This practice is rated as Good overall. At the previous inspection in November 2014 the practice was rated as Outstanding overall.

The key questions at this inspection 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

We carried out an announced comprehensive inspection at Parish Fields Medical Practice on 7 March 2019 as part of our inspection programme.

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 rated the practice as requires improvement for providing safe services because:

• The provider did not ensure the proper and safe management of medicines, in particular, the safe and secure storage of medicines and restricting access to medicines including controlled drugs. Following our inspection, the practice responded by making security improvements.

We rated the population group people with long term conditions as requires improvement because:

• Quality and outcomes framework (QoF) data for 2017/18 was below local and national averages and the practice were not able to demonstrate that improvements made had positively impacted on the quality of care provided.

However, we also found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs, with the exception of patients with long term conditions.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centred care, however improvements were required in the quality of care provided to people with long term conditions.

The areas where the provider must make improvements are:

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

We identified areas where the provider could improve and should:

• Continue to monitor, evaluate and improve the quality of care provided to patients with long term conditions.
• Review access to services to improve timely access to care and treatment for patients.
• Improve the identification of carers to enable this group of patients to access the care and support they need.
• Review and improve systems and processes for patient outcomes, particularly in relation to exception reporting and the recording of the smoking status of patients.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We inspected this practice on 17 November 2014 as part of our new comprehensive inspection programme.

Parish Fields Practice is located in a building which is shared with another GP practice in Diss and serves a population of around 7600.

The overall rating for this practice is outstanding. We found the practice was good in the safe, caring and well led domains and outstanding in the effective and responsive domains. We found the practice provided outstanding care to patients in vulnerable circumstances and families, children and young patients. We found that the practice provided good care to older patients, patients with long term conditions, working age patients and patients experiencing poor mental health.

Our key findings were as follows:

• The practice had a system for reviewing and responding to safety alerts and significant events.
• Staff took account of changes in national guidance when planning patient care.
• Staff had access to training to update their skills.
• Practice staff provided proactive and tailored services to support vulnerable patients
• The practice had a robust governance structure in place with designated lead and administrative staff for a range of areas, alongside a range of different meetings for staff.
• Staff spoke of a culture of quality improvement and learning through partnership working
• The practice was not afraid to challenge local commissioning arrangements in order to improve outcomes for patients

We saw several areas of outstanding practice including:

• The practice was working with Norfolk and Norwich University Hospital and the University of East Anglia as part of a pilot project to better identify patients at risk of type 2 diabetes and to reduce the risk of these patients developing type 2 diabetes through lifestyle change and motivational support. We saw evidence that clinical audit work around gestational diabetes had enabled the practice to identify more patients who were at risk and to support them with lifestyle changes during pregnancy. The practice could demonstrate how their proactive partnership approach was achieving better outcomes for their patients.

• Parish Fields Practice had developed a clinical audit programme which was both comprehensive and embedded. The practice had completed an extensive scheme of clinical audit cycles, covering a broad range of clinical areas. There was evidence that this had led to improvements in outcomes for patients. We saw that the results of audits had been shared routinely across clinical teams, both internall and externally. Staff spoke of a culture of quality improvement and continuous learning within the practice.

• The practice had identified the needs of its local population and engaged with partner agencies to secure improvements to services where these were identified. The practice recognised the dichotomy of wealth and deprivation that exists in Diss and the surrounding area. The practice held food bank vouchers for those who were in need and worked in partnership with the Trussell Trust (a community body which aims to alleviate hunger and poverty). Practice staff were particularly aware of children in need and they worked closely with the Clinical Commissioning Group (CCG), local schools and Public Health teams to ensure that children who may be vulnerable accessed services. Arrangements were in place to ensure that traveller families registered and that traveller children were immunised. Care and support were offered on site at a local women’s refuge and across short term housing providers to ensure that the needs of these patients were identified and met. Strong and bespoke joint working arrangements were in place with the Norfolk Recovery Partnership to support patients with drug and alcohol addiction.

• The practice used information received to ensure patient care was being planned effectively. For example, the practice received hospital data on admissions and A&E attendances daily. This information was disseminated to the patient’s named GP via email by an administrator within the practice. If a patient remained in hospital for more than seven days, the named GP rang the hospital to discuss the admission and to attempt to facilitate discharge. Patients were contacted by their named GP within 48 hours following discharge from hospital.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice