Norton Medical Centre

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our previous inspection in 2022, the practice was rated requires improvement at providing a responsive service because patients experienced poor access to the practice. At this assessment, we have rated the practice as inadequate. The practice was unable to demonstrate that they had taken appropriate actions to address lower areas of satisfaction from patient feedback. We took urgent enforcement action under Section 31 of the Health and Social Care Act 2008 and imposed conditions on the providers' registration. We were not assured there was an effective system in place to triage service users safely.'

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke to the patient participation group who meet regularly, they disclosed concerns around the new total triage system.

They told us staff will make changes where they can but did not provide an example of a change being implemented.

They also advised that the care received once on an appointment had been attained was good.

We spoke to the 7 local care homes, most of the care homes disclosed concerns in relation to the e-consult systems and how it was impractical for nursing home staff to use. Furthermore they raised concerns over the over-reliance on community matrons to provide patient care.

The most recent NHS Patient Survey demonstrated that patients at the practice face challenges in accessing an appointment and contacting the practice. Overall patient satisfaction is 55%, the National average sits at 74% and the ICB average 77%.

Our clinical searches demonstrated that patients were being offered an annual review, however we found patients who required a follow-up appointment from this review were not always seen, patients were directed to complete an e-consult lite to book this review.

Staff acknowledged difficulties in accessing the surgery, they told us that once the e-consult system had closed for the day, patients would be signposted elsewhere, or would have to wait.

The leadership team felt this was a fair approach, and we saw evidence of the e-consult system being closed by 9am. This meant that once the e-consult system was closed, patients were directed elsewhere including 111 or to attend urgent or emergency care services. This meant that people were not at the centre of their care and treatment choices and were not involved in decisions about how to respond to any relevant changes in their needs.

During our assessment, we reviewed evidence which indicated strong positive engagement with patients who have a learning disability.

We discussed care home residents, leaders told us they were reviewed via a virtual ward round, an Advanced Nurse Practitioner leads this. Leaders were unable to tell us how often they visit the homes in person. They also expressed to us that care home residents were triaged via e-consult in line with the rest of the patients, leadership did not see issue with this at the time of our assessment.

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

In relation to care home patients, it was noted that there was an over reliance on community matrons.

We saw some evidence that the practice were able to provide holistic care to specific patient groups, for example patients with a learning disability.

We noted the practice had not carried out any quality audits to establish whether the triaging of care home residents via e-consult was an effective way for care home staff to gain access to a GP.

We received no feedback from patients which would indicate a difficulty in obtaining information from the practice.

The NHS patient survey results demonstrate that patients found it challenging to book an appointment with a clinician of their choice.

When e-consult is closed, children and palliative patients are able to contact the surgery for an e-consult lite via telephone, there was a sign in the waiting room which demonstrated this to patients, it is unclear how this is demonstrated to patients who do not go to book a face to face appointment.

Staff told us patients were kept up to date via text messages and social media updates.

Leaders told us that patients were able to request an appointment with a clinician of their choice, however could not provide information on how long they would be expected to wait for this.

We noted a large amount of information on the practice website, however there was no process or structure in place for patients who were unable to access the internet.

There was no policy or oversight on how to provide information to patients when e-consult had closed for the day.

Where English was not a persons first language translation services were available.

The most recent NHS Patient Survey demonstrated that patients at the practice face challenges in accessing an appointment and contacting the practice. Overall patient satisfaction is 55%, the National average sits at 74% and the ICB average 77%.

We have received 7 cases in the last 12 months ,1 of these provided positive feedback specifically relating to patient care, 86% of the feedback received was directly relating to difficulties in accessing the practice.

At time of assessment it was difficult to establish how many complaints the practice had received in the last 12 months, due to the recording from leadership.

Leaders told us during the assessment that complaints were discussed at either a complaints meeting or a reflective practice meeting. We could not establish the criteria for each meeting.

Complaints were not regularly reviewed for any themes and trends, and there was a generic response sent to all complaints relating to access.

Members of the leadership team made reference to a ‘demanding patient population’ being the reason for a large number of complaints.

We reviewed a complaints policy, and various significant events forms. It was unclear who was responsible for overall oversight of complaints and significant events.

We reviewed incomplete reflective practice minutes, we saw evidence of complaints taking over 12months to be resolved to by the practice.

We saw no evidence of any change or improvement due to complaints or significant events.

It is unclear if the provider had responded to all complaints received due to the policy not being embedded into practice at the time of assessment.

Since our assessment the provider has implemented a new system to manage complaints and significant events and we will review this at our next assessment.

The most recent NHS Patient Survey demonstrated that patients at the practice face challenges in accessing an appointment and contacting the practice. Overall patient satisfaction is 55%, the National average sits at 74% and the ICB average 77%.

We have received 7 cases in the last 12 months ,1 of these provided positive feedback specifically relating to patient care, 86% of the feedback received was directly relating to difficulties in accessing the practice.

Within the ICB the practice has the highest rate of patients using Urgent and Emergency Care.

We reviewed data which indicated that between 1st August 2023 – 31 July 2024 10,921 patients from the Practice attended an Urgent Treatment Centre or Emergency care facility.

Within the same time frame, there were 7733 calls to 111 from patients of the practice.

Leaders acknowledged that there was a national problem with GP demand.

Management advised that the practice had moved to the use of e-consult and felt access had improved.

Leaders were clear at time of assessment that when e-consult closed for the day, no patients except palliative or an acutley unwell child would be triaged. Leadership told us that for elderly patients, or those who may start work when e-consult opens, a relative could complete this on their behalf.

We reviewed evidence of patients who had attempted to get an appointment going on to become seriously unwell due to being triaged incorrectly.

Management told us that reception and admin staff do not triage patients, however over the phone once internet e-consults have closed admin staff are responsible for the re-direction of patients to other services.

Leaders were unable to provide a clear overview of how patients were triaged once an e-consult was completed.

Patients at the practice were told to book an appointment via e-consult, for patients who could not access the internet, they were told to telephone or attend the practice in person.

We saw no evidence of how these appointments were delegated or how many were available each day.

We saw no evidence from the practice which considered the appropriate triage of patients, to prevent a first come first served approach.

The practice were not monitoring the triage system at the time of our assessment.



We raised immediate concerns with the practice in relation to how patients were being triaged and the limited availability to get an appointment. We also expressed concern over the lack of oversight of the large number of patients each day being sent elsewhere for care.

The triage system was not effective for monitoring patients, we reviewed a basic flowchart for clinical staff on which only 3 symptoms were required to see a GP face to face as a first point of clinical intervention.

It was unclear the role the receptionist had in deciding which patients were triaged once the online system had closed for the day.

The online system provides clear safety-netting advice to patients, however there is no system in place to ensure patients in person or over the phone receive the same advice if an appointment is not available.

We noted the practice had not carried out any quality audits to establish whether the new process was successful.

Since our assessment the provider have began implementing improvements to triaging and patient access, this will be reviewed at our next assessment.

The most recent NHS Patient Survey demonstrated that patients at the practice face challenges in accessing an appointment and contacting the practice. Overall patient satisfaction is 55%, the National average sits at 74% and the ICB average 77%.

The survey reported that 17% of patients with a disability or long term condition could book an appointment with the clinician of their choice. However 35% of patients without a long term condition reported being able to access the clinician of their choice.

We spoke with care home staff and asked them if the new service was satisfactory. They told us that they struggled to access GP's on behalf of their residents.

They had not been consulted on the process and had not been asked for their ongoing feedback.

Leaders told us that there was support available for carers, they also told us that amendments could be made to appointments to accommodate those patients with a learning disability. Where appropriate the practice also told us they would access translation services in advance of appointments.

In the waiting room we saw information of support services available for specific groups of patients was on display.

The practice provided support to people with learning disabilities by providing some information in easy read format.

The practice utilised a social prescriber for patients who were carers, further support was available for young carers.

Staff were unable to provide evidence that specific groups of patients were monitored, or that they were triaged in an appropriate manner when appointment capacity was reached.

We noted the practice had not carried out any quality audits to establish whether the new process was successful.

The most recent NHS Patient Survey demonstrated that patients at the practice face challenges in accessing an appointment and contacting the practice. Overall patient satisfaction is 55%, the National average sits at 74% and the ICB average 77%.

Community matrons were responsible for completing emergency healthcare plans for palliative patients. It was unclear which members of clinical staff reviewed this information. Following our assessment staff told us these plans were then reviewed by a named GP.

At the time of assessment leadership advised us that the practice had quarterly palliative care meetings.

We raised immediate concern with this frequency. Since our assessment the practice have increased the frequence of these meetings to monthly.

Staff told us patients or relatives of a palliative patient were able to contact the surgery without the need to complete an e-consult.

Staff told us palliative patients had a named GP, we were unable to determine how much involvement this GP had with the patient.



We reviewed a significant event which would indicate a named GP did not have full oversight of their palliative patients.

We reviewed the practice palliative care policy and protocol, there was a lack of practice level information.

There was a lack of process and management of patients who required a prescription for end of life medication. We saw evidence of delays for this group of patients. We reviewed evidence of quarterly palliative care meetings; we raised concerns about the frequency of these meetings at the time of assessment. The practice told us that there was on going monitoring for patients who received a palliative diagnosis within this time, however there was no formal protocol for this that could be reviewed by leaders. Leaders also lacked clear oversight of palliative care registers, including how often patients were reviewed specifically in relation to any changes in wishes, such as DNACPR, or plans for end of life care. Since our assessment the practice have implemented electronic DNACPR records, and patients will also receive a paper copy. This will be reviewed at our next assessment