Norwood Surgery

Updated 2 May 2017

Norwood Surgery is a partnership practice run by five GP partners (four male, one female) and is located on a residential street in Southport, Merseyside. The practice provides GP services to approximately 9,000 patients. All services are delivered under a GMS contract. Norwood Surgery falls within Southport and Formby Clinical Commissioning Group (CCG). The practice is a teaching practice, hosting GP registrars.

The partnership GPs are supported by a salaried GP (male) three practice nurses (all female) and a healthcare assistant (female). The practice administration team is overseen by a practice manager. The practice manager has a deputy who oversees the work of 16 administration and reception staff. The practice is open from 8am to 6.30pm each day, with extended hour’s appointments available from 6.30pm – 8.30pm each Monday and Thursday evening. The practice closes on one Wednesday afternoon per month for staff training.

The practice premises provide patient services on ground and first floor level. The building is fully accessible for patients with limited mobility, with the premises being upgraded recently to provide fully accessible consulting rooms on the first floor which are accessed by a newly installed patients lift. Car parking is available outside the practice and there are clearly marked disabled parking spaces to the front of the building. There is a lift outside the building for those patients unable to use the steps to the front door of the premises.

Inside the surgery premises there are four GP consulting rooms and a fully equipped treatment room at ground floor level. Patient toilets are available which are fully accessible and have been upgraded to provide baby change facilities. There is a small, private room available for any mothers who need to breast feed, or for any patients who need more privacy when dealing with matters at the reception desk. Part of the reception desk has been dropped down to allow easier wheelchair access and communication for disabled customers. The first floor can be accessed by a lift and has three GP consulting rooms. As part of the refurbishment of the building, where necessary the width of doorways were increased to allow easy wheelchair access.

Morning surgeries at the practice commence at 8am and last for two hours thirty minutes. Afternoon surgeries also last for two hours thirty minutes and are staggered so that appointments are available from 2pm to 6pm each afternoon. Patients who need to be seen as an emergency are seen at the end of each surgery.

When the practice is closed, patients ringing the surgery are directed by a phone message to ring NHS 111. Following review of patients, NHS 111 can refer patients to the locally commissioned out of hours service, Go to Doc.

Updated 2 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Norwood Surgery, Southport on 10 November 2016. Overall the practice is rated as Good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other providers to share best practice. The work of the practice with patients with type two diabetes had achieved positive results.
• The monitoring of diabetes patients who no longer relied on medicines to control diabetes, had led to other findings which contributed to advances in care for patients with other long term conditions, such as heart disease and poor liver function.

• Feedback from patients about their care was consistently positive.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example GPs and nurses started all morning surgeries at 8am to allow working patients, students and school children better access to appointments. This complemented two, late evening surgeries each week.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and responded to them compassionately and constructively. For example, considerable modifications were made to the building to allow easier access for disabled patients, following feedback from those patients and their carers and family members.
• The practice had a clear vision which had quality and safety as its top priority. This was regularly reviewed and discussed with stakeholders and staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

There were areas where the practice could make improvements. The practice should

• Prioritise the replacement of fabric covered chairs in consulting rooms.

• Lock away any prescription pads left in printers overnight.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 May 2017

The practice is rated as outstanding for the care of patients with long term conditions.

• The practice had achieved positive results in helping patients manage their type 2 diabetes through diet and lifestyle advice. In diabetes medication alone, this had reduced the spend of the practice by over £57,000.

• Results from groups of diabetic patients monitored by clinicians showed these patients experienced sustained weight loss, improved cholesterol levels, improved blood pressure readings and a return to normal blood glucose levels.
• A patient we spoke with described the positive change in their life, following cessation of diabetes control medication.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Practice clinicians had investigated instances of poor recovery of patients with exacerbated symptoms of their respiratory illnesses, such as COPD and asthma, as well as those with cystic fibrosis. As a result it was identified that poorly maintained nebuliser equipment in patient’s homes impacted on patient recovery. This was highlighted to the CCG and is now on the CCG risk register, meaning this information will be shared with practices and nebuliser equipment in people’s homes will be checked.
• Longer appointments and home visits were available when needed; we saw that staff knew the practice population well and ensured any patients needing longer appointments had access to these when necessary.
• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 2 May 2017

The practice is rated as good for the care of families, children and young people.

• A partner at the practice with a specialist interest in cardiovascular disease had used Park Runs to engage patients of all ability, joining patients on weekly runs in a park close to the practice. This initiative has grown, with several GPs, nurses and the practice manager taking part in runs each week with an increasing number of patients from the practice of all ages taking part.

• Practice clinicians had produced info-graphics which spelt out clearly to patients the amount of hidden sugars in their diet. Several younger people as well adults are receiving support from clinicians to change their diet and lifestyle.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Data for rates of cervical screening by the practice showed the percentage of women receiving this intervention was slightly higher than local and national averages, at 82%. (CCG and national average 81%).

• Appointments were available every morning at 8am and at two late evening surgeries each week. Premises were suitable for children and babies.

• We saw positive examples of joint working with midwives and health visitors.

Updated 2 May 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Uptake of flu vaccine amongst older patients was good, with 80% of patients receiving the vaccine.

• The practice employed a pharmacist directly to specifically run the STOPP START medication review plan for older patients on multiple medicines.

• The practice healthcare assistant had screened older patients to identify those at risk of frailty. Comprehensive care plans were developed for these patients and shared with the multi-disciplinary care team.

Updated 2 May 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Practice clinicians had conducted audit on those patients at risk of cardio vascular disease, and the effect of low glycaemic index foods on symptoms of this condition. Results were shared with other clinicians, in particular from cardiologists both locally and nationally who have visited the clinicians to review and discuss results.

• The practice offered appointments with male and female clinicians, with a choice for those patients who expressed a preference.

• The practice had identified 144 patients (1.6% of the practice register) who were also carers, and ensured carers had good access to GPs and nurses.

• Figures from the last GP Patient Survey showed:

• The percentage of respondents to the GP Patient Survey who were very satisfied or fairly satisfied with their GP practice opening hours, was 92% compared to the CCG average of 84% and national average of 79%.

• The percentage of respondents to the GP Patient Survey who stated that the last appointment they got was convenient was 100%, compared to the CCG average of 95% and national average of 92%.

Updated 2 May 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• All staff have received dementia awareness training and the practice is a ‘Dementia Friendly’ practice.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Some improvement was needed in the review of patients who had received a diagnosis of dementia within the past 12 months.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 2 May 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice demonstrated that it listened to patients who felt vulnerable and responded positively to any issues they raised.

• The practice held a register of patients living in vulnerable circumstances including those with a a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.