We previously carried out an announced comprehensive inspection at Norton Canes Practice on 13 November 2017. The overall rating for the practice was good. The practice was rated as requiring improvement in providing safe services. A breach of legal requirement was found and a requirement notice was served in relation to safe care and treatment. The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Norton Canes Practice on our website at .

This inspection was an announced comprehensive inspection carried out on 1 October 2018 to confirm that the practice had met the legal requirements in relation to the breach in regulation that we previously identified.

This practice is rated as Good overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

At this inspection we found:

• The practice leaders had taken the findings from the previous CQC inspection to improve the services provided and patient safety and care. Each area for improvement had been actioned and our findings at this inspection showed improvements had been made and sustained.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice had effective systems, processes and practices in place to protect people from potential abuse and staff had received safeguarding training appropriate to their role.
• There were systems in place for identifying, assessing and mitigating risks to the health and safety of patients and staff. The system for managing patient safety alerts and the monitoring of patients on high risk medicines had improved.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice actively worked with the patient participation group (PPG) to meet the needs of their patients and had increased the membership of the PPG.
• The practice had hosted a range of health awareness sessions for their patients and members of the local community. The most recent session was on diabetes. Over 30 people attended and feedback was very positive.
• Information to support patients with making a complaint was now readily available.
• Systems had been put in place to monitor and deal with uncollected prescriptions.
• There was a focus on continuous learning and improvement at all levels of the organisation.
• The practice had pro-actively identified and increased the number of carers registered and were working with external partners to support their carers.

The areas where the provider should make improvements are:

• Consider obtaining a hearing loop system to assist patients with a reduced range of hearing.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. We previously inspected the service on 26 November 2015 and rated the service Good overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

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

We carried out an announced comprehensive inspection at Norton Canes Practice on 13 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had systems, processes and practices in place to protect people from potential abuse. Staff were aware of how to raise a safeguarding concern and had access to internal leads and contacts for external safeguarding agencies.
• The practice had systems to manage most risks so that safety incidents were less likely to happen When incidents did happen, the practice learned from them and improved their processes.
• There were systems in place for identifying, assessing and mitigating most risks to the health and safety of patients and staff. However, the system for managing patient safety alerts and the monitoring of patients on high risk medicines required review.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.

• The partners had reviewed its workforce and had recently employed a health care assistant, a part-time locum GP and taken on a physician associate to help meet the health and social needs of patients.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found it easy to make an appointment.
• The practice was equipped and maintained to treat patients and meet their needs.
• The practice worked with the patient participation group (PPG) to meet the needs of their patients.
• There was a focus on continuous learning and improvement at all levels of the organisation.

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

• Ensure care and treatment is provided in a safe way to patients. See the Requirement Notice at the end of this report for more details.

The areas where the provider should make improvements are:

• Ensure information about how to make a complaint is easily available for people to access.

• Review the monitoring of uncollected prescriptions.

• Review and improve the system for managing patient safety alerts.

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 Norton Canes Practice on 26 November 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings were as follows:

• Staff knew how to and understood the need to raise concerns and report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and acted upon.
• Risks to patients were assessed and well managed.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• Best practice guidance was used to assess patients’ needs and plan and deliver their care.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patient information, including how to complain was available and easy to understand.
• Patients told us they could get an appointment when they needed one.
• 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.

We saw several areas of outstanding practice including:

• The practice organised evening Health Awareness Sessions, where they invited speakers, for example specialist nurses. Patients registered at the practice were invited to these sessions, and the local community were also made aware via the local village newsletter. The most recent event held on 11 November 2015 was about Stroke Prevention, and the guest speaker was the local stroke nurse specialist. Staff told us this was well attended and included people who were not registered at the practice.

There were also areas of practice where the provider needs to make improvements.

The provider should:

• Record clinical audits in a way that clearly identifies the four stages of the audit cycle.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice