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Archived: The Norwich Road Surgery Good

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Inspection Summary


Overall summary & rating

Good

Updated 8 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Norwich Road Surgery on 26 January 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows;

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, and addressed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Improvements were needed for auditing of infection prevention and control measures and for cold chain management of medicines.
  • 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 practice proactively sought feedback from staff and patients, which it acted on.

We saw one area of outstanding practice:

  • The practice had recognised the need to be supportive in providing care to ethnic minority patients with 11% of its population not having English as their first language. For example by proactively inviting non-English speakers to join the patient participation group and by requesting patients that they submit information to the practice about their (children’s) immunisations so that medical records could be updated and additional vaccinations could be provided if required.

The areas where the provider must make improvement are:

  • Infection control audits must be undertaken and any required improvements implemented.
  • Cold chain management of medicines must be implemented and monitored effectively.

The areas where the provider should make improvement are:

  • Implement a robust risk assessment system, including premises related risks.
  • Ensure staff are supported with timely appraisals.
  • Ensure all consumable equipment is in date and fit for use.
  • Ensure mandatory staff training is up to date for all members of staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 July 2016

Effective

Good

Updated 8 April 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and comparable to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 8 April 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice generally in line with others for several aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect.

Responsive

Good

Updated 8 April 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.
  • Patients said there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
  • The practice had recognised the need to be supportive in providing care to ethnic minority patients. For example by proactively inviting non-English speakers to join the patient participation group and by sending a letter to patients requesting they submit information to the practice about (children’s) immunisations so that medical records could be updated and additional vaccinations could be provided if required.
  • The practice provided GP cover to a local probation hostel, patients from this hostel often presented without summaries and medication and required introduction time into the care of the GPs as well as close monitoring of medication use and delivery.
  • The practice provided GP cover to a women’s refuge. Patients from this location often presented with social problems as well as mental and physical health concerns. The practice also assisted habitants with other matters such as housing matters and personal touches. Two clinical members of staff had attended the refugee women's group to give a presentation on contraception, for those not speaking English a translator was present to translate everything there and then.
  • The practice provided GP cover to a YMCA centre where the practice cared for 41 patients with varying and health-challenging situations.

Well-led

Good

Updated 8 April 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of being open and honest. The practice had systems in place for recognising notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active, undertook regular meetings which were attended by the practice manager and a GP and were involved in several developments related to the practice.
  • There was a strong focus on continuous learning and improvement at all levels.
  • The practice was a training practice with the lead GP being a trainer for trainee GPs and medical students. Two further clinicians were associated trainers.
Checks on specific services

People with long term conditions

Good

Updated 8 April 2016

The practice is rated as good for the care of people with long-term conditions.

  • Nursing and GP staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Patients with long term conditions such as diabetes, hypertension and heart disease were reviewed six monthly, which was more often than the National Institute for Health and Care Excellence(NICE) guidance recommends.
  • The practice worked with local asthma and diabetes specialist nurses for those patients with more complex needs.
  • Quality Outcome Framework performance for a variety of long term conditions was equal to or better than the CCG and national average.
  • Longer appointments and home visits were available when needed.
  • Long term condition clinics were held during which care plans could be modified in light of discussion with the patient.

Families, children and young people

Good

Updated 8 April 2016

The practice is rated as good for the care of families, children and young people.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, we saw evidence to confirm this.
  • The practice had a comprehensive cervical screening programme. The practice’s percentage of patients receiving the intervention according to 2014-2015 data was 77.8%, which was below the England average of 81.8%. Patients who didn’t attend their appointment were followed up with letters in their own language (for non-English speakers) and via the telephone.
  • A family planning clinic was held weekly, during which a GP could fit contraceptive coils and implants.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives.
  • Childhood immunisation rates for the vaccinations given to under twos ranged from 89.9% to 100% compared to the local average of 94.8% to 97.1% and for five year olds from 88.1% to 93.6% compared to the local average of 92.6% to 97.2%.

Older people

Good

Updated 8 April 2016

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.
  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs. The practice provided GP cover to a local mixed residential home where a nurse practitioner provided weekly ward rounds.

Working age people (including those recently retired and students)

Good

Updated 8 April 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • Extended hours appointments were available twice a week.
  • The practice was proactive in offering telephone appointments and online services as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 April 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • The practice had 97 registered patients with dementia, of which 87 were deemed to require annual reviews, of which 82 had received an actual review since April 2015.

  • The practice had 79 registered patients with mental health conditions, of which 46 were deemed to require annual reviews, of which 39 had received an actual review since April 2015.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Outstanding

Updated 8 April 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a translation need or learning disability.
  • The practice offered tailored information and advice about the NHS to patients that were refugees in their own language. The practice was proactive in ascertaining the immunisation status of refugees with young children by means of a specially written letter for when these patients registered
  • The practice carried out annual health checks for people with a learning disability and seven out of 38 of these patients had received a review since April 2015. The practice explained that it had recently added this list to their register and were in the process of inviting all remaining patients within a month of our inspection.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations and supported a local women’s refuge.
  • The practice provided GP services to a local YMCA, seeing people at short notice if required.
  • The practice provided GP cover to a local probation hostel, which involved liaison with prison staff and implementation of special arrangements around prescribing for patients residing there. Patients from this hostel often presented without summaries and medication and required introduction time into the care of the GPs as well as close monitoring of medication use and delivery.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.