders explained they met monthly with multi-agency staff to discuss and improve outcomes for people with complex needs. The practice supported a residential care home for older people, the manager confirmed that staff attended the home weekly, staff responded promptly to their requests, and they had good lines of communication with the practice. The local integrated care system stated they did not have any comments to make about the practice.

Staff at the GP extended hours service had access to patients’ full medical records, and information was shared regarding safeguarding with urgent and emergency services. The practice was informed about patients who had attended any emergency services promptly and any follow up was reviewed by the GP. The GP partners were responsible for the overview of specific clinical areas. We reviewed a sample of shared care agreements and found no concerns.

The national GP patient survey carried out from January to March 2023 had 115 responses. This found 87% of patients stated their needs had been met. When asked about accessing the practice, 51% stated the experience of making an appointment was very or fairly good. CQC received 18 complaints from July 2023 to February 2024, there were no specific complaints regarding supporting people to live a healthier life, but 4 referred to their care and treatment and 6 were regarding access to the practice. CQC did not speak to patients on the days of the assessment.

The practice had a full-time care coordinator who contacted patients with complex needs or who were vulnerable regularly, to ensure their needs were being met. They would refer patients to the social prescriber, welfare and social organisations and help them make secondary care appointments. The practice was also working at improving the cervical screening and childhood immunisation patient uptake and were training care coordinators in motivational interviewing to help them speak with patients about the positive effects of immunisation and screening. Staff had engaged with the community through other groups for example, digital exclusion work, young person’s engagement work, a World Café and working together.

The practice had a system in place to enable the coordinator to contact all patients who were vulnerable or had complex needs. The full-time care coordinator provided advice about local support groups and activities. Posters and leaflets were available to direct patient where to seek further advice. The practice had a list of patients who acted as carers for relatives and had staff who were carers champions.

We could not collect the evidence to score this evidence category.

Leaders described how they monitored the uptake of patient monitoring for long term health conditions monthly at the quality and safety group and compared their results with other practices in their primary care network. The leaders and staff told us that audits were discussed at clinical meetings; this was confirmed in the minutes of the meetings we reviewed. The leaders explained how they conducted multiple audits which were linked to areas where they felt quality could be improved such as patient group directives and areas where there were complaints. The leaders explained that cancer care reviews were carried out quarterly which reviewed all aspects of the patients care. They also worked with the local Integrated Care System prescribing board to identify areas they needed to target.

The provider submitted clinical and management audits, these covered medicines, health condition monitoring, and opioids, which they had carried out to improve outcomes for patients. The leaders held monthly quality and safety group meetings which monitored patients’ outcomes, where the findings were shared with the local integrated care system.

The provider submitted their performance data from 1 April 2023 to 31 March 2024 the practice had carried out patient annual health reviews. For example, 76% children’s asthma care plans, 65% of adult asthma care plans, 1640 out of 1933-foot examinations for diabetes, 101 out of 142 learning disability reviews, and 78% of antipsychotic monitoring.

We could not collect the evidence to score this evidence category.

Clinicians understood the requirements of legislation and guidance when considering consent and decision making. We saw that consent was documented. Clinicians supported patients to make decisions. Where appropriate, they assessed and recorded a patient’s mental capacity to make a decision.

The leaders submitted a copy of the consent policy and withdrawal of consent forms policy last reviewed in January 2024. We reviewed five patients Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions and found they were made in line with relevant legislation and were appropriate. Most staff had completed mental capacity act training.