Modality Partnership (AWC) Also known as Modality Partnership

We carried out an announced inspection at Modality Partnership (AWC) between the dates of 11 to 14 July 2022. Overall, the practice is rated as Outstanding.

Set out the ratings for each key question

Safe - good

Effective – good

Caring - good

Responsive – outstanding

Well-led – outstanding

This inspection was a comprehensive inspection of the service following the merger of eight previously registered, separate locations. The merger was completed in March 2022. This service had not previously been inspected.

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 shorter 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
• 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 of the registered location and seven branch sites.
• Feedback from 23 staff questionnaires.

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:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• There were consistently high levels of engagement with staff and people who used services.
• Patients received safe and effective care. We saw that the management of patients and their medicines was safe.
• The practice were continuing to respond to the GP National Patient Survey. Patient satisfaction with access and appointment times was below national averages.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice could demonstrate the prescribing competence of non-medical prescribers, and there was regular review of their prescribing practice supported by clinical supervision, peer review, meetings and training.
• The way the practice was led and managed promoted a high level of staff engagement and the delivery of high-quality, person-centre care.

We found areas of outstanding practice:

• An advanced nurse practitioner (ANP) identified a patient during a consultation who did not have access to a supply of food. When the ANP was unable to source a local foodbank, they engaged with the community and set one up in a church hall. As wider concerns were identified in the area, the ANP moved to identify local support services including financial help, support for loneliness, mental health and walking groups. The provider supported the ANP to work half a day per week on building the resource. A website and an ‘app’ for patients were developed, to which national information was also then added. The information gathered, links and resources were also printed on the back of COVID-19 vaccinations cards which were given to patients. At the time of our inspection, 1,000 new users per month were noted with links to over 500 organisations.
• Pop-up clinics for support with long-term conditions, mental health and vaccinations were regularly held in local community venues. Alongside the team, the community engagement lead worked with community organisations, faith leaders, voluntary services and patient groups to identify and forge links with local hard-to-reach communities.
• During carer’s week in June 2022, the practice held a large event for carers in a local shopping centre. Alongside the local carers’ organisation, carers were offered resources, therapy sessions, reiki and Indian head massage. The event was reported to be very well attended by over 70 carers with the venue being chosen following previous carer feedback that it would be accessible. Over 50 new referrals were made to the local carers resource as a result of the event.
• Regular weekly outreach clinics were offered to hard-to-reach patients in local community venues. Once per fortnight the service was offered at an Asian community association and the second week would be held at a centre which supported people from an Eastern European background. The team had access to interpreters and worked with other outreach teams to deliver joined up care. We were told that a number of undiagnosed medical conditions such as diabetes and high blood pressure had been identified during these clinics.
• Each Wednesday a GP supported a drug and alcohol project in an inner city area between 4pm and 7pm. This inclusion work was targeted at the homeless, those who may be experiencing mental health issues and people who may be leading chaotic lifestyles and not engaging with their GP.
• Team ‘huddles’ took place at 8am and 1pm each working day. These 10 minute online meetings enabled leaders to review the capacity across all sites for the day, identify areas or teams who may need additional support. This plan was reviewed, along with ongoing demands at the 1pm ‘huddle’. Concerns were also raised, discussed and highlighted at a divisional level at a later meeting during the morning. The focus of the meeting was the safety of staff and patients.

Whilst we found no breaches of regulations, the provider should:

• Review practice polices to ensure they reflect local arrangements, contain the names of lead clinicians and direct staff to the best course of action in the event of an emergency. For example, with regards to child and adult safeguarding and infection prevention and control.
• Maintain a record of staff vaccinations in line with best practice.
• Work to improve access to the service and increase patient satisfaction.

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