Nork Clinic

Updated 14 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Nork Clinic on 14 April 2015. Breaches of legal requirements were found during that inspection within the safe domain. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the legal requirements in relation to the following:

• Ensure that all staff are trained in safeguarding of children at a level appropriate to their role and that contact details for local authority safeguarding teams are accessible to all staff within the practice.
• Ensure risk assessment and monitoring processes effectively identify, assess and manage risks relating to fire safety arrangements.
• Ensure the actions identified as a result of auditing of infection control processes are documented and reviewed so that progress and completion can be monitored.
• Ensure all remedial works and ongoing monitoring recommendations are implemented in order to reduce the risk of exposure of staff and patients to legionella bacteria.

We undertook a focused inspection on 5 April 2016 to check that the provider had implemented their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

Our key findings across the areas we inspected were as follows:-

• All staff were trained in safeguarding of children at a level appropriate to their role and contact details for local authority safeguarding teams are accessible to all staff within the practice.

• Risk assessment and monitoring processes were effectively used to identify, assess and manage risks relating to fire safety arrangements.

• Actions identified as a result of auditing of infection control processes were documented and reviewed so that progress and completion was monitored. All actions identified had been completed.

• Remedial works were implemented in order to reduce the risk of exposure of staff and patients to legionella bacteria. Ongoing monitoring recommendations had not yet been fully implemented. However, we saw a clear plan in place to ensure this was followed through, including regular temperature monitoring and descaling of a shower head.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 June 2015

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 patients at risk of hospital admission were identified as a priority. Care plans had been introduced to minimise the risk of unplanned hospital admissions. Longer appointments and home visits were available when needed. All of these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 25 June 2015

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. However, not all practice staff had received training in the safeguarding of children at a level appropriate to their role. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors.

Updated 25 June 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice had a dedicated telephone line for those patients who were over the age of 75 years and were considered to be most vulnerable. All patients over the age of 75 years had a named GP. The practice ensured early referral to services for memory assessment. Older patients were able to request that prescriptions were sent directly to their choice of pharmacy to avoid the need for collection from the practice.

Updated 25 June 2015

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 identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice offered extended hours by opening on one evening each week to meet the needs of people who worked during the day. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. Health checks were available to all new patients registering with the practice. NHS health checks were available to all patients aged from 35-74 years.

Updated 25 June 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). People experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. GPs in the practice worked closely with community mental health teams to refer patients for counselling or cognitive behavioural therapy. One community mental health service provided counselling and support to patients from the practice on one day each week. The practice liaised closely with a local mental health consultant to manage the care of patients with poor mental health. It carried out care planning for patients with poor mental health such as dementia and learning disabilities. The practice undertook dementia screening of patients and ensured early referral to memory assessment services. The practice provided information to patients experiencing poor mental health about how to access various support groups and voluntary organisations. Longer appointments were available to patients if required.

Updated 25 June 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It had carried out annual health checks for patients with a learning disability. Longer appointments were available to patients where needed, for example when a carer was required to attend with a patient. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had identified those vulnerable patients requiring support to minimise the risk of accident and emergency attendance and unplanned hospital admissions. Care planning was in place to support those patients. Patients receiving palliative care were supported by regular multidisciplinary team reviews of their care needs. 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.