High Street Surgery

Updated 27 January 2023

High Street Surgery is located in Lowestoft at:

The Surgery

High Street

Lowestoft

NR32 1JE

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 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 12,435. This is part of a contract held with NHS England.

The practice is part of a wider network of GP practices in the Lowestoft Primary Care Network (PCN).

Information published by Public Health England shows that deprivation within the practice population group is in the second lowest decile (two 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 1.2% Asian, 97.1% White, 0.4% Black, 1.1% Mixed, and 0.2% Other.

The age distribution of the practice population closely mirrors the local and national averages. There are more male patients registered at the practice compared to females.

There is a team of three GP partners and two salaried GPs. The practice has a team of four advance nurse practitioners and three nurses who provide nurse led clinics for long-term conditions, the practice has two health care assistants and an emergency care practitioner. The GPs are supported at the practice by a team of reception/administration staff. The practice manager and assistant practice manager provide managerial oversight.

The practice is open between 8am and 6:30pm Monday to Friday. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments. Extended hours appointments are available at the practice from 7am to 8am on Mondays and Tuesdays.

Extended access is provided locally by Lowestoft Primary Care Network (PCN), where late evening and weekend appointments are available. Out of hours services are provided by Integrated Care 24 (IC24)and accessed via the NHS 111 service.

Updated 27 January 2023

We carried out an announced comprehensive inspection of High Street Surgery on 21 September 2022. Overall, the practice is rated as requires improvement.

Safe - Requires improvement

Effective - Requires improvement

Caring - Good

Responsive - Requires improvement

Well-led - Inadequate

Following our previous inspection on 25 October 2021, the practice was rated requires improvement overall and for the safe, effective and well led key questions but rated as good for caring and responsive key questions. The practice has an inspection history of requires improvement and inadequate ratings since April 2015 and has been unable to evidence sustained improvements.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for High Street Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up on breaches of regulation from our previous inspection on 25 October 2021 and in line with our inspection priorities.

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 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:

• Patients did not always receive effective care and treatment that met their needs.
• Although improvements had been made in the uptake of childhood immunisations, we found the practice were still below local and national averages for cervical screening and some prescribing areas.
• The practice did not evidence that all medicines were prescribed safely to patients with the required monitoring.
• We found gaps in the system for gaining assurance that externally employed staff had a Disclosure and Barring Service (DBS) check. The practice took immediate action to address this.
• The practice had effective processes for supervision and competency checks for all staff, these were formally recorded for proactive learning.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice respected patients privacy and dignity and patient confidentiality was maintained throughout the practice.
• GP patient survey data was below CCG and national averages, the practice had engaged in patient feedback exercises to understand patients poor experiences of accessing the practice, however, verified data was not available to measure improvements.
• The way the practice was led and managed did not promote the delivery of person-centre care. We identified shortfalls in systems that required further embedding such as the monitoring of long-term conditions. We found examples where leadership was ineffective and service user care was of poor quality as a result of this and the practice had failed to identify the areas of poor performance. The practice has an inspection history of requires improvement and inadequate ratings since April 2015 and has been unable to evidence sustainable improvements.

We found a breach of regulation. The provider must:

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

In addition, there were areas the provider could improve and should:

• Continue to improve engagement with patients eligible for the cervical cancer screening programme to improve uptake.
• Continue to review and reduce where appropriate, prescribing rates for hypnotic, psychotropic and opioid based medicines.
• Continue to identify, contact and assess patients who are eligible for NHS health checks.
• Continue to review and improve the newly implemented system and process to gain feedback from patients.

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 Hospitals and Interim Chief Inspector of Primary Medical Services