Background to this inspection
Updated
7 October 2021
Narborough Road Surgery is located in Leicester at:
193 Narborough Road
Leicester
Leicestershire
LE3 0PE
It has no branch surgery. However, the partners run two other practices in Leicester who are registered with the CQC separately from Narborough Road Surgery.
The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury, family planning and surgical procedures.
The practice offers services from one site.
The practice is situated within the Leicester City Clinical Commissioning Group (CCG) and delivers General Medical Services (GMS) to a patient population of about 2,500. This is part of a contract held with NHS England.
The practice is part of a wider network of GP practices and is in the Leicester Foxes Primary Care Network.
Information published by Public Health England shows that deprivation within the practice population group is in the fifth lowest decile (5 of 10). The lower the decile, the more deprived the practice population is relative to others.
According to the latest available data, the ethnic make-up of the practice area is 76% White, 15% Asian, 3.5% Black, 3% Mixed, and 2% Other.
There is a team of four GPs (including two partners) who provide cover. The practice has a team of two nurses who provide nurse led clinics for long-term conditions. The GPs are supported at the practice by a team of reception/administration staff. The practice manager is based at the practice to provide managerial oversight, whilst an assistant practice manager is based at one of the other two practices run by the partners.
Due to the enhanced infection prevention and control measures put in place since the pandemic and in line with the national guidance, most GP appointments were telephone consultations. If the GP needs to see a patient face-to-face then the patient is offered an appointment at the surgery.
Extended access is provided locally by Leicester City Healthcare Hubs, where late evening and weekend appointments are available. Out of hours services are provided by 111.
Updated
7 October 2021
We carried out an announced inspection at Narborough Road Surgery on 9 September 2021. Overall, the practice is rated as Good.
Safe - Good
Effective - Good
Well-led - Good
Following our previous inspection on 17 February 2020, the practice was rated Requires Improvement overall and for safe, effective and well-led key questions but good for caring and responsive services.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Narborough Road Surgery on our website at www.cqc.org.uk
Why we carried out this inspection
This inspection was a focused inspection to follow up on:
- Safe
- Effective
- Well-led
- Regulation 17 HSCA (RA) Regulations 2014 Good governance breach
- Areas identified as ‘shoulds’ in previous inspection
How we carried out the inspection
Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.
This included:
- Conducting staff interviews using telephone and video conferencing
- Completing clinical searches on the practice’s patient records system and discussing findings with the provider
- Reviewing patient records to identify issues and clarify actions taken by the provider
- Requesting evidence from the provider
- A short site visit
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 have rated this practice as Good overall and good for all population.
We found that:
- The practice had addressed the issues which led to a breach notice being issued at the previous inspection.
- Improvements had been made in immunisations, cancer screening uptake and the identification and support for carers.
- 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.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. 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-centre care.
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