Steyning Medical Practice Also known as The Steyning Health Centre

Updated 25 August 2017

Dr Noren and Partners is located in purpose built premises. There are consultation rooms on two floors and a lift to support patients with limited mobility.

The practice is contracted with NHS England to provide a General Medical Services (GMS) to the patients registered with the practice. The practice serves 12,099 patients from the local village and rural area. The practice demographics show that the population has a higher prevalence of patients over 50 years old compared to the national average and a significantly lower prevalence of 20 to 40 year olds and children under 10 years. National data suggested there is minimal deprivation across the local population. Fifty one percent of patients registered have a health condition which requires ongoing care compared to the national average of 54%. The local population was predominantly white British by ethnic origin (97%).

There are four male and three female GPs working at the practice. There are six nurses, two healthcare assistants, a phlebotomist and a paramedic practitioner. A number of administrative staff and a practice manager support the clinical team.

There are 6.5 whole time equivalent (WTE) GPs and 7.3 WTE nursing staff, healthcare assistants and paramedic practitioner.

Dr Noren and Partners is open between 8.00am and 6.30pm Monday to Friday. There were extended hours on Tuesday from 7am and on Wednesdays and Thursdays until 8pm.

Out of hours GP services were available when the practice was closed by phoning 111 and this was advertised on the practice website.

The practice provides services from:

• Steyning Health Centre, Steyning, West Sussex BN44 3RJ and
• Upper Beeding Surgery, 14 Dawn Close, Upper Beeding, West Sussex, BN44 3WG.

We only visited Steyning Health Centre as part of this inspection. 

Updated 25 August 2017

Letter from the Chief Inspector of General Practice

When we visited Dr Noren & Partners at Steyning Health Centre on 10 January 2017 to carry out a comprehensive inspection, we rated them as good overall. However, we found the practice required improvement for the provision of effective services and we told them that they must:

• Assess, monitor and mitigate risks relating to the health, safety and welfare of patients related to repeat medicine reviews.

We also said they should:

• Continue to work towards improving the recording of care outcomes for patients with chronic obstructive pulmonary disease.

Following our inspection, the practice sent us an action plan setting out the action they would take to meet the legal requirements in relation to the breaches in regulations that we had identified.

This inspection was an announced focused inspection carried out on 21 July 2017 to confirm that the practice had carried out their action plan and was now meeting the legal requirements. This report should be read in conjunction with the full report of our inspection on 10 January 2017, which can be found on our website at www.cqc.org.uk .

We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of effective services. Overall the practice remains rated as good.  

On our inspection of 21 July 2017 we found the practice had made improvement and now met the legal requirements in the areas they had previous breached. Specifically we found:

• The practice had reviewed their process for ensuring patients on repeat medicines had these medicines reviewed at appropriate intervals. They had taken action in a number of areas and we saw data that showed significant improvement. For example, in the 12 months  up to 21 July 2017, 80% of patients on four or more medicines had a medicine review recorded in their notes compared to the 51% we found at our previous inspection.
• The practice had continued to improve their reviewing and recording of care outcomes for patients with chronic obstructive pulmonary disease (a chronic lung disease). We saw data which showed that for the year April 2016 to March 2017 the practice had achieved 33 of the 35 quality framework points available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 February 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and had appropriate training.
• Patients at risk of hospital admission were identified as a priority.
• Nurses were supported by lead GPs in each clinical area and met regularly to discuss care and treatment processes and individual patients.
• The most recent published results showed the practice was performing well compared to national averages and local averages.
• Medicine reviews were not always recorded properly on the record system and therefore not necessarily always monitored effectively
• All these patients were offered structured annual review to check their health needs were being met.
• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• National data regarding Chronic obstructive pulmonary disease performance showed improvements were required. The practice had made plans to improve this performance.
• Diabetes care was highly personalised and there was work to identify patients at risk of diabetes and manage the risk to their health.

Updated 22 February 2017

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
• The practice’s uptake for the cervical screening programme was 82%, which was similar to the national average of 82%.
• Immunisation rates were similar to average for most standard childhood immunisations, but lower for one area.
• Staff explained how they treated children and young people in an age-appropriate way including recognition of their rights to access treatment.
• We saw positive examples of joint working with midwives and health visitors.
• Joint working with external organisations took place in the management of children at risk of abuse.
• The patient participation group provided talks for young people on their specific areas of health concerns, such as sexual health.

Updated 22 February 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the high proportion of older people in its population.
• GPs offered personalised care to patients in care and nursing homes.
• The premises were accessible for patients with limited mobility.
• Medicine reviews were not always recorded properly on the record system and therefore not necessarily always monitored effectively.
• Patients over 75 had a named GP to maintain continuity of care.
• Care planning was provided for patients with dementia.
• Patients at risk of admission to hospital were provided with care plans.
• Early visiting home visits were provided where necessary and also a paramedic practitioner was employed to undertake home visits.

Updated 22 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been considered and the practice had adjusted the services it offered enable continuity of care.
• Patients’ feedback on the appointment was higher than the national and local GP survey averages.
• The practice responded to any areas where the appointment system could be improved by implementing minor illness nurses and additional support systems to help patients’ book appointments.
• Extended hours appointments were available three days a week.
• The practice was proactive in offering online services
• A full range of health promotion and screening was available that reflects the needs for this age group.
• Travel vaccinations were available both privately and on the NHS.

Updated 22 February 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Performance for mental health related indicators in 2016 was 100% compared to the national average of 93% and regional average of 91%.
• The proportion of patients on mental health register with an up to date care plan and an up to date physical assessment was 63%. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advanced care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 22 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• Patients with learning disabilities were offered annual health checks.
• The practice held a register of patients living in vulnerable circumstances including patients with dementia and learning disabilities.
• The practice offered longer appointments for vulnerable patients.
• A list of 470 patients deemed as requiring priority appointments were listed as gold patients. This enabled priority to be provided for appointments or call back by receptionists. Patients on the palliative care register, cancer register, some patients with multiple morbidities, those with dementia and carers could become gold patients.
• Patients with no fixed address could register at the practice if needed and homeless patients could be referred to a local specialist GP service.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• Joint working with external organisations took place in the management of patients at risk of abuse or harm.