The Care Quality Commission
  • Doctor
  • GP practice

Norwich Practices Health Centre and Walk in Centre

Overall: Good read more about inspection ratings

Rouen House, Rouen Road, Norwich, Norfolk, NR1 1RB (01603) 677500

Provided and run by:
Norwich Practices Ltd

Important: This service was previously registered at a different address - see old profile

All Inspections

24 February 2022

During an inspection looking at part of the service

A summary of CQC findings on urgent and emergency care services

in Norfolk and Waveney.

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for Norfolk and Waveney below:

Norfolk and Waveney

Provision of urgent and emergency care in Norfolk and Waveney was supported by services, stakeholders, commissioners and the local authority. The health and care system in this area lies across a large, predominantly rural, geographical area with a large proportion of the population aged over 65 years.

Compliance with CQC regulations has historically been challenging across Norfolk and Waveney, particularly in Acute, Mental Health and Adult Social Care services, many of which have been rated Requires Improvement or Inadequate.

We spoke to staff in services across primary care, urgent care, acute, ambulance services, mental health and adult social care. Staff told us of increased pressure across urgent and emergency care pathways, staffing issues and a lack of capacity in key sectors including GP and Dental practices and social care. These issues were resulting in inappropriate calls to 999 and attendances in emergency departments.

There were delays in discharge for patients who were medically fit but unable to access appropriate packages of care to enable them to leave hospital.

We previously inspected mental health services in the Norfolk and Waveney area in November and December 2021 and found, due to an increase in referrals and staffing shortages, patients in the community had long waits to be seen. This led, in some cases, to patients deteriorating and requiring urgent and emergency treatment. In addition to this, some inpatient services (such as CAMHS) did not have available beds within the area. Patients were kept in urgent and emergency care settings whilst a bed was found.

During inspections of acute services, we found patients unable to access appropriate and timely care to meet their mental health needs.

We inspected a number of GP practices and found some concerns in relation to access for patients trying to see or speak to their GP. We found high levels of staff absence resulting in some staff working long hours and experiencing increased pressure on their services.

To try and alleviate the increasing demand on Emergency Departments, GP streaming services had been introduced in EDs in Norfolk and Waveney. Patients who presented at the ED with problems which were deemed suitable for a primary care appointment could be referred to a co-located primary care service. In some cases, streaming services helped to prevent up to 33% of patients attending the ED.

We inspected urgent care services in the Norfolk and Waveney area and found these to be well-run. However, an on-going shortage of out of hours and urgent care appointments, particularly for urgent dental care, meant patients couldn’t always be appropriately signposted by NHS111. This meant patients often presented to ED for treatment. NHS111 in Norfolk and Waveney had also experienced significant staff shortages, much of which has been due to the COVID-19 pandemic. Leaders in this service had a recovery plan in place; however, staff shortages and increased demand had resulted in significant delays in call answering and call-back times in comparison to the national targets and there was also a very high call abandonment rate, meaning people ended the call before speaking to an advisor. Whilst performance across Norfolk and Waveney did not meet national targets and people experienced significant delays, these delays were, on average, shorter than regional and national averages.

We inspected emergency departments (ED) in Norfolk and Waveney between December 2021 and February 2022 and found lengthy delays for people accessing emergency care. A high number of patients were waiting over 12 hours in ED resulting in overcrowding. This impacted on ambulance handovers and further delays in releasing ambulance crews into the community to respond to 999 calls.

Staff shortages have had a significant impact on social care services across Norfolk and Waveney. In addition, the provision of domiciliary care services is challenging due to the rurality of the area. At the time of our inspections, a care hotel was being utilised in Norfolk and Waveney. We spoke to healthcare professionals who had provided services to people being cared for at the hotel and found them to be safe and generally well cared for. The number of people receiving care in the hotel was small and the aim was for them to only stay for a very short amount of time before going home. This service is commissioned until the 30 April 2022, a formal evaluation will take place before any future plans are agreed.

Some social care and learning disability services in Norfolk and Waveney have struggled to achieve compliance with CQC regulations and a rating of good. Some support has been established across Norfolk and Waveney to help services improve. However, the impact of any support to date has been limited.

Staff shortages and service quality has significantly reduced capacity across social care and learning disability services in Norfolk and Waveney. This has resulted in significant delays in transferring people from hospital to their own home or an appropriate place of care. This in turn meant people who were medically fit for discharge remained in hospital delaying the admission of new patients. These delays and poor flow resulted in overcrowded EDs and an inability to transfer patients from ambulances.

Strategic, system wide workforce planning and increased community provision of health and social care is needed to meet the needs of the local population. This is needed to reduce the pressure on urgent and emergency care services and to reduce the risk of harm to people living in Norfolk and Waveney.

We carried out an announced focused inspection at Norwich Practices Walk-in Centre on 24 February 2022. This focused inspection was carried out using our Pressure Resilience methodology which meant that we did not use all the key lines of enquiry and the report has not been rated.

At this inspection we found:

  • The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
  • The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated people with compassion, kindness, dignity and respect.
  • Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

9 October 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Norwich Practices Health Centre and Walk in Centre on 4 August 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Norwich Practices Health Centre and Walk in Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection undertaken on 9 October 2017. Overall the practice is now rated as good.

Our key findings were as follows:

  • The practice demonstrated improved systems to assess, monitor, and improve the quality and safety of the services provided in the carrying on of regulated activities (including the quality experience of service users in receiving those services).
  • The practice had improved the systems and process to ensure that staff were safely employed. Staff training was prioritised and accurate records kept.
  • There were new systems and processes in place to ensure that the coding of medical records and the recall of patients ensured patients received appropriate follow ups; for example, those for long term conditions. The practice had produced a guide for any locum GPs who may work at the practice.
  • Patients with learning disabilities had received health reviews in a timely manner.
  • The practice had reviewed the national patient survey data published in July 2017, and this showed significant improvements from the data of July 2016.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice were able to evidence significant events were recorded and discussed at practice meetings.
  • Risks to patients were assessed and well managed. Comprehensive risk registers were held and clinical and non-clinical audits were carried out.
  • Information about services and how to complain was available to patients and the practice recorded verbal and written complaints.
  • Patients said they found it relatively easy to make an appointment with a named GP.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice offered a walk in phlebotomy service and had on site sessions provided by the community mental health nurses.
  • Practice staff felt supported by management and the GPs. The practice proactively sought feedback from staff and used the patient participation group survey for feedback from patients.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • Patients said they were treated with compassion, dignity, and respect and they were involved in their care and decisions about their treatment.
  • The practice had implemented systems to pro-actively identify patients who were carers to ensure they received appropriate support.

We saw areas of outstanding service

  • The practice looked after patients in two local care homes. One nurse practitioner with a prescribing qualification and a health care assistant (HCA), both directly employed by the practice provided on site healthcare at one of these homes where 120 patients; this service was provided five days a week. These staff members were based at the care home and available throughout the day to undertake both acute and proactive health care. The nurse and HCA had undertaken the wound care of patients which would have normally been dealt with by the community nurses. Due to the more frequent and timely service, the patients wounds had healed more quickly and they had been discharged from the caseload. Data shared with us from the CCG showed a significant reduction in the community nursing team visits. The CCG also shared data with us that showed the percentage of patients with no unplanned admission or attendance at A+E for the care home was 66% compared to 51% for other care homes in Norwich. The HCA attended the weekly Forget-me-Not session at the home, this session is dedicated to those patients living with dementia in the home. We saw copies of two leaflets written and designed by the nurse practitioner which gave patients, family, friends, and carers detailed, easy to understand information on comfort care for people approaching the end of life and for people with advance dementia approaching the end of life. A comprehensive log was kept of all the patients in the care homes to support care. This log detailed the diagnosis, review dates including date the patient was last seen by a GP, anticipated needs of the patients preferred place of care and the fragility status of the patient. This system was supported by the CCG who intended to use this model of care more widely.
  • The practice had managed the local Special Allocation Scheme (SAS) patient group since October 2011. This scheme was for patients who were not able to be registered with a GP practice. Patients registered on this scheme had access to a nurse practitioner for advice Monday to Friday from 8.30am until 6.30pm and had pre booked appointments with a GP twice a week. Statistics shared with us from the chair of the SAS showed that the total number of patients on the scheme to date was 76. Of these, 11 had moved to another region and five had transferred to the provider for health services for people who are homeless. Of the remaining 60 patients, 40 (67%) had been registered at a surgery of their choice and none of these had returned to the SAS. The practice told us these positive results were achieved through continuity of care, dedicated team work, and ensuring care plans were agreed with the patient and adhered to. In some cases, the practice undertook joint working with the patient’s new practice to ensure safe handover of care. We saw evidence of detailed discussions by the practice team in relation to these patients who were at significant risk and potentially could be marginalised. These included discussions in relation to those that were experiencing poor mental health, those who had recently left prison, and those were at risk of self-harming.

The areas where the provider should make improvement are:

  • Continue to explore ways to encourage patients to attend appointments and engage with national screening programmes for cervical breast and bowel cancer.
  • Continue to monitor the GP patient survey and feedback and respond to the results as appropriate.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

4 August 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Norwich Practices Health Centre and Walk In Centre on 4 August 2016. Overall the practice is rated as requires improvement. Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Some staff were overdue training required by the provider, needed to provide them with the skills, knowledge, and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect.
  • Information about services and how to complain was available and easy to understand.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Ensure that patients with learning disabilities receive timely annual health reviews.
  • Ensure that staff files are kept up to date, specifically for locum staff.
  • Ensure that information about the service provided is monitored (for example, results from the National GP Survey) and used to drive improvements.
  • Ensure there is an effective system in place to ensure staff training is kept up to date.
  • Ensure that exception reporting outcomes within indicators of the Quality Outcomes Framework are improved. The practice had achieved higher averages than local and national exception reporting during 2013/14 (20%) and 2014/15 (22 %). A new strategy including arrangements for GPs to improve read coding and the appointment of a lead QOF nurse had been implemented and were proving successful according to QOF data for 2015/16, but the exception reporting had continued to remain above average at 23%.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice