The Care Quality Commission
  • Doctor
  • GP practice

The Humbleyard Practice

Overall: Requires improvement read more about inspection ratings

Cringleford Surgery, Cantley Lane, Norwich, Norfolk, NR4 6TA (01603) 507604

Provided and run by:
Humbleyard Practice

All Inspections

26 July 2023

During a routine inspection

We carried out an announced comprehensive at The Humbleyard Practice on 26 July 2023. Overall, the practice is rated as requires improvement.

Safe - Requires improvement.

Effective - Good

Caring - Good

Responsive - Requires improvement.

Well-led - Requires improvement.

Following our previous inspection published on 27 January 2017, the practice was rated good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Humbleyard Practice on our website at www.cqc.org.uk

Why we carried out this inspection.

We carried out this inspection to follow up concerns reported to us.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included.

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.
  • Staff questionnaires

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We found that:

  • There had been significant growth of new housing within the practice area in recent years. Since 2010 the practice list size had grown from 14167 patients to the current list size of 21970. Data provided by the practice showed an increase in the number of patients each month since January 2010. This had caused significant workload challenges for the practice to meet the clinical and non-clinical needs of patients. The practice continued to try and meet this challenge as there was a lack of other primary care provision in the area.
  • The practice had systems and processes in place to ensure medicines were prescribed safely.
  • The practice had recognised the need to review and change the strategy and structure of the practice and had developed a plan to achieve this. This plan had resulted from the leaders recognising that staff morale was low, staff retention and recruiting was a challenge and there was a high workload for all staff.
  • The practice did not evidence clear monitoring of action plans such as infection prevention and control to ensure all actions were completed.
  • We found the practice did not have an action plan in place to ensure they had clear oversight and were not actively monitoring all risks, such as backlogs of work.
  • The practice had failed to demonstrate good governance procedures were in place to mitigate all risks as some systems and processes had failed to ensure risks were fully reviewed, documented, and monitored to drive safe and effective services and ensure all actions from risk assessments were completed.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.

We found a breach of regulation. The provider must:

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

In addition, the provider should:

  • Continue, monitor and encourage patients to attend appointments for the cervical cancer screening programme.
  • Continue to monitor patient feedback particularly in respect of telephone access to the practice.
  • Continue to monitor feedback from staff to improve communication and consistency across all sites.
  • Continue to encourage patients who are carers to be added to the practice register in order to obtain any support that is available to them.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

20 December 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Humbleyard Practice on 20 December 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, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Feedback from patients about their care was positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice in line with, or above, others for most aspects of care.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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 well supported by management.
  • The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider should make an improvement is:

  • Ensure near miss errors identified by staff before medicines were dispensed to patients are recorded and monitored.
  • Ensure that carers are proactively identified.
  • Ensure that verbal complaints are recorded consistently.

We saw one element of outstanding practice:

  • The practice proactively monitored children who did not attend their appointment and followed them up for potential safeguarding reasons. We viewed documented actions and responses for these situations and found this provided a safe approach to reviewing safeguarding needs for children. In October 2015 the practice had audited a week of consultations to confirm adherence to their policy of recording who accompanies a child to a consultation, and to check that staff were recording consent for vaccinations or intimate examinations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During a check to make sure that the improvements required had been made

Evidence that we received from the provider has demonstrated that improvements have been taken to improve the quality of the cleaning across each of the three surgeries. Further assurance has been provided that infection prevention and control systems have improved through the purchase of waste bins for clinical areas, the completion of staff training and a check that staff were protected against acquiring blood borne viruses.

Staff had received an annual appraisal and mandatory training and were supported to complete further professional development when appropriate to do so.

13, 20 January 2014

During a routine inspection

When patients of all ages attended the practice for treatment, appropriate levels of consent were sought by clinical staff before the treatment or procedure was completed.

We observed staff talking with patients, looked at records and spoke with patients and staff during our visits to the three practice locations. We found that patients valued the service they received and had confidence in the care and support they received from the staff. One patient told us, "The service is as good, whatever doctor I see."

There were systems in place to reduce the risk and spread of infection although further improvements were needed to ensure these were effective.

Staff had access to training, received some professional development and were supported by their managers. However, staff did not always receive relevant mandatory training or an annual appraisal.

The service had comprehensive systems in place for monitoring the quality of the service they provide. Systems included; audits of health and safety, fire safety, portable appliance testing, auditing of disease registers, records and clinical governance. The views of patients were sought and their feedback was acted upon.