We carried out an announced comprehensive inspection at Old Catton Medical Practice on 29 January 2018. The overall rating for the practice was good, with a requires improvement rating for providing safe services. We issued a requirement notice against regulation 17 of the Health and Social Care Act Regulations 2014 Good governance, as the practice did not have effective systems for managing safety alerts and pathology results in a timely way.

We also identified areas the practice could improve and should:

• Review the use of information technology systems to drive improvement, including coding suspected cancer referrals and the templates used to record care and treatment for palliative care patients.
• Provide timely annual reviews for patients with learning difficulties.
• Monitor and review patient survey results and respond accordingly.

The full comprehensive report on the January 2018 inspection can be found by selecting the ‘all reports’ link for Old Catton Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 15 November 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 29 January 2018.

This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

Overall the practice is now rated as good, with a good rating for providing safe services.

At this inspection we found:

• Systems and processes were reviewed and improved to effectively manage safety alerts and pathology results.
• The system for coding suspected cancer referrals was reviewed and improved and the recording template for palliative care templates was effective in record all necessary information.
• The practice reviewed their list of patients with learning difficulties and increased the numbers of structured annual reviews completed. We also saw that patients who had not yet had an annual review were scheduled to have one.
• The practice had also reviewed the latest GP patient survey data and were taking action to improve the results, including commissioning a telephone system audit, increasing GP staffing levels, increasing telephone answering capability during busy periods.

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

Please refer to the detailed report and the evidence tables for further information.

This practice is rated as Good overall. (Previous inspection September 2015 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Old Catton Medical Practice on 29 January 2018.

At this inspection we found:

• The practice had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the practice learned from them and improved their processes. The practice shared outcomes of significant events with staff and other local GP practices where appropriate.
• 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.
• Staff were consistent and proactive in helping patients to live healthier lives.
• The facilities and premises were appropriate for the services delivered.
• The practice learned from external safety events as well as patient and medicine safety alerts but two recent safety alerts regarding the prescribing of gabapentin and quinine had not been received by the practice. When we raised this with the practice they undertook responsive action immediately.
• Annual health assessments for people with a learning disability were undertaken; however the practice had 35 patients on the learning disabilities register, of which only five had received a health review in 2017. After the inspection the practice informed us that 12 of these patients had been seen in the period October to December 2016.

• The practice used information technology systems to monitor and improve the quality of care but we found improvement was needed to optimise its use. For example, the practice did not make use of a recording template for palliative care patients and processes for reviewing pathology (blood test) results could not assure us that all results had been reviewed timely.
• Results from the July 2017 annual National GP Patient survey showed that patients’ satisfaction with the practice was generally below local and national averages.
• The practice had a clear vision and credible strategy to deliver high quality care and promote good outcomes for patients.

The area where the provider must make improvements as they are in breach of regulations is:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Review processes for, and the use of, the information technology systems to drive and monitor good quality care.
• Review the processes for the coding of two week wait cancer referrals.
• Ensure patients with a learning difficulty receive timely annual reviews.
• Review the recording template for palliative care patients.
• Continue to review patient survey results and respond to these results accordingly.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Old Catton Medical Practice on 23 September 2015. Overall the practice is rated as good.

We found the practice to be safe, effective, caring, responsive to people’s needs and well-led. The quality of care experienced by older people, by people with long term conditions and by families, children and young people is good. Working age people, those in vulnerable circumstances and people experiencing poor mental health also receive good quality care.

Our key findings were as follows:

• The practice had a good understanding of the needs of the practice population and services were offered to meet these.
• The practice had robust significant event and complaints procedures and reviewed these regularly to ensure appropriate action would be taken.
• Feedback from patients and observations throughout our inspection showed the staff were kind, caring and helpful. The clinical staff at the practice provided effective consultations, care and treatment in line with recommended guidance.
• New staff received appropriate inductions into their role.
• There was visible practice leadership and staff felt supported by the management and were involved in the vision of providing high quality care and treatment to patients.

We saw one area of outstanding practice:

• The practice had a programme of monthly visiting speakers and consultants to drive staff development and learning. Invitations to attend were circulated to other practices locally. Staff received protected learning time, up to one afternoon per week, if required.

However there was one area of practice where the provider needs to make improvements. Importantly the provider should:

• Improve the arrangements for the security of blank prescription forms in line with NHS guidance.

Professor Steve Field

CBE FRCP FFPH FRCGP Chief Inspector of General Practice

People we spoke with were generally satisfied with the service they received. Some people expressed opinions about the changes that the practice had gone through over the last few years but told us that things ‘appeared to be getting better’.

One person told us “I telephoned this morning for an appointment. I was telephone triaged which I think is great and I was in to see the doctor within two hours, even better.” They went on to say “The nurses are brilliant and the reception staff are usually okay, though the doctors can vary depending on who you get to see.”

Of the seven people we spoke with, three people expressed the view that doctors could be more understanding on occasion.

Most of the people we spoke with had telephoned in that morning to see a doctor. All said getting an appointment was now much easier than it used to be. Another person we spoke with had a pre-booked appointment. They said they sometimes find they can wait a long time in the waiting room before seeing the doctor. Most of the people we spoke with said that they felt listened to and that they were treated with respect and dignity. They told us appointments were usually thorough, that the doctor took time to explain things, that they were of sufficient length and not rushed.

The practice building was easy to access with ample parking. All windows facing public areas had blinds and privacy glass. There was a toilet accessible to people with disabilities on the ground floor.