Nightingale Medical Centre

Updated 23 November 2021

Nightingale Medical Centre is located in Peterborough at:

Damson Drive

Dogsthorpe

Peterborough

PE1 4FS

The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury and surgical procedures.

The practice is situated within the Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) and delivers General Medical Services (GMS) to a patient population of about 6,200. This is part of a contract held with NHS England.

The practice is part of a wider network of GP practices which includes Ailsworth Medical Centre and Westwood Clinic.

Information published by Public Health England shows that deprivation within the practice population group is in the second lowest decile (two of 10). The lower the decile, the more deprived the practice population is relative to others.

According to the latest available data, the ethnic make-up of the practice area is 57% Asian, 21% White, 15% Black, 4% Mixed, and 3% Other.

The age distribution of the practice population closely mirrors the local and national averages. There are more male patients registered at the practice compared to females.

There is a team of a GP and a locum GP who provide services on a regular basis. The practice has a team of an advanced care practitioner (nurse practitioner with a prescribing qualification), two nurses and a physician associate . The GPs are supported at the practice by a team of reception/administration staff. The practice manager is based at this location and provides managerial oversight for this practice and Ailsworth Medical Centre.

Due to the enhanced infection prevention and control measures put in place since the pandemic and in line with the national guidance, most GP appointments were telephone consultations. If the GP needs to see a patient face-to-face then the patient is offered an appointment.

The practice opens between the hours of 8am and 6.30pm, Monday to Friday. Outside of practice opening hours patients are able to access pre-bookable evening and weekend appointments through a network of local practices. In addition to this, a service is provided by Herts Urgent Care, by patients dialling the NHS 111 service.

Updated 23 November 2021

We carried out an announced inspection at Nightingale Medical Centre on 14 October 2021 . Overall, the practice is rated as requires improvement.

Safe - Good

Effective - Good

Caring - Requires improvement

Responsive – Requires improvement

Well-led - Good

When this service registered with us on January 2020, it inherited the regulatory history and ratings of its predecessor, Welland Medical Practice. The predecessor was the same provider, operating from different premises but providing the same services to the same practice population.

The practice under the previous registration was inspected in April 2016 and rated as good overall and for providing effective, caring, responsive and well-led services and rated as requires improvement for providing safe services. We undertook a desk top review of the safe domain in September 2016 and rated the practice as good for providing safe services.

A comprehensive inspection under the previous registration took place on 29 November 2018. The practice was rated as inadequate for providing safe, effective, responsive and well-led services, and rated as requires improvement for caring services.

A comprehensive inspection under the previous registration was undertaken on 25 June 2019 and the practice was rated as requires improvement. The practice was rated requires improvement for providing safe, caring and well led services. They were rated as good for providing caring services and inadequate for providing responsive services.

A comprehensive inspection under the previous registration was then undertaken on 13 August 2019. The practice was rated as requires improvement for providing safe, caring and well-led services. We rated the service as inadequate for providing responsive services and good for providing effective services.

We previously carried out a comprehensive inspection of Nightingale Medical Centre on 26 March 2020 and the practice was rated requires improvement overall and for providing caring and responsive services. The practice was rated as good for providing safe, effective and well-led services.

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

Why we carried out this inspection

We carried out an announced, comprehensive inspection at the practice to review in detail the actions taken by the provider to improve the quality of care. This inspection included:

• The key questions of safe, effective, caring, responsive and well-led.
• The follow up on breaches of regulation and areas where the provider ‘should’ improve identified at our previous inspection.

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 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:

• Requesting evidence from the provider and reviewing this.
• 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.
• Conducting staff interviews using video conferencing.
• Gaining feedback from staff by using staff questionnaires.
• Requesting and reviewing feedback from the Patient Participation Group.
• A short 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 have rated this practice as requires improvement overall and for caring and responsive services. We have rated the good for safe, effective and well-led services.

We found that:

• The practice provided care in a way that kept patient’s safe and protected them from avoidable harm. The practice had made and sustained the improvements required to address the concerns identified in our last inspection relating to clinical oversight.
• Patients received effective care and treatment that met their needs.
• The practice had employed a wider skill mix and additional clinical and non-clinical staff. Additional staff training including communication skills and customer service.
• Although the GP data survey results was still low, the practice in house survey showed positive improvements.
• The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way. However, data from the GP patient survey showed the practice performance in relation to access had declined.
• We found the practice system and process to ensure all medicines were linked to a diagnosis or particular problem was not always wholly effective.
• We found the practice system and process did not always ensure information for all patients with potential chronic kidney disease was recorded.
• The practice told us they were reviewing the quality of their care plans to ensure they were comprehensive and shared with the patients.
• The practice had agreed plans to address any backlogs such as the reviews for patients with long term conditions.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• Data from the GP patient survey (July 2021) had continued to decrease since our last inspection for both caring and responsive services. Although the practice had an action plan and had made improvements, these improvements had not had sufficient impact to reflect a more positive patient experience.

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

• Implement and monitor the action plan to address the backlog of long-term condition reviews.
• Monitor the system to ensure all patient records are fully summarised, correctly coded, and that medicines are linked to diagnosis or problems within the clinical record.
• Monitor and embed the systems and processes newly implemented to ensure all patients taking high-risk medicines are monitored appropriately.
• Continue to improve the system to ensure patient care plans are documented and in a format that is useful to patients and other health professionals.
• Continue to monitor and encourage patients/guardians to attend their appointments for the baby Measles Mumps and Rubella immunisation and cervical screening.
• Continue to monitor and improve patient experience in relation to caring services and access to the GP practice.

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