Norvic Family Practice Also known as Victoria Health Centre

This practice is rated as Requires improvement overall. (Previous inspection January 2018 -Inadequate overall)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? - Requires improvement

We carried out an announced comprehensive inspection at Norvic Family Practice on 16 January 2018. The overall rating for the service was Inadequate. Breaches of legal requirements were found and after the inspection we issued warning notices for Regulation 12: Safe care and treatment and Regulation 17: Good governance, HSCA (RA) Regulations 2014. The service was also placed into special measures.

We undertook a further inspection on 6 June 2018 to confirm that the service had carried out their plan to meet the legal requirements in relation to the warning notices issued. During the inspection we found the service had met the requirements of the warning notice. However, ongoing improvements were still required. We issued a requirement notice for Regulation 17: Good governance HSCA (RA) Regulations 2014.

The previous inspection reports for the service can be found by selecting the ‘all reports’ link for Norvic Family Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 5 September to 2018. The purpose of the inspection was to confirm if the service had made sufficient improvements and be removed from special measures. We did not visit the branch practice site as part of this inspection, which is known as Norman Road Surgery and located at 110 Norman Road, Smethwick, West Midlands B67 5PU. However, we followed up actions and reviewed evidence in relation to it.

At this inspection we found:

• There were some systems and processes in place to keep people safe such as the appropriate and safe use of medicines and safeguarding procedures. However, not all risks had been assessed and managed effectively.
• The practice reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence based guidelines. However, improvements were required in areas such as the uptake of cervical and bowel cancer screening, asthma reviews and the high exception reporting rates for diabetes.
• Staff treated patients with compassion, kindness, dignity and respect.
• Patients did not find the appointment system easy to use and reported that they were not always able to access care when they needed it.
• The complaints system was not robust to ensure complaints were responded to effectively and in a timely manner.
• There was a lack of leadership oversight to ensure good governance. Systems and processes were not always embedded to ensure risks were assessed and managed and improvements sustained.

The areas where the provider must make improvements as they are in breach of regulations.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are

• Review the exception reporting rates for diabetes to see if improvements can be made to ensure patients are exception reported only when appropriate.
• Consider how to further increase uptake for cervical screening to ensure the minimum coverage target for the national screening programme is met.
• Improve the review rates of patients with asthma.
• Promote the uptake for bowel cancer screening to ensure results are in line with the national average.
• Explore ways to improve staff engagement with patients to ensure patients experience are positive.
• Review the findings of the national GP survey and consider ways to improve patient satisfaction in relation to access to appointments and getting through to the practice by phone.

This service was placed in special measures in March 2018. During this inspection we identified that insufficient improvements had been made such that there remains a rating of inadequate for safe and requires improvement for effective, responsive and well led. We have met with the providers to discuss the on-going non-compliance with the regulations.

I am extending the period of special measure for a further six months. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service.

We carried out an announced comprehensive inspection at Norvic Family Practice on 16 January 2018. The overall rating for the practice was Inadequate. Breaches of legal requirements were found and after the comprehensive inspection we issued the following warning notices:

• A warning notice informing the practice that they were failing to comply with relevant requirements of the Health and Social Care Act 2008. As a result, the practice were required to become compliant with specific areas of Regulation 12: Safe care and treatment HSCA (RA) Regulations 2014, by 17 May 2018.

• A warning notice informing the practice that they were failing to comply with relevant requirements of the Health and Social Care Act 2008. As a result, the practice were required to become compliant with specific areas of Regulation 17: Good governance HSCA (RA) Regulations 2014, by 17 May 2018.

The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Norvic Family Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 June 2018, at the main site Norvic Family Practice, 5 Suffrage Street, Smethwick, West Midlands, B66 3PZ . This was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the warning notices issued. This report only covers our findings in relation to those requirements. We did not visit the branch practice site as part of this inspection, which is located at Norman Road Surgery, 110 Norman Road, Smethwick, West Midlands B67 5PU. However, we followed up actions and reviewed evidence which related to the branch practice and referred to this in the warning notice.

Our key findings were as follows:

• There were a number of policies and procedures to govern activity however, some lacked detail and were not followed consistently. Disclosure and barring check (DBS) were not carried out in line with the practice policy for checks. The recruitment policy lacked detail on the pre- employment checks required.

• The practice had made positive changes to ensure reliable systems were in place for the appropriate and safe use of medicines. This included the monitoring of patients in receipt of high risk medicines.

• There were risk assessments in relation to safety issues. This included fire safety and infection prevention and control.

• The system for recording and learning from significant events was not clear or consistent to support learning and improvements.

• The practice acted on and learned from national safety alerts such as alerts from the Medicines and Healthcare products Regulatory Agency (MHRA). Staff were able to demonstrate that they had taken necessary action in response to specific safety alerts.

• The practice had made some improvement to the governance processes. However, there was a lack of oversight in some areas such as recruitment files and significant events.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate overall. (The practice was previously inspected in November 2016 and rated as requires improvement)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

We carried out an announced comprehensive inspection at Norvic Family Practice also known as Victoria Health Centre 16 November 2016. There is a branch surgery (Norman Road Family Surgery) which we also visited. The overall rating for the practice was requires improvement. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Norvic Family Practice on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Norvic Family Practice on 16 January 2018 and this report covers our findings. We also visited the branch surgery (Norman Road Family Surgery). Overall the practice is rated as inadequate.

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. However, reviews and investigations were not thorough enough to review risks effectively.
• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, there were no risk assessments in the absence of Disclosure and Barring Service (DBS) check for reception staff carrying out the role of a chaperone.
• Infection control audits were not current and a concern identified from a previous audit had not been actioned.
• Risk assessments such as fire, health and safety, COSHH and legionella had not been carried out at the branch site. Staff we spoke with told us that they were concerned about fire safety at the branch site. The practice did not have access to risk assessments carried out by the landlord (NHS Property Services) at the main site.
• The practice did not routinely review the effectiveness and appropriateness of the care it provided. Care and treatment was not always delivered according to evidence- based guidelines. The practice did not have an effective system to monitor patients on high risk medicines.
• The practice did not operate an effective recall system for medicine reviews and there was no systematic process for reviewing long term conditions.
• There was insufficient attention to safeguarding children. Staff did not recognise or respond appropriately to possible concerns.
• There was no evidence to demonstrate the use of patient feedback to improve the service.
• The practice had a number of policies and procedures to govern activity but not all were embedded.
• Patients we spoke with during our inspection were positive about their interactions with staff and said they were treated with compassion and dignity.
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements. Staff did not feel empowered to feedback concerns or improvement areas. Staff were overdue appraisals.
• There was little innovation or service development and improvement was not a priority among staff and leaders.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

• Ensure patients are protected from abuse and improper treatment.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvement are:

• Ensure effective processes are in place so all patients are able to access care and treatment. This included assistance for patients using a wheelchair are and those who had difficulty with their hearing.
• Ensure carers are supported to take up offers for health checks.
• Ensure cleaning schedules are available for relevant staff at the main site.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice