Chet Valley Medical Practice

Updated 7 August 2023

Chet Valley Medical Practice

George House

40-48 George Lane

Loddon

Norwich

Norfolk

NR14 6HQ

The practice has a dispensary which we visited as part of this inspection.

The provider is registered with CQC to deliver the Regulated Activities: diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury, family planning and surgical procedures.

The practice is situated within the Norfolk and Waveney Integrated Care System (ICS) and delivers General Medical Services (GMS) to a patient population of about 8932. This is part of a contract held with NHS England.

The practice is part of a wider network of GP practices, South Norfolk Healthcare in Partnership (SNHiP) primary care network (PCN).

Information published by Office for Health Improvement and Disparities shows that deprivation within the practice population group is in the eighth decile (8 of 10). The lower the decile, the more deprived the practice population is relative to others.

According to the latest available data, the ethnic make-up of the practice area is 0.7% Asian, 98.3% White, 0.1% Black, 0.8% Mixed, and 0.1% Other.

The age distribution of the practice population closely shows a larger population of older patients and a lower population of working age people.

There is a team of 7 GPs who provide cover at the practice. The practice has a team of 2 nurse practitioners and 3 nurses who provide nurse led clinics for long-term conditions. The GPs are supported at the practice by a team of reception/administration staff. The practice manager and operations manager provide managerial oversight.

The practice is open between 8am to 6.30 pm Monday to Friday. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments.

Extended access is provided as part of the South Norfolk Healthcare in Partnership (SNHiP) primary care network (PCN). Late evening and weekend appointments available.

Out of hours services are provided by IC24 accessed through the 111 service.

Updated 7 August 2023

We carried out an announced comprehensive inspection at Chet Valley Medical Practice on 7 June 2023. Overall, the practice is rated as requires improvement.

Safe – requires improvement.

Effective - requires improvement.

Caring – good.

Responsive - requires improvement.

Well-led - requires improvement.

Following our previous inspection published 19 January 2017, the practice was rated outstanding overall and for all key questions because:

• There was a clear strong leadership structure and staff felt engaged, supported and valued by management. The practice proactively sought feedback from staff and patients, which it acted upon.
• The practice had a robust and comprehensive range of governance arrangements that were regularly reviewed to ensure their effectiveness.

At this inspection, we found that those areas previously regarded as outstanding practice were now embedded throughout the majority of GP practices. While the provider had maintained some of this good practice, the threshold to achieve an outstanding rating at this inspection had not been reached. During this inspection we identified areas of concern and therefore the practice is now rated requires improvement for providing safe, effective, responsive and well-led services and good for providing caring services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Chet Valley Medical Practice on our website at www.cqc.org.uk

Why we carried out this inspection.

We carried out this inspection to follow up concerns follow up concerns reported to us.

Outline focus of inspection to include:

• Key questions inspected.
• Areas followed up including ‘shoulds’ identified in previous inspection.
• Areas of concern that had been reported to us.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.
• Staff questionnaires

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We found that:

• Prior to this inspection, the practice had recognised there were areas of improvement needed and had developed a detailed action plan. The new management team which included a GP lead had worked with the Integrated Care Board to address these shortfalls. This included management of patients prescribed high risk medicines and access.
• The GP leaders had developed more effective leadership and had clinical and management oversight of the progress made against a risk register and action plan. Some of the improvements and new ways of working had been newly implemented, and needed to be further embedded to ensure they were safe, effective, and sustained.
• The new systems and processes did not wholly evidence that safe and effective care was always delivered to all patients.
• The improved systems had resulted in staff taking on new and additional roles, which had contributed to some low morale.
• The practice had installed a new computer system which has been installed 3 weeks prior to the inspection, staff told us this had increased the levels of stress they were experiencing and, in some areas, there were backlogs of work or staff shortages.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Not all patients could access care and treatment in a timely way.

We found 2 breaches of regulations. The provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the provider should:

• Continue to monitor the system and process to ensure all patients including those with a learning disability are followed up within an appropriate timeframe.
• Continue to encourage patients to attend for NHS health checks.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care