Parish Fields Practice

Updated 8 July 2021

• Parish Fields Practice is situated within the NHS Norfolk and Waveney Clinical Commissioning Group (CCG) and provides services to approximately 8,200 patients under the terms of a general medical services (GMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.
• The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services, family planning, surgical procedures and treatment of disease, disorder or injury.
• The practice can offer dispensing services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy.
• The provider is a partnership of three male and one female GP partners. The clinical team also includes one regular locum GP (a retired partner), one advanced nurse practitioner, with another advanced nurse practitioner starting 1 July 2021, four practice nurses and one healthcare assistant. The dispensary has a dispensary manager and four other dispensers. There is a practice manager who leads the non-clinical team, supported by an assistant practice manager who leads the administrative staff and a lead receptionist who supports receptionists.
• There are higher than average numbers of patients over the age of 65, in common with the characteristics of the local area, and fewer patients aged under 18 than the national average. Information published by Public Health England rates the level of deprivation within the practice population group as seven, on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Life expectancy for males and females in the practice population is in line with local and national averages
• The practice’s opening times are from 8am until 6.30pm Monday to Friday. Triaging of any online clinical queries starts at 7.30am by an advanced nurse practitioner and a GP. Appointments with a HCA are available from 8am Monday to Friday, with other clinician appointments available from 8.30am Monday to Friday, although appointments with a nurse practitioner could be arranged from 7.30am. The dispensary is open between 8.30am to 6.30pm Monday to Friday.
• Out-of-hours GP services are provided by IC24, via the NHS111 service.

Updated 8 July 2021

We carried out a desk-based review of Parish Fields Practice on 23 July 2021.

This practice is rated as good overall.

At our previous inspection published on 24 April 2019, the practice was rated as good overall and for providing effective, caring, responsive and well-led services. The practice was rated requires improvement for providing safe services and was issued with a requirement notice. The population group people with long term conditions was also rated requires improvement. The full reports for previous inspections can be found by selecting the ‘all reports’ link for Parish Fields Practice on our website at www.cqc.org.uk

This desk-based review was to follow up on the breach of Regulation and areas where the provider ‘should’ improve identified at our previous inspection. We found the required improvements had been made and the practice is now rated as good for providing safe services and for the population group people with long term conditions.

In this review we found:

• Improvements had been made to the safe and secure storage of medicines, which included medicines which required refrigeration and controlled drugs.

• The practice had undertaken work to improve their quality and outcomes framework (QOF) performance data for people with long term conditions. Their performance had improved in all indicators, apart from one where this had reduced in line with national performance. The practice had lower than average performance for one indicator; however, the personalised care adjustment rate was also low. The practice had further improved their long-term condition management system in April 2021.

• At the previous inspection the percentage of women eligible for cervical cancer screening at a given point in time who were screened adequately within a specified period (within 3.5 years for women aged 25 to 49, and within 5.5 years for women aged 50 to 64) was 74.4%. This was from Public Health England data from 1 April 2017 to 31 March 2018. At the last inspection, the uptake was compared with the England average which was 71.7% and there was no statistical variation. However, at this inspection, uptake was compared with the 80% national target and the practice was below this target at 74.4%. Arrangements were in place to follow up non-responders to cervical screening invitations. Patients were contacted by a clinician, so that any clinical issues could be discussed, and an appointment booked. Clinicians also discussed this opportunistically during patient consultations. Appointments for cervical screening were available Monday to Friday with flexibility of appointment time, and patients could book an appointment online. Early morning appointments at 7.30am were available by arrangement. Text reminders were also sent to patients to remind them to book a cervical screening appointment and to remind them about booked appointments.

• At the previous inspection, the practice had identified 72 patients with caring responsibilities (approximately 0.9% of the practice population). Improvements had been made and the practice currently had 257 patients registered as carers which was just over 3% of the practice population. Carers were offered annual health checks, flu vaccinations and longer appointments where necessary. The practice offered a dispensary delivery service, which was further extended in response to COVID-19 to support vulnerable patients who were shielding and their carers. The practice held a carers support group which had been temporarily stopped due to COVID-19, although it was planned to restart this group once COVID-19 restrictions were lifted, and carers felt confident to attend. The practice had a social prescriber available who carers could be referred to for support and advice.

• The practice patient participation group undertook a patient survey in August 2019 and from 46 respondents, 91% were very or fairly happy with their experience at the practice. The most recent National GP patient survey data from 1 January 2020 to 31 March 2020 showed improvements in relation to access from the data from the same time period in 2018. This included for ease of getting through on the phone, satisfaction with GP practice appointment times, satisfaction with type of appointment offered and overall experience of making an appointment.

Whilst we found no breaches of regulations, the provider should:

• Continue to monitor, evaluate and improve the quality of care provided to patients with long term conditions, to confirm the new system which commenced in April 2021 does achieve the expected performance outcomes.
• Continue work to review and improve the uptake of cervical screening.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care.

Updated 8 July 2021

Updated 24 April 2019

Updated 24 April 2019

Updated 24 April 2019

Updated 24 April 2019

Updated 24 April 2019