Letter from the Chief Inspector of General Practice

When we visited Dr Noren & Partners at

Steyning Health Centre on 10 January 2017 to carry out a comprehensive inspection,

we rated them as good overall. However, we found the practice required

improvement for the provision of effective services and we told them that they

must:

• Assess, monitor and mitigate risks relating

  to the health, safety and welfare of patients related to repeat medicine

  reviews.

We also said they should:

• Continue to work towards improving the

  recording of care outcomes for patients with chronic obstructive pulmonary

  disease.

Following our inspection, the practice sent

us an action plan setting out the action they would take to meet the legal

requirements in relation to the breaches in regulations that we had identified.

This inspection was an announced focused

inspection carried out on 21 July 2017 to confirm that the practice had carried

out their action plan and was now meeting the legal requirements. This report

should be read in conjunction with the full report of our inspection on 10

January 2017, which can be found on our website at

www.cqc.org.uk

.

We have amended the rating for this practice

to reflect these changes. The practice is now rated good for the provision of

effective services. Overall the practice remains rated as good.

On our inspection of 21

July 2017 we found the practice had made improvement and now met the legal

requirements in the areas they had previous breached. Specifically we found:

• The practice had reviewed their process for ensuring patients on repeat

  medicines had these medicines reviewed at appropriate intervals. They had taken

  action in a number of areas and we saw data that showed significant

  improvement. For example, in the 12 months  up to 21 July 2017, 80% of patients on four or

  more medicines had a medicine review recorded in their notes compared to the

  51% we found at our previous inspection.

• The practice had continued to improve their reviewing

  and recording of care outcomes for patients with chronic obstructive pulmonary

  disease (a chronic lung disease). We saw data which showed that for the year

  April 2016 to March 2017 the practice had achieved 33 of the 35 quality

  framework points available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Noren and Partners on 10 January 2017. Overall the practice is rated as good. However, requirements were required in providing effective services. Our key findings were as follows:

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

• There was a system in place for reporting and recording significant events, for learning to be circulated to staff and changes implemented where required. Reviews of complaints, incidents and other learning events were thorough.
• Risks related to premises, storage of medicines, equipment and to the provision of medicines onsite were assessed and well managed.
• Staff assessed patients’ ongoing needs and when they delivered care to patients it was in line with current evidence based guidance.
• The practice was performing above average on most clinical outcomes in terms of national data.
• However, the recording of care for patients with chronic obstructive pulmonary disease showed that improvements were needed. The practice had recognised this and had taken action to improve. However at the time of inspection it was too early to assess whether the action had led to improvements.
• Reviews of patients on repeat medicines were not always recorded properly and did not ensure effective monitoring. There were other monitoring processes in place, but these did not fully mitigate the risk of poor recording in terms of reviews undertaken.
• The practice planned its services based on the needs and demographic of its patient population and was highly responsive where services could be altered to meet specific needs.
• The appointment system met the needs of patients and was continually reviewed to improve access to the practice.
• Patients’ feedback suggested they felt well cared for and supported.
• Staff were trained in order to provide them with the skills, knowledge and experience to deliver effective care and treatment. Staff were able to ask for and receive additional training where it was identified as a benefit to individuals and to the service.
• The planning of care for vulnerable groups such as patients with cancer, dementia and complex health needs enabled responsive care.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice supported an open culture and continuous learning environment to drive improvement.

Areas the provide must make improvements are:

• Assess, monitor and mitigate risks relating to the health, safety and welfare of patients related to repeat medicine reviews.

Areas the provide should make improvements are:

• Continue to work towards improving the recording of care outcomes for patients with chronic obstructive pulmonary disease.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice