Norton Medical Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

.At our previous inspection in 2022, the practice was rated good at providing a safe service. At this assessment, we have rated the practice as requires improvement. We found; one breach of the legal regulations in relation to safe care and treatment Safeguarding systems, processes and practices were not sufficient. There was no robust system regarding significant events and complaints in which the practice took time to share learning. After the assessment, the provider informed us of improvements they were making in response to our findings. We will review these at our next assessment.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had a complaints and significant events process in place. However, this was not monitored effectively. We saw evidence of patients receiving a standard acknowledgment following the submission of a complaint.

Furthermore, we saw evidence of complaints taking up to 3 months to be reviewed and 1 year to be discussed with the patient.

We also saw evidence of a ‘standard’ response being provided to patients who made complaints relating to access.

We did not see evidence of changes in the practice since the last report and the people's experience reflected this.

When we spoke with staff they told us that learning from complaints and significant events was not always shared efficiently across the whole practice team.

The leadership team told us they communicated via email, newsletter and had held meetings but not with all of the staff present. Leaders told us it was the role of team leaders to deliver this feedback, however this was not evidenced. There was an inconsistency in the frequency of meetings.

Leaders could not tell us the rationale behind the meeting schedule or how complaints or significant events were discussed at these meetings. Furthermore leaders could not provide examples of any learning or improvements implemented from these meetings.

We saw evidence that demonstrated staff did not always feel included as part of the significant events processes.

Furthermore we saw no evidence that staff were advised of learning derived from significant events.

We immediately addressed concerns around the oversight of incidents and significant events, the practice provided us with a plan for improvements, which we will continue to monitor.

We saw examples of complaints from patients where they had not received referrals to other agencies in a timely or accurate manner.

We spoke with care home staff and asked them if the 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. Prior to the final report publishing, the provider shared some more positive feedback from care home managers. This had been gathered after our assessment.

Community teams also expressed challenges in receiving responses to tasks sent, or being able to speak with a GP.

Leaders could not tell us how the practice positively engaged with other services to ensure patients were kept safe.

We saw evidence of minimal engagement at multi-disciplinary team level.

Staff had not implemented any learning based on significant events, and we reviewed numerous incidents of the practice submitting significant events relating to other professionals, it is unclear if there was any joined learning.

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

Our clinical searches showed very small percentages of patients who had been incorrectly coded or not received the appropriate treatment. There were issues with patients not accessing follow up appointments after attending for an annual review, for example patients who required further follow up if HBA1C was out of range. The practice did not have a process to monitor this.

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

We received no information from patients relating to safeguarding.

Staff who completed the staff feedback questionnaire had a knowledge of who the safeguarding lead was.

We did not see evidence that safeguarding was being discussed on a regular basis. Our searches and GP interview showed that the practice did not have a safeguarding register.

Leaders told us there was a designated safeguarding admin member of staff, who deals with referrals and oversight of at risk patients.

The practice did not provide evidence of this person being trained to level 4 which is the required level for this role.

When asked at interview staff were unable to provide us with an example of a recent safeguarding event that was discussed by clinical staff within the practice.

Furthermore at interview the safeguarding lead for the practice was unable to tell us the process for safeguarding beyond passing a referral to the admin team.

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

We saw evidence in staff training which highlighted not all members of staff were trained to level 3 where required.



We reviewed evidence during our assessment which showed a lack of regular documented safeguarding minutes.

We reviewed evidence which demonstrated a lack of consistent safeguarding updates being provided to a wider team.

The overall oversight of safeguarding was inconsistent, staff told us that searches were being carried out and that overviews were in place however these have not been provided.

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 was 55%, the National average sits at 74% and the ICB average 77%.

We have received 7 cases in the last twelve 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.

Care homes provided positive feedback relating to the member of staff who carried out the virtual ward round, however they told us that the way in which they gained access to a GP was challenging, and did not take into consideration if this method met the needs of residents.

We reviewed evidence which demonstrated a quarterly palliative care meeting, we expressed concern with the frequency of this meeting, and since our assessment the practice have increased the frequency of these meetings. Leaders told us that all GP's, Social Prescribing Link Workers, and Community Teams were invited to these meetings.

The practice told us there was a PCN wide MDT which a GP would attend if required.

During our assessment we asked management if the total triage model was holistic, staff could not provide assurance that they had considered all patients when implementing the current system.

Management provided evidence of in excess of 20 different meetings on a timetable. However it was unclear how these linked together to impact or support patients in a positive way.

There is no evidence of the practice having structured input with other professionals to aid improvement.

There was no ongoing audits or improvements to monitor patient outcomes.

Staff were able to provide accurate and up to date information on health and safety and fire.

Staff knew where emergency medications were stored, staff also knew how to report and who was responsible for ordering of items that were nearing expiration dates.

Fire risk assessment and Health and Safety risk assessments had been carried out and appropriate actions were taken.

Equipment and facilities were clean and tidy.

The practice stored medicines appropriately. Risk assessments were in place to determine the range of medicines held.

Emergency equipment was stored in reception, this was organised, and staff knew where it was.

We reviewed evidence which indicated all processes were being managed effectively.

We found that important checks of the emergency trolley were being carried out.

Patients have told us that they struggle to access a GP appointment when needed.

Patients also continue to raise concerns with the practice regarding accessing appointments.

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 was 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 the leadership in the practice. They told us 9 staff had left since our last inspection and an advert was out to replace a GP who was leaving.

Leaders were unable to provide clear staffing levels to us throughout the assessment. It is unclear how many staff worked each day, and how far in advance management planned staffing rotas. We saw evidence of staff on annual leave being counted in numbers of staff at work.

Furthermore leaders could not tell us how many patients each person saw each day.

We checked staff records which indicated the practice carried out the required employment checks and there was an induction process.

Recruitment checks were carried out in accordance with regulations.

It was unclear how the practice managed staffing levels effectively, leaders were unable to explain to us the rationale used to determine staffing levels across the service

We saw no evidence which indicated patients had a negative experience of IPC. Patient toilets were clean. Patients had access to water to drink, hand washing facilities and a toilet on all floors.

Staff had received training on infection prevention and control.

There was a named infection prevention and control lead, and staff were aware of this.

The Provider maintained a clean and appropriate environment in managed premises that facilitated the prevention and control of infections. Appropriate standards of cleanliness and hygiene were met. Staff had received effective training on infection prevention control (IPC). Audits were carried out on IPC which identified out of date face masks and alcohol hand gel. The practice acted on the issue identified and placed an order to replenish the stock. Clinical rooms had adequate provisions of personal protective equipment (PPE). Staff managed disposal of waste safely.

We saw evidence that the practice regularly carried out hand washing audits. There was evidence that equipment was being checked when required. There was evidence of staff being up to date with required Infection Control training.

We reviewed some complaints from patients which indicated that they had struggled to get medication or prescriptions when ordered. The practice did not demonstrate that they had carried out any analysis to understand or identify areas for improvement.

Staff told us that the system of ordering repeat medication ran well within the practice, we did not see evidence to suggest this was not the case.

Staff were able to demonstrate that medication safety was embedded within practice.

The practice held appropriate emergency medicines.

There was medical oxygen and a defibrillator on site and systems to ensure these were regularly checked and fit for use.

Vaccines were appropriately stored. The fridges were used only to store vaccines and were large enough to allow sufficient space around the vaccine packages for air to circulate.

Clinical searches showed small percentages of patients who had not received monitoring when required. During interview the GP told us that the patient recall team would attempt to contact patients, it was unclear if patients were unable to gain access to an appointment or if they had chosen to not attend the surgery for follow up. Staff told us patient recall send two invites to patients requiring monitoring, where they have contacted us and appointments are not yet available, they will be added to a waiting list and offered an appointment when they become available. This process is not audited therefore staff cannot confirm if patients have declined or not been able to book an appointment.

The information we reviewed indicated that outcomes for patients in relation to their medication were mainly positive. We saw medicines were stored safely. Patients were able to access medicines in a timely manner