Norton Medical Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our previous inspection in 2022, the practice was rated good at providing an effective service. At this assessment, we have rated the practice as requires improvement. We found that the practice did not hold or engage in regular multidisciplinary team meetings to discuss patient care or engage with local services and stakeholders. We identified no concerns regarding consent to care and treatment.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At our last assessment patients told us they struggled to access the surgery. At this assessment patients have raised issues with using the new online system to access the surgery.

Staff were unable to tell us that they reviewed palliative patients, or patients in other vulnerable groups to ensure care needs were met effectively. Leadership told us that digital flags were used within the care records system to highlight any specific individual needs, such caring responsibilities. Social prescribing initiatives were utilised to provide support to those who needed it.

There were not effective systems in place to record and monitor the status of palliative patients.

The practice had a system in place to identify people with caring responsibilities.

The practice also had a lead for patients with a learning disability (LD)

We did not receive any concerns from patients about evidence-based care and treatment.

We reviewed data which demonstrates the prescribing of pregabalin, and gabapentin was significantly higher than expected. Leaders were not able to provide evidence of processes in place to reduce the prescribing rate.

Leaders were not able to provide evidence that searches or audits were completed regularly to identify any patients with potential missed diagnoses. We found 82 patients within the practice’s system that may have a missed diagnosis of chronic kidney disease (stages 3-5). Of the sample reviewed of these patients, none had a urine ACR test completed, which is an important marker of kidney damage. The practice told us following our site visit they currently have a GP carrying out an audit around this issue.

The practice did not carry out regular clinical audits or carry out improvements based on evidence based practice.

The practice did not have an embedded system in place to audit the work of non medical prescribers.

Care home staff told us that they struggle to access the practice outside of the scheduled virtual ward round carried out. This will have an impact on people's experience of how staff, teams and services work together.

We received no comments from patients in relation to the practice working with other services.

The practice had limited engagement with external agencies and partners.

Staff told us there were no regular multidisciplinary team (MDT) meetings to discuss patients whose circumstances may make them vulnerable.

We were told this was on an ad hoc basis.

We consulted with stakeholders. They continued to express concerns over the practice and how it was run and operated.

There was no evidence that multidisciplinary team meetings were attended or held regularly by the practice.

The provider had a GDPR (general data protection regulation) policy in place and safe processes for information sharing.

Referral letters were not always completed in a timely manner and there was not a clear procedure for staff to follow to action incoming and outgoing letters and discharge summaries.

We did not receive feedback from patients about how the provider supported patients to live healthier lives.

According to the NHS GP Patient Survey 2024, only 48% of surveyed patients say they have had enough support from Norton Medical Centre in the last 12 months to help manage their long-term condition or illness.

Staff told us that they were able to signpost patients to social prescribing teams.

They also told us about other programmes they ran such as diabetes prevention and stop smoking campaigns.

Patients had acess to professionals at Primary Care Network level such as a menopause and weight loss clinic.

Social prescribers were available at PCN level to support patients with a wide variety of their needs. The practice had information available within the waiting room to support national priorities and initiatives to improve the populations health, for example, stop smoking campaigns and tackling obesity.

We identified 77 patients prescribed an ACE inhibitor or angiotensin II receptor blocker who were overdue clinical monitoring. The practice did not have processes in place to ensure patients attended for their required monitoring, to facilitate the safe and appropriate prescribing of these medications.

From our clinical searches, we found that medication reviews have been coded on patient records without it being documented that the patient was consulted, or that the necessary safety monitoring has been completed.

The practice had a process which aimed to ensure all patients were consulted, after three no contacts patients medication was reduced.

We reviewed a small amount of complaints which indicated some patients had raised complaints relating to diagnosis of treatment. Due to the way complaints were managed at the time of assessment we were unable to ascertain if these had been discussed by the practice.

Staff told us that patients could see a clinician of their choice to maintain consistency however could not tell us how long a patient would wait for this, as it was dependent on each different clinician. No average wait time was provided.

Furthermore we saw no evidence of innovative practice which had led to patient care being improved.

Clinical searches we completed showed systems in place for monitoring patients with long term conditions and those on high-risk medicines.

However, diabetes care could be improved further as although we found patients were having annual reviews, follow up appointments were not always being completed.

We saw some evidence of referrals and blood results being missed. The practice have provided evidence that this process has been updated, we will review this at our next assessment.

Staff told us that there was a process in place to ensure all patients with a learning disability were reviewed annually. Amendments were made where required to ensure these patients received the care required. We identified 2 cases in which there were problems with DNACPR orders, including one instance where a patient had been incorrectly coded as DNACPR on their medical records. We informed practice leaders of this immediately.

Our assessment raised no concerns in this area, and we received no specific feedback from patients on this.

Leaders told us that written consent forms were used for minor surgical procedures, and that verbal consent was documented for everything else.

The practice had procedures in place to ensure that informed consent was obtained and documented.