Agenda item

Following a recent Committee request, representatives of Norton Medical Centre were in attendance to provide a response to the latest Care Quality Commission (CQC) inspection of its services.  NHS North East and North Cumbria Integrated Care Board (NENC ICB) personnel were also present and made the following initial statement:

‘In the context of the NHS in England, the Integrated Care Board (ICB) oversees the commissioning of health services, while the Care Quality Commission (CQC) regulates the quality of those services, including general practices.

The ICB has duties to ensure that commissioned services meet the CQCs standards and to respond to CQC assessments and concerns.

When any practice receives an adverse rating from the CQC, the ICB is notified and asked to carry out its own investigation under the terms of the GP contract.  The ICB is required to issue either a Quality Improvement Plan or a contract Remedial Notice to any practice that receives ‘requires improvement’ or ‘inadequate’ ratings.  The practice must demonstrate and provide evidence of improvement where concerns have been identified, therefore the ICB work with both the practice and CQC closely to ensure actions are taken to address any areas identified.’

Led by a GP Partner from Norton Medical Centre and supported by the Practice Manager, a presentation (circulated in advance and included within the meeting papers) was given covering the following:

·       Practice profile

·       Pre-inspection preparation

·       Post-CQC inspection outcome

·       Key themes identified in CQC report

·       Support received

·       Next steps

·       Supplementary information: CQC inspection ratings and areas of positive practice identified

The practice had been inspected routinely over several years, with its previous overall rating being ‘Good’.  It was advised ahead of the CQCs latest visit that an inspection was planned to look at two domain areas: ‘Responsive’ and ‘Effective’.

The inspection took place on 12 July 2024, after which the CQC requested further documentation and evidence.  Following the inspection, the practice was advised that the CQC would be issuing a notice of decision on 15 October 2024 in relation to Regulation 12 (Safe care and treatment), as well as a warning notice on 8 November 2024 in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).  The regulator was not assured that there was a safe system in place to triage service-users safely and found the practice lacked oversight of significant event monitoring.  The practice was disappointed by the findings which it felt did not reflect the hard work of practice staff, and it was noted that the practice had been living with this for some time even though the CQCs report was only published in March 2025.

An Action Plan in response to the inspection findings was agreed in conjunction with the CQC and the ICB and was included in the presentation for information – this demonstrated the issues identified by the regulator across each of its key domains, the action taken to date, and planned actions for the future.  Specific achievements highlighted included the introduction of a new care navigation system, improvements to triaging and patient access, the appointment of a new Practice Manager, and the implementation a new management structure (job descriptions and roles / responsibilities were being reviewed to ensure accountability and oversight).  It was also noted that some staff had left the practice to allow processes to change (subsequent recruitment was ongoing), and that GPs continued to manage a high volume of daily patient contacts, with further pressures created due to the number of eConsults requiring triage.

Further to the intended work outlined within the Action Plan, a list of ‘next steps’ was provided to give assurance on the future direction of the practice.  Included within this was a recognition that change took time and that for it to embedded fully, distributed leadership and culture development was required.  There were, however, many positive areas of practice identified by the CQC with which to build on, as referenced in the supplementary information slides.

The presentation concluded with comments from NENC ICB representatives who acknowledged that it was difficult for a practice to receive an adverse rating and that it did take time for a practice to respond.  Norton Medical Centre had worked hard over the last few months and understood that strengthening its offer was an ongoing process (not just something in response to the CQC).  The ICB would continue to work with both the practice and the CQC regarding changes to provision.

Thanking the practice for the information provided and the work it had already undertaken in response to the CQCs inspection findings, the Committee reflected on the positive feedback Members had received from users of the practice who had expressed an element of shock at the CQCs report.  In response to a query on GP recruitment, the Committee was informed that whilst the practice had lost GPs who had made the decision to move overseas, these were being replaced, with additional capacity being created via the offer of increased hours for existing staff.

Regarding the management structure, the Committee sought clarity on what needed to change in order for the practice to be successful.  Members heard that the practice did not previously have the right people in the right roles, and that the introduction of a Business Manager role would be beneficial (this would provide further support for the Practice Manager in addition to the recent appointment of their Personal Assistant).  Responding to other Committee queries, it was noted that the practice operated a call-back system (and tried to use digital platforms rather than physical appointments where appropriate), had managed to retain its salaried doctors for some time (despite the lure of more lucrative locum work), and was a teaching practice (though concern was relayed about the quality of GP trainees).

The practice was asked if it had a Patient Participation Group (PPG).  Confirming that one was in place, it was stated that the current membership was somewhat skewed and was not reflective of the registered population – efforts were therefore being made to get more appropriate representation on this group.  Discussion turned to patients declining health-checks and whether there was any evidence that specific demographics were avoiding these – whilst no clear pattern had been identified in this regard, the practice drew attention to younger people not seeing themselves as ill / at-risk, and the challenges, for some, in accessing services during the working day (though the practice did offer evening / Saturday appointments).  Ultimately, there was a level of personal responsibility around taking up the option of health-checks.

Questions concluded with the Committee querying whether the practice itself felt progress was being made.  Referencing past limitations around the organisational structure, Members were assured that important steps had been taken and that the desire to improve existing services should also be prevalent anyway.  The practice had benefitted from external support, but it remained vital to ensure the right staff were in the right place.

AGREED that the Norton Medical Centre response to the latest Care Quality Commission (CQC) inspection of its services be noted.