Norton Medical Centre

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that the service met people’s needs, and that staff treated people equally and without discrimination.

At our last assessment, we rated this key question as inadequate. At this assessment, the rating has changed as is now Requires Improvement. The practice had implemented a new system of triage; this was not in place at our last inspection.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Care plans reflected physical, mental, emotional, and social needs of patients including those related to protected characteristics under the Equality Act. Our review of clinical records showed patients were supported to understand their condition and were involved in planning for their care needs. They were also involved in decisions about their care.

Documentation was clear, and we saw evidence of a digital flag system being used where required. Patients were satisfied with the care they received when attending an appointment. Results from the National GP Patient Survey told us 87% of patients who responded felt their needs were met during their last GP appointment.

The service understood the diverse health and care needs of people and their local communities, so care was usually joined-up, flexible and supported choice.

Since our last assessment some work had been undertaken to consider if patients were attending a local walk-in centre rather than the practice due to the distance, this was ongoing and had not concluded. This was in response to high secondary care attendance figures. The practice were aware of the high attendance rates and had plans to address it. We will review this at our next assessment.

We saw the practice worked in partnership with other services to meet the needs of its patient population such as a frailty nurse and a social prescriber. We received feedback from local care homes who told us communication with the practice had improved notably since our last assessment.

The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Information to promote the uptake of screening and immunisation programmes was available in a range of languages.

The practice had access to interpreter services, including British Sign Language. Information provided by the service met the Accessible Information Standard.

Patients were informed as to how to access their care records and make complaints or provide compliments. The practice utilised social media to maintain communication with patients.

We spoke with the Patient Participation Group (PPG) who told us since our last assessment they did not feel valued by practice management. They told us they did not feel that suggestions were valued. At the time of our assessment a meeting was scheduled. Members of the PPG told us that 3 days prior to this meeting they had not received an agenda or confirmation that the meeting was going ahead we are unsure if this meeting went ahead, we did review minutes from previous PPG meetings.

The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result.

The auditing and recording of complaints had improved since our last assessment, but the embedding of changes derived from complaints needed further improvement. This was evident in recurring themes of matters people were raising as complaints.

We reviewed some minutes from team meetings, however further minutes requested were not provided, and therefore we cannot be assured that learning from complaints was being shared with staff other than those who were directly involved. We cannot be assured that circulating minutes on TeamNet ensures staff have read, understood and would implement any changes.

We reviewed examples of telephone audits being carried out by leaders; however, these had not been followed up when errors had been made. We discussed this with the leadership team, who told us that ensuring staff were on board with changes had been difficult. Management told us that this was something they would aim to improve and we will review this at our next assessment.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it. At our last assessment, we found the practice did not have a safe or effective system of triage in place.

In response to our last assessment, the National GP Patient Survey data and feedback from members of the community the provider had identified changes to improve access to the service. Whilst some improvements had been made, patients told us they still found it difficult to gain access to the practice. The practice had a system which enabled patients to complete an e-consult, or telephone to book an appointment, staff members would complete the e-consult on the patients behalf. Since our last assessment the practice have also implemented a software which assists care navigation ensuring patients who need to be seen are prioritised.

The National GP Patient Survey data showed that 19% of patients who responded found it easy to access the practice via telephone, compared to a national average of 53%. We reviewed significant events relating to e-consult or triage. We saw that the practice had made improvements in being able to recognise where triage had been unsuccessful, however, further work was needed on embedding changes when things went wrong.

We also reviewed an audit of triage’s carried out by reception staff and raised concerns with leadership at the time of our site visit. These related to staff not triaging effectively or accessing a GP at the time of the patient call. We looked at 5 examples. Management told us they would re-run this audit to ensure it was being carried out effectively with measurable outcomes. Prior to our inspection the audit had been carried out by team leads.

The practice had continued to develop the triage GP role, as well as recruiting another salaried GP. Treatment rooms were available on the ground floor, and a ramp and automatic door had been fitted to the entrance.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. Carers, veterans and other vulnerable groups were clinically coded. The practice utilised acurix messaging to target specific patient groups where required.

Feedback provided by people using the service, both to the provider as well as to CQC, was positive. Staff treated people equally and without discrimination. Care homes aligned to the surgery told us patients were well cared for by the practice and raised no concerns.

We also reviewed learning disability registers within the practice. The lead for this cohort of patients was able to demonstrate an awareness of patients who required accessibility arrangements. The practice were up to date with reviews for these patients.

Staff proactively sought ways to address any barriers to improving people’s experience and worked with local organisations, including within the voluntary sector, to address any local health inequalities. Staff understood the importance of providing an inclusive approach to care and made adjustments to support equity in people’s experience and outcomes. The provider had processes to ensure people could register at the practice, including those in vulnerable circumstances such as homeless people. Staff used appropriate systems to capture and review feedback from people using the service, including those who did not speak English or have access to the internet. Leaders also told us since our last assessment they had run a session where members of the PPG taught patients how to use the NHS App.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. The practice had made improvements in relation to end of life care and had sourced support from stakeholders to enable to most effective care for end-of-life patients. We reviewed a policy which the practice had revisited to ensure patients had choice of appointments and a named clinician. We also noted more regular palliative care meetings, with a range of external professionals.

Our records review showed people were supported to consider their wishes for their end-of-life care, including cardiopulmonary resuscitation. This information was shared with other services when necessary.