Norwood Medical Centre

Updated 21 March 2016

Norwood Medical Practice is a busy town practice providing care and treatment to approximately 11044 patients of all ages, based on a General Medical Services (GMS) contract agreement for general practice. The practice is part of NHS Cumbria clinical commissioning group (CCG.) The practice is based in Barrow-in-Furness and we visited the following location as part of the inspection:

• 99 Abbey Road, Barrow-in-Furness, Cumbria. LA14 5ES.

The district within which the practice is located has the lowest life expectancy for males and females in Cumbria. The practice serves an area where deprivation is higher than the local CCG and England averages. The practice has a low proportion of patients from ethnic minorities, for example, only 1.1% of the population are Asian.

The practice is located in an adapted residential building and provides patients with mobility needs with access to some treatment and consultation rooms on the ground floor. The practice offers a range of chronic disease clinics as well as services aimed at promoting patients’ health and wellbeing. There are seven GP partners (three male and four female), a managing partner, a deputy practice manager, a medicines support staff member, a patient liaison adviser, a clinical care co-ordinator and a team of administrative and reception staff. The practice also has a nurse practitioner and a team of five nurses (all female.)

The practice’s core opening hours are Monday to Friday between 8am and 6pm. In addition, early morning and late evening extended hours appointments are also provided from: 6:30pm to 7:30pm on a Monday and Thursday evenings; 7am on a Tuesday morning; 7:30am on Wednesday, Thursday and Friday mornings. GP appointment times were available as follows:

Monday: 8am to 7:20pm.

Tuesday: 7:10am to 5:20pm.

Wednesday: 7:30am to 4pm.

Thursday: 7:30am to 7:20pm.

Friday: 7:30am to 4:40pm.

When the practice is closed patients can access out-of-hours care via the Cumbria Health On-Call service, and the NHS 111 service.

Updated 21 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Norwood Medical Practice on 18 November 2015. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The NHS National GP Patient Survey of the practice showed high levels of patient satisfaction with the quality of GP and nurse consultations.
• Staff were committed to supporting patients to live healthier lives through a targeted and very proactive approach to health promotion.
• Risks to patients and staff were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• The practice was well equipped to treat patients and meet their needs.

• All staff were actively engaged in activities to monitor and improve quality and outcomes for patients.

• Information about how to complain was available and easy to understand.
• Very good arrangements had been made to meet the needs of patients who were also carers.
• Patient feedback about access to the practice and appointments was mixed. Whilst some patients were satisfied with access, the NHS GP Patient Survey results showed lower levels of satisfaction than the local Clinical Commissioning Group and national averages. The practice had taken steps to address this by making changes to their appointment system and how they met patients’ needs.
• The leadership, governance and culture at the practice were used to drive and improve the delivery of high-quality person-centred care. There was a clear leadership structure and staff felt supported by the management team. Very good governance arrangements were in place.
• The practice had a clear vision for the development of the practice and safety as its top priority. The strategy and supporting objectives were stretching and challenging, whilst remaining achievable. Staff were committed to providing their patients with good quality care.

We also saw areas of outstanding practice:

• There were very good arrangements for meeting the needs of patients who required dermatological care and treatment. The senior GP partner acted as a GP with a Special Interest, and had set up a local community dermatology clinic at the practice. 220 patients had received care and treatment at the clinic during 2014/15. All patients, including those not registered with the practice, were seen and treated within three weeks of being referred to the clinic. Of these 514 patients, 53 had been diagnosed with skin cancer and, where relevant, an appropriate referral had been made to specialist services. This is outstanding because the practice is providing an additional service which reduces the burden on hospital services and enables patients to receive care and treatment closer to home.  
• The practice demonstrated a very caring and responsive approach to patients and their individual needs. They had a dedicated member of staff in a patient liaison adviser (PLA) role, who was available, at all times the practice was open, to offer practical and emotional support to patients, and to advocate on their behalf with other agencies and support groups. On average, the PLA provided assistance to at least two patients every week. This is outstanding because it showed a strong commitment to helping patients who are facing emotional and practical challenges in their lives.
• Overall, there were very good arrangements for meeting the needs of patients diagnosed with dementia. The practice had designated clinical dementia leads who had worked with the rest of the team to improve their performance regarding the early diagnosis of dementia. Patients identified as being at risk of developing dementia were contacted by telephone and invited to make an appointment for their annual health care review. Where clinical staff had concerns about a patient’s memory, allocated memory clinic appointments were also available at the practice. Clinicians were proactive in caring out dementia screening, where they thought patients were at risk of developing dementia. Several members of staff had completed the ‘Dementia Friends’ training course, to help them provide dementia patients with appropriate care and support.

However, there were also areas where the provider needs to make improvements. The provider should:

• GPs should carry emergency medicines for use on home visits in acute situations.
• Continue to review and improve the practice’s telephone access and appointment system.
• Ensure that the guidance issued by NHS Protect regarding prescription security is followed.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 March 2016

The practice is rated as outstanding for the care of people with long-term conditions. There are aspects of the practice that are outstanding which therefore impact on all population groups.

Nationally reported data showed the practice had performed well in providing recommended care and treatment, for the clinical conditions commonly associated with this population group. For example, the practice had achieved 100% of the total QOF points available to them for providing recommended clinical care to patients who had chronic obstructive pulmonary disease. This was 2.4% above the local CCG average and 4% above the England average.

Very effective systems were in place which helped ensure patients with long-term conditions received an appropriate service which met their needs. Patients at risk of emergency hospital admissions were identified as a priority, and steps had been taken to manage their needs. Arrangements had been made to follow up these patients when they were discharged from hospital, or if they had had contact with the local out-of-hours service provider. Staff worked in partnership with local Case manager and Care Navigator staff to support patients they had judged were at risk of crisis and losing their independence, so they could access suitable sources of help. The practice used the ‘Year of Care’ approach as their model for providing personalised care to this group of patients. This approach had helped to promote patients’ involvement in managing their long-term conditions. It had also helped to reduce the number of times patients with more than one long-term condition needed to visit the practice.

Staff used their skills, competence and experience to deliver more efficient and coordinated care to the patients. Staff had completed the training they needed to provide patients with safe care.

There were very good arrangements for meeting the needs of patients who required dermatological care and treatment. The senior GP partner acted as a GP with a Special Interest, and had set up a local community dermatology clinic at the practice.

Updated 21 March 2016

The practice is rated as good for the care of families, children and young people. There are aspects of the practice that are outstanding which therefore impact on all population groups.

Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients. For example, the QOF data, for 2014/15, showed the practice had obtained 100% of the overall points available to them for providing contraceptive services. This was 3.2% above the local CCG average and 3.9% above the England average. Staff provided a range of services for families and younger patients, including family planning and contraceptive advice. The practice had a same-day care protocol, which prioritised parents contacting the practice about a young child. Staff had received training in how to implement this. The parent of any child who failed to attend a planned appointment, or who had been admitted into hospital from an asthma attack, received a follow up telephone call from practice staff. The practice offered a full childhood immunisation programme, and new mothers were able to access Well Baby clinics and a six week baby check.

Updated 21 March 2016

The practice is rated as good for the care of older people. There are aspects of the practice that are outstanding which therefore impact on all population groups.

Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group. For example, the practice had achieved 100% of the total Quality and Outcome Framework (QOF) points available to them, for providing recommended clinical care to patients who had cancer. This was 0.2% above the local CCG average and 2.1% above the England average. Good arrangements were in place for managing the needs of older patients. Patients aged 75 years and over had been allocated a named GP to help ensure their needs were met. The way clinical staff carried out home visits prioritised older patients with the most urgent needs and helped to reduce patient waiting times. It also helped to promote greater patient choice regarding when they were visited. The practice’s clinical records system was used to ‘flag’ patients with mobility issues, so that reception staff would be reminded to offer them a ground floor consultation room. Telephone ordering of prescriptions was made available to older patients who might experience difficulties with the usual systems for doing this. Staff were able to make information available in large print to help older patients understand the services available to them.

Updated 21 March 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). There are aspects of the practice that are outstanding which therefore impact on all population groups.

Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients. For example, the QOF data, for 2014/15, showed the practice had obtained 100% of the overall points available to them for providing care and treatment to patients who had hypertension. This was 1.1% above the local CCG average and 2.2% above the England average. The practice had assessed the needs of this group of patients and developed their services to help ensure they received a service which was accessible, flexible and provided continuity of care. The practice was proactive in offering online services, as well as a full range of health promotion and screening that reflected the needs of this group of patients. Extended hours GP and nurse appointments were offered to make it easier for working patients to access appointments.

Updated 21 March 2016

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). There are aspects of the practice that are outstanding which therefore impact on all population groups.

There were good arrangements for meeting the needs of patients with mental health needs. The QOF data, for 2014/15, showed the practice had performed well by obtaining 100% of the overall points available to them for providing recommended care and treatment to patients with mental health needs. This was 4.6% above the local CCG average and 7.2% above the England average. Patients with mental health needs were offered an annual health review and were provided with advice about how to access various support groups and voluntary organisations. They were also able to access ‘talking therapies’ which help meet the needs of patients with a range of mental health problems. Arrangements were in place to follow up any patients with mental health needs who failed to attend a planned appointment. Examples of responsive care included inviting patients to attend a consultation following a long period of in-patient hospital care, and proactively reviewing the needs of any new patient registering with the practice who had a significant psychiatric history. Staff had also recently attended a dementia prescribing update to keep up-to-date with new guidance. Several members of staff had completed the ‘Dementia Friends’ training course, to help them provide dementia patients with appropriate care and support.

Updated 21 March 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. There are aspects of the practice that are outstanding which therefore impact on all population groups.

There were good arrangements for identifying and meeting the needs of vulnerable patients, and for ensuring continuity of contact with them. The practice had a very detailed and comprehensive strategy that set out how staff should identify and meet the needs of vulnerable patients. We saw evidence which confirmed the practice enacted their strategy and regularly reviewed it to make sure it was effective and responsive. Alerts were added to patients’ medical records so that all staff were aware of their vulnerability. Clinical staff held regular multidisciplinary meetings, which were used to discuss the needs of vulnerable patients. There were systems which supported clinical staff’s understanding of the risks to their vulnerable patients. There was a good system in place for handling, prioritising and escalating incoming information about patients who had cancer, and end of life needs.

Lead clinical staff had been identified for patients with learning disabilities. They regularly liaised with the local community learning disability team to ensure they were kept up-to-date about patients’ needs. There were longer appointments available for patients with learning disabilities and annual health checks were also offered. The practice had produced information in an appropriate format for this group of patients, to help them understand the services available to them. All staff had completed training in how to meet the needs of patients with learning disabilities.