This practice is rated as Good overall. (The previous inspection was in March 2015 where we rated the practice as good overall)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive at Narrowcliff Surgery on Wednesday 11 April 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• There had been changes and improvements in the governance processes within the nursing team and with the management of medicines requiring refrigeration since the last inspection.
• Medicines were managed well at the practice and the practice had lower than local and national prescribing rates for opioid and antibiotic prescribing and prescribing costs.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients gave positive feedback about the care and treatment they received. Results from the July 2017 national GP patient survey showed the practice had performed better than CCG and national averages for all 23 questions.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. Staff said the practice was a good place to work and added that the leadership team were supportive and encouraged career development and learning.
• There was evidence of systems and processes for learning, continuous improvement and innovation. The practice had taken part in many local pilots to test new methodology and software.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Narrowcliff Surgery was inspected on Tuesday 10 March 2015. This was a comprehensive inspection.

Overall the practice is rated as good.

Specifically, we found the practice to be good for providing effective, caring and responsive services. It was also good for well led and providing services for the six population groups. It required improvement for providing safe services.

Our key findings were as follows:

There was a track record and a culture of promptly responding to incidents, near misses and complaints and using these events to learn and change systems so that patient care could be improved. However, some policies and procedures were not being followed or monitored effectively. For example, infection control procedures did not identify the risks associated with the spread of infection and medicine processes had not being monitored to ensure checks were being carried out.

Staff were aware of their responsibilities in regard to consent, safeguarding and the Mental Capacity Act 2005 (MCA).

The practice was clean and tidy.

Medicines were managed well at the practice but temperature checks on refrigerated medicines were not always carried out and some documents required for the administration of vaccines had not been completed.

The GPs and other clinical staff were knowledgeable about how the decisions they made improved clinical outcomes for patients.

Data outcomes for patients were equal to the average locally. Where data had been identified as being lower than expected, plans were in place to improve the outcomes for patients.

Patients were complimentary about how their medical conditions were managed.

The practice was pro-active in obtaining as much information as possible about their patients which does or could affect their health and wellbeing. Staff knew the practice patients well, were able to identify people in crisis and were professional and respectful when providing care and treatment.

The practice planned its services to meet the diversity of its patients. There were good facilities available, adjustments were made to meet the needs of the patients and there was an effective appointment system in place which enabled a good access to the service.

The practice had a vision and informal set of values which were understood by staff. There was a leadership structure in place and staff felt supported.

We found areas where the provider MUST make improvements.

• The provider must protect patients and others against the risks associated with the unsafe use and management of medicines, by means of making of appropriate arrangements for the safe keeping, administration and disposal of medicines.

• The provider must ensure that patients and others are protected against identifiable risks of acquiring infection by an effective operation of systems to assess, prevent, detect and control the spread of infection.

We also found areas where the provider SHOULD make improvements. The provider should:

• Ensure systems are in place to ensure staff are aware of, follow and monitor the policies and procedures which govern activity. For example, infection control audits and procedures and medicines management. Fridge temperature management

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with seven patients who were visiting Narrowcliff on the day of our inspection and heard from six of the virtual patient participation group. All twelve patients informed us they thought the practice was “really good” “absolutely fine” and “excellent”.

Patients were pleased with the service they received from the practice. Patients told us they had been involved in the decisions made about their care. We were told that staff treated people with respect and dignity. One patient said "The doctor always shows an interest in me and listens carefully to what I have to say." Patients said it was easy to get an appointment when they wanted. Patients with children were also very pleased with the care their family received.

Patients felt confident and safe in the care of the doctor and nurse. Staff were clear about what action they would take if they saw or suspected any bad practice or abuse. Staff had been given formal training in safeguarding adults.

Patients told us that they always felt safe in the care of the staff. There were appropriate arrangements in place which ensured that staff kept their knowledge and skills up to date. Staff spoke about the supportive environment and confirmed that they had access to adequate training.

There were effective systems in place to monitor the quality of the service provided and patients felt able to give feedback about the service they received.