The Care Quality Commission
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  • GP practice

Parish Fields Practice

Overall: Good read more about inspection ratings

The Health Centre, Mount Street, Diss, Norfolk, IP22 4WG (01379) 642023

Provided and run by:
Parish Fields Practice

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Parish Fields Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Parish Fields Practice, you can give feedback on this service.

23 June 2021

During an inspection looking at part of the service

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.

7 March 2019

During a routine inspection

This practice is rated as Good overall. At the previous inspection in November 2014 the practice was rated as Outstanding overall.

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Parish Fields Medical Practice on 7 March 2019 as part of our inspection programme.

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 rated the practice as requires improvement for providing safe services because:

  • The provider did not ensure the proper and safe management of medicines, in particular, the safe and secure storage of medicines and restricting access to medicines including controlled drugs. Following our inspection, the practice responded by making security improvements.

We rated the population group people with long term conditions as requires improvement because:

  • Quality and outcomes framework (QoF) data for 2017/18 was below local and national averages and the practice were not able to demonstrate that improvements made had positively impacted on the quality of care provided.

However, we also found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs, with the exception of patients with long term conditions.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centred care, however improvements were required in the quality of care provided to people with long term conditions.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.

We identified areas where the provider could improve and should:

  • Continue to monitor, evaluate and improve the quality of care provided to patients with long term conditions.
  • Review access to services to improve timely access to care and treatment for patients.
  • Improve the identification of carers to enable this group of patients to access the care and support they need.
  • Review and improve systems and processes for patient outcomes, particularly in relation to exception reporting and the recording of the smoking status of patients.

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

17 November 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We inspected this practice on 17 November 2014 as part of our new comprehensive inspection programme.

Parish Fields Practice is located in a building which is shared with another GP practice in Diss and serves a population of around 7600.

The overall rating for this practice is outstanding. We found the practice was good in the safe, caring and well led domains and outstanding in the effective and responsive domains. We found the practice provided outstanding care to patients in vulnerable circumstances and families, children and young patients. We found that the practice provided good care to older patients, patients with long term conditions, working age patients and patients experiencing poor mental health.

Our key findings were as follows:

  • The practice had a system for reviewing and responding to safety alerts and significant events.
  • Staff took account of changes in national guidance when planning patient care.
  • Staff had access to training to update their skills.
  • Practice staff provided proactive and tailored services to support vulnerable patients
  • The practice had a robust governance structure in place with designated lead and administrative staff for a range of areas, alongside a range of different meetings for staff.
  • Staff spoke of a culture of quality improvement and learning through partnership working
  • The practice was not afraid to challenge local commissioning arrangements in order to improve outcomes for patients

We saw several areas of outstanding practice including:

  • The practice was working with Norfolk and Norwich University Hospital and the University of East Anglia as part of a pilot project to better identify patients at risk of type 2 diabetes and to reduce the risk of these patients developing type 2 diabetes through lifestyle change and motivational support. We saw evidence that clinical audit work around gestational diabetes had enabled the practice to identify more patients who were at risk and to support them with lifestyle changes during pregnancy. The practice could demonstrate how their proactive partnership approach was achieving better outcomes for their patients.
  • Parish Fields Practice had developed a clinical audit programme which was both comprehensive and embedded. The practice had completed an extensive scheme of clinical audit cycles, covering a broad range of clinical areas. There was evidence that this had led to improvements in outcomes for patients. We saw that the results of audits had been shared routinely across clinical teams, both internall and externally. Staff spoke of a culture of quality improvement and continuous learning within the practice.
  • The practice had identified the needs of its local population and engaged with partner agencies to secure improvements to services where these were identified. The practice recognised the dichotomy of wealth and deprivation that exists in Diss and the surrounding area. The practice held food bank vouchers for those who were in need and worked in partnership with the Trussell Trust (a community body which aims to alleviate hunger and poverty). Practice staff were particularly aware of children in need and they worked closely with the Clinical Commissioning Group (CCG), local schools and Public Health teams to ensure that children who may be vulnerable accessed services. Arrangements were in place to ensure that traveller families registered and that traveller children were immunised. Care and support were offered on site at a local women’s refuge and across short term housing providers to ensure that the needs of these patients were identified and met. Strong and bespoke joint working arrangements were in place with the Norfolk Recovery Partnership to support patients with drug and alcohol addiction.
  • The practice used information received to ensure patient care was being planned effectively. For example, the practice received hospital data on admissions and A&E attendances daily. This information was disseminated to the patient’s named GP via email by an administrator within the practice. If a patient remained in hospital for more than seven days, the named GP rang the hospital to discuss the admission and to attempt to facilitate discharge. Patients were contacted by their named GP within 48 hours following discharge from hospital.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice