Paston Surgery

Updated 3 December 2018

• The name of the registered provider is Paston Surgery.
• The address of the location is 9-11 Park Lane, North Walsham, Norfolk NR28 0BQ.
• The practice is registered to provide diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.
• Paston Surgery provides services to approximately 6,600 patients in a semi-rural area in north Norfolk.
• The practice has three GP partners (two female and one male) and two female salaried GPs. There is a management team including a practice manager, an operations manager, a data and compliance manager, an IT co-ordinator and a finance officer. The practice employs three practice nurses and two health care assistants. Other staff includes a team of administration and reception staff, a dispensary manager, senior dispenser and three dispensers.
• The practice holds a General Medical Services contract with NHS England. The practice is able to offer dispensing services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy. We visited the dispensary as part of this inspection.
• The practice is open between 8.30am and 6pm Monday to Friday. Appointments can be booked in advance and the practice was part of a local scheme to offer appointments in the evening and on weekend mornings. Urgent appointments are available for people that need them. Online appointments are available to book in advance.
• When the practice is closed patients are automatically diverted to the GP out of hours service provided by Integrated Care 24. Patients can also access advice via the NHS 111 service.
• We reviewed the most recent data available to us from Public Health England which showed the practice has a smaller number of patients aged 0 to 44 years old compared with the national average. It has a larger number of patients aged 55 and over compared to the national average.
• Income deprivation affecting children is 15%, which is higher than the CCG average of 13% and lower than the national average of 20%. Income deprivation affecting older people is 15%, which is higher than the CCG average of 12% and lower than the national average of 20%. Life expectancy for patients at the practice is 81 years for males and 83 years for females; this is comparable to the CCG and England expectancy which is 80 years and 83 years.

Updated 3 December 2018

We carried out an announced comprehensive inspection at Paston Surgery on 15 November 2018 as part of our inspection programme. The practice was previously inspected in June 2016 and rated as good.

Our inspection team was led by a CQC inspector and included a GP specialist advisor and a second CQC inspector.

Our judgement of the quality of care at this service is based 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.

This means that:

• People were protected from avoidable harm and abuse and that legal requirements were met.
• The provider had a detailed action plan in place to address shortfalls within the practice, such as an overhaul of the recruitment system and addressing lower than average results from the GP Patient Survey.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• The practice was fully engaged with reviewing and monitoring the clinical service they offered and used this information to make changes and drive care. For example, they were reviewing the coding for patients with cancer and recording outcomes for patients on high risk medicines to ensure this was appropriate.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• People’s needs were met by the way in which services were organised and delivered. For example, the practice was a veteran and dementia friendly practice.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.
• The practice encouraged continuous improvement and innovation. For example, they were supporting a nurse through a masters’ degree. This included time off and mentorship.
• Staff reported they were happy to work in the practice and proud of the changes that had been made.

Whilst we found no breaches of regulations, the provider should:

• Continue to review and improve the coding of patients with cancer, diagnosed within the preceding 15 months, who have a patient review recorded as occurring within 6 months of the date of diagnosis to improve outcomes for these patients.
• Embed the new system for the recording of appropriate blood monitoring tests for patients on high risk medicines.
• Continue to review outcomes from the national GP Patient Survey and implement plans to improve these.

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

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

Updated 3 December 2018

Updated 3 December 2018

Updated 3 December 2018

Updated 3 December 2018

Updated 3 December 2018

Updated 3 December 2018