Norton Medical Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our previous inspection in 2022, the practice was rated good at providing well-led services. At this assessment, we have rated the practice as requires improvement. We found one breach of the legal regulations in relation to governance.

We found that systems and processes in place were not working as intended, overseen effectively, or structured in a way that enabled the provider to fulfil their responsibilities to the practice population. Following our assessment, the practice has informed us of immediate changes they are making to management.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The leadership articulated there were difficulties in recruiting GP’s and told us they were fully staffed. Leaders were unable to tell us of any imminent or long-term future plans or improvements for the practice.

Staff at time of assessment were unaware of any ongoing issues or concerns from care home staff, stakeholders or other professional groups as they had not sought feedback or support externally.

Leaders told us that the priority was to maintain safe appointment numbers for staff. There was no oversight or strategy to improve or review this to benefit patients who could not gain access to an appointment. Leaders lacked oversight of the needs of communities, specifically those who were unable to access an appointment when it was needed.

The practice submitted a business plan which indicated plans for improvement at Primary Care Netowrk (PCN) level. The practice submitted a mission statement, we did not see evidence of this at time of our site visit.

Staff told us they were not sure of the vision or strategy within the practice at time of assessment.

We reviewed evidence which indicated the majority of staff had completed equality and diversity training.

We spoke with partners, staff in leadership roles and staff via questionnaires. Leaders told us they had a number of strategies for communicating with staff including emails and face to face meetings. However, we saw whole team staff meetings where issues could be discussed and addressed were not held. Meetings were compartmentalised into individual departments and people. This indicated that leadership was not operating effectively throughout the service. Prior to publication of the report, the provider told us that given the large number of staff, whole staff meetings were not productive therefore, they have departmental meetings and team lead meetings with the management team.

Staff told us they felt the leadership team were approachable and visible.

We were not reassured that there were processes in place which demonstrated leadership within the practice was effective.

Since our assessment we have received evidence of immediate changes in relation to leadership, we will review these changes at the next assessment to see if they are effective and have become embedded into practise.

We received no feedback from staff that would indicate there was issues at the time of inspection in relation to raising concerns.

There was a Freedom to Speak Up (FTSU) guardian in place from a practice within the PCN, the practice manager was a FTSU guardian for a practice close by.

Staff told us via our questionnaires that they were only invited to meetings after an event if it related to them, it is unclear how information is fed back to all staff.

Thank you for your comments. We have updated the report as follows:

We did not see evidence that the leadership team worked to include staff in decisions made in relation to the place in which they work. After the assessment the provider told us staff were involved where this was appropriate. We saw no evidence that would indicate leaders do not act in a manner which excludes people based on diversity. Staff had completed equality and diversity training.

Staff were not able to provide evidence which indicated there was overall good governance in place. There were numerous systems in place that did not work in an effective manner, for example in reviewing incidents and complaints within the practice.

Management were not able to demonstrate clearly the roles and responsibilities of members of the leadership team, and we noted a significant disconnect between management and clinical staff. Furthermore staff could not tell us how far in advance staff rotas were completed, how many staff worked each day, or where there were gaps in staffing levels. After the assessment, the provider told us the rota is reviewed monthly and weekly by rota leads who would fill any gaps needed

We noted several issues during the course of our assessment that indicated that quality assurance within the practice was not functioning correctly. Examples of this include, lack of oversight of significant events, lack of cohesive systems in place to monitor safeguarding and vulnerable patients. We observed a lack of processes which enabled staff to consider themes and trends of complaints and incidents within the practice.

We spoke with care home staff and asked them if the service they received from the practice was satisfactory. They told us that they struggled to access GP's on behalf of their residents. They had not been consulted on the total triage process and had not been asked for their ongoing feedback.

Staff told us there was no regular multi disciplinary team meeting within the practice and this was on an ad hoc basis. Staff attended a PCN wide MDT but this was on an ad hoc basis. Leaders told us the practice had a quarterly palliative care meeting; it was unclear at the time of the assessment how palliative patients were monitored outside of these meetings

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

We noted the practice had not carried out any quality audits to establish whether the new triage system was an effective way to manage care home patients. The practice were not involved in any quality improvement projects.

Leaders told us of the difficulties and challenges they currently faced in relation to patient access.

Leaders told us on several occasions that staff can only see a limited number of patients each day, staff were not able to confirm this number during assessment, but did tell us that it was more than the number recommended by BMA.

Leaders failed to recognise the need to continuously monitor the system that was in place.

The leadership team told us they had not reviewed results of the NHS Patient Survey. When we asked about the results management told us the practice used their own data and did not rely on this survey as an accurate reflection of the patient voice.

They told us they had done limited reviews of the triage system.

Furthermore they told us that they felt the online system was working better than the previous telephone system.

We saw no evidence that indicated at the time of assessment the practice was involved in any innovative or quality improvement work. The leadership team did not include all staff, or external partners in learning from significant events. The practice had recently implemented a total triage system, they had not reviewed this or considered complaints as a point of learning from this.

There was no process in place in relation to effectively using the total triage model.

Since our assessment the provider has informed us of some immediate changes they have made in relation to leadership. At the next assessment will review these changes to see if they have been effective and are embedded into practise.