Archived: The Norwich Road Surgery

Updated 12 July 2016

The Norwich Road Surgery is situated in Ipswich, Suffolk. The practice provides services for approximately 9800 patients. The practice holds a Personal Medical Services (PMS) contract.

According to Public Health England information, the patient population has a higher number of patients aged 25 to 29 compared to the practice average across England. It has slightly lower proportions of patients aged five to 20 and 35 to 54 compared to the average across England.

The number of male patients over 65 years of age is above average. Other age groups are in line with the practice average across England. Income deprivation affecting children and older people is slightly below the practice average across England, as is the overall deprivation across the practice population.

The practice has three GP partners, one male and two female and one female salaried GP, who was due to leave the day after our inspection. There are four nurse practitioners, five practice nurses, and two health care assistants. The practice also employs a practice manager and office teams with individual leads.The practice is a training practice and had one GP trainee at the time of our inspection.

The practice’s opening times at the time of the inspection were 8am to 6.30pm Monday to Friday. Extended hours were available on Monday evenings from 6.30pm until 8pm and Wednesday mornings from 7am until 8am. During out-of-hours, appointments were available with GP+ (an Ipswich GP based out-of-hours provider) between 18:30 and 21:00 on weekdays and between 9am and 9pm during weekends. During the remaining out-of-hours times CareUK provided GP services.

Updated 12 July 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

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.

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%.

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.

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.

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.

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.