Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Norbury Health Centre 2 on 18 July 2016. The overall rating for the practice was Good, however the practice was rated as Requires Improvement for the key question: are services Well Led? The full comprehensive report on the Month Year inspection can be found by selecting the ‘all reports’ link for Norbury Health Centre 2 on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 11 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 18 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing well led services.

At our previous inspection on 18 July 2016, we rated the practice as requires improvement for providing well led services as the provider had not acted upon the below averages results from the National Patient Survey (published in January 2016) with regard to access to care and treatment; and had not ensured all patients with a learning disability had received an annual review.

We also highlighted other areas where the provider should take action:

• Take appropriate steps to identify patients who are also carers to allow the practice to provide support and suitable signposting.
• Record when fire evacuation drills are carried out and amalgamate the four separate fire safety policies into one, up to date, cohesive document.
• Carry out a pre-acceptance audit with regard to clinical waste management.
• Review the repeat prescription policy and ensure it is being followed.
• Regularly review and update when necessary the business continuity plan.
• Complete the audit cycle for by re-auditing each of the audits carried out.
• Review their handling of complaints to ensure that all complaints are recorded and that information on the complaints process is made available to patients.

Our key findings at this inspection were as follows:

We found that the provider had taken a number of measures to improve, and had also taken action on the areas we had identified for improvement.

Results from the National Patient Survey published in July 2016 indicated that the practice performance had improved in relation to access to care and treatment, although results were still below national average. We saw that results were discussed at clinical meetings and patients were being encouraged to cancel appointments they did not need so as to free them up for others. Reception staff had received training in signposting patients to alternative, appropriate services. We were told that the practice was trying to address complaints about access by changing the telephone system, and they provided us with details of two new systems they were considering.

Thirty (out of 49) patients (61%) with a learning disability had received an annual review up to the end of February 2017. This compared to 20% at the time of the last inspection. The provider sent us a copy of a clinical meeting where we could see that the needs of these patients had been discussed.

We also found that the provider had taken the following action with regard to the good practice areas:

• The practice had taken steps to help identify patients who were also carers, including displaying a poster asking such patients to contact reception and also a poster relating to a local carers group. They had also obtained leaflets relating to a carers drop in centre.

• The provider had taken measures to improve fire safety. We saw a copy of the fire log book which indicated the fire alarms were being tested weekly, and regular fire drills were now being carried out. There was also an updated fire safety policy.

• Practice staff had carried out an in-house pre-acceptance audit with regard to clinical waste management.

• The practice had reviewed its repeat prescribing policy and was also recording on a database uncollected or lost prescriptions.

• The business continuity plan had been reviewed and updated and a copy was sent to us, along with a business continuity risk assessment.

• The Practice sent us a copy of a completed, two-cycle, antibiotic prescribing audit. This indicated that there had been a 69% (44 compared to 14 patients) reduction in the number of patients who have been prescribed cephalosporins, quinolones and co-amoxiclav in May 2016 compared to March 2015. The practice also sent in two completed audits relating to two week referrals and obesity. Whilst these had been completed with a second cycle, the audits did not demonstrate how the outcomes had led to an improvement in the quality of patient care.

• The practice had improved the complaints procedure information available to patients. A new poster had been displayed in the waiting area; the process was signposted on the practice website and we saw evidence that the practice was risk rating each complaint and also recording the outcome.

  However, there remained areas of practice where the provider should continue to make improvements.

  In addition the provider should:

• Continue to review the results from the national GP patient survey and implement measures to improve patient satisfaction with access to care and treatment, particularly with regard to telephone access.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Norbury Health Centre on 18 July 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Most risks to patients were assessed and well managed, with the exception of fire safety. The practice had carried out just one fire drill since 2014.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Processes were in place for handling repeat prescriptions but we noted staff were not following the repeat prescribing policy in relation to prescriptions that were not collected.Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Data from the Quality and Outcomes Framework (QOF) showed most patient outcomes were in line with the national average.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However, data from the national patient survey showed patient outcomes in a number of areas were below the national average.
• The number of annual reviews carried out for patients on the learning disability register was low.

• I

  Written information about services was available but not everybody would be able to understand or access it. For example, there was limited written information in other languages despite there being a large number of patients for whom English was not their first language. However the electronic check in system and the practice website provided access to information in other languages.

• Information about how to complain was available; however, not all patients were aware they could make a complaint if they felt it was necessary. Not all verbal complaints were logged. Improvements were made to the quality of care as a result of complaints and concerns.
• Patient satisfaction with access to care and treatment was below the national average.
• 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Review the results from the 2016 national GP patient survey and implement measures to improve patient satisfaction with access to care and treatment, particularly with regard to telephone access.

• Review processes to significantly improve the proportion of patients with a learning disability for whom an annual review is carried out.

In addition the provider should:

• Take appropriate steps to identify patients who are also carers to allow the practice to provide support and suitable signposting.

• Carry out regular

  Record when fire evacuation drills are carried out and amalgamate the four separate fire safety policies into one, up to date, cohesive document.

• Carry out a pre-acceptance audit with regard to clinical waste management.ovide

  practice information in appropriate languages and formats.

• Review the repeat prescription policy and ensure it is being followed.
• Regularly review and update when necessary the business continuity plan.
• Complete the audit cycle for by re-auditing each of the audits carried out.
• Review their handling of complaints to ensure that all complaints are recorded and that information on the complaints process is made available to patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice