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.

In response to the CQCs previous mid-2024 inspection (published in March 2025) which saw Norton Medical Centre downgraded from ‘Good’ to ‘Requires Improvement’ (the ‘responsive’ domain being deemed ‘Inadequate’), the Committee invited the practice to provide its response to the regulator’s findings – this was subsequently considered at the Committee meeting in May 2025.

In March 2026, the CQC published its latest view of Norton Medical Centre following an inspection in October 2025.  The practice’s overall rating remained ‘Requires Improvement’, but whilst the ‘effective’ and ‘responsive’ domains had been upgraded, the ‘well-led’ domain was downgraded to ‘Inadequate’.  Prior to the publication of these findings, the CQC served a warning notice on Norton Medical Centre on 17 November 2025 for failing to meet the regulations relating to safe care and treatment.

Reflecting on these latest outcomes, the Committee agreed that the practice should provide a further response.  Representatives were therefore in attendance at this meeting and, led by the Interim Practice Manager and supported by three GP Partners, a presentation was given which included the following:

·       Latest Inspection: Conducted by the CQC on 2 October 2025 and published on 6 March 2026, the practice was graded ‘Good’ in the ‘effective’ and ‘caring’ domains, ‘Requires Improvement’ in the ‘safe’ and ‘responsive’ domains, and ‘Inadequate’ in the ‘well-led’ domain.

·       Safe: Areas of improvements and strengths were found in relation to safeguarding, clinical systems and continuity, environmental and infection control, and patient safety in practice.  However, focus was required around safety culture and learning, staffing and competency, medicines safety (it was noted that previous medication issues involved an external agency that was supporting the practice), and incident-reporting and governance.

·       Responsive: Achievements around person-centred care, equity and inclusion, and future planning were seen as areas of improvements and strengths, whilst work was needed on service access, listening and engagement, communication and information, and care co-ordination.

·       Well-Led: Shortfalls were identified in terms of equality, diversity and inclusion, governance and risk management, partnership and stakeholder working, learning and improvement, leadership and culture, leadership capability, and ‘freedom to speak up’.

·       Well-Led Action Plan: To improve leadership and accountability, action would be taken around recruitment, establishing the practice’s ‘vision’, strengthening staffing and meeting structures, reviewing the risk register, and enhancing communication with staff and patients (e.g. ‘You said, we did’).  Further actions in relation to staff engagement, wellbeing and support (staff survey; 1:1s and appraisals), patient and public involvement (Patient Participation Group (PPG); patient feedback), responding to concerns (complaints process; ‘freedom to speak up’), and monitoring and demonstrating improvement (regular reviews; engagement with staff; engagement with stakeholders for feedback) had also been identified.

·       Staff Survey: Results were relayed from a post-inspection staff survey which focused on eight areas – safety and speaking up, leadership and management, workload and pressure, learning from mistakes, behaviour, respect and culture, wellbeing and support, and confidence in improvement:

o   74% strongly agreed that mistakes were treated as an opportunity to learn

o   95% strongly agreed / agreed that they felt safe to speak up if something did not feel right

o   64% agreed leadership communicated clearly with staff

o   61% agreed that their workload was manageable

o   65% strongly agreed / agreed that there was a culture of kindness and professionalism

o   43% agreed that they knew there was wellbeing support available to them

o   48% felt informed of the CQC improvement actions being taken

Specific questions on what was working well and one change that would make a big, positive difference were included in the survey, with examples of feedback provided within the presentation.

·       Changes: A number of changes had been implemented to address concerns raised by the regulator – these included locums being in place to support with capacity and demand, use of the Digital Staff Pool (facilitated by Hartlepool and Stockton Health (H&SH)), recruitment for a Practice Manager (and Deputy Practice Manager) and a further GP Partner, the re-introduction of the staff newsletter, and use of TeamNet (a knowledge, compliance and workforce management solution for primary care functions) to support with incidents / complaints.  A revised meeting structure, a review of pay structure, work with the PPG on a patient survey, and the introduction of appraisals with the clinical team were further developments, with the practice also benefitting from the support of the Local Medical Committee (LMC), H&SH and the Primary Care Network (PCN) it was a member of.

·       Access: A graphic illustrated the themes that patients were contacting Norton Medical Centre for, with administrative help (e.g. fit notes, test results, updates on previous queries) being comfortably the most prevalent reason (over 16%).  The number of weekly eConsults submitted to the practice between 18 May 2026 and 14 June 2026 ranged from around 700 to approximately 850 (a total of 3,035 (by 2,431 individual patients) over this four-week period).

Thanking Norton Medical Centre representatives for their attendance and the information provided, the Committee reflected on this being the second time in just over a year that the practice had been asked to respond to issues raised by the CQC and emphasised the need for assurance that concerns were being addressed.

Referencing the CQCs most recent report, the Committee highlighted comments from staff questioning the ‘professionalism of management, including attitudes towards staff members, breaches of staff confidentiality and allegations of foul language being used’, as well as staff stating they felt threatened by redundancies.  The Interim Practice Manager responded by stating that significant changes had been made to the leadership team since the last inspection, and that there was now a different culture / environment around the surgery (as evidenced by the recent staff survey responses).  Attempts were being made to recruit management personnel who would work well with GP Partners.

Regarding the practice’s Patient Participation Group (PPG), the Committee noted the CQCs findings that ‘Representatives from the PPG described feeling unsure of their role. They told us they often felt useless and not informed or consulted with in relation to changes made within the practice’ and ‘The PPG also told us that their concerns were not always taken seriously’.  The Interim Practice Manager felt there had previously been a lack of clarity on the issues raised by the PPG and that the agenda had been changed for future group meetings to assist in this regard.  Following this up, Members noted the stated ambition during last year’s presentation to the Committee to get more appropriate representation on the group and asked what had been done to realise this.  The practice offered to provide further details after the meeting, though confirmed that timings of meetings had been varied to make them more accessible (particularly to those who were employed and struggled to attend during the standard working day), also stating that PPG members were offered the opportunity to take on specific roles / responsibilities (though this was still a work-in-progress).

The Committee expressed particular concern over the CQCs observation that the practice ‘did not always ensure medicines and treatments were safely managed’, something which was surely a fundamental requirement of a general practice.  Norton Medical Centre personnel expressed confidence that the work undertaken in response to these latest CQC findings would ensure there were no further issues in relation to medication.

Attention was drawn to the numerous references within the CQCs inspection report relating to practice leaders not listening, with Members also emphasising how vital respect to and from staff was as it was they who ensured the service was operational.  Again, recent changes to the leadership structure were highlighted, as was the sense of a re-energised workforce who were vital in providing safe and effective care.

Focus turned to the staff survey undertaken by the practice since its latest CQC outcomes were published.  Responding to several Committee queries, it was confirmed that staff could remain anonymous if they wished (four of the 39 respondents included their name when submitting their views), there was now a wellbeing lead within the clinical team, staff appraisal format / paperwork had been changed, training opportunities had been discussed and supported, and department leads had met to discuss the CQC improvement actions being taken (to increase the number of staff who felt informed about these).

Seeking clarity on Norton Medical Centre’s patient list size and its current clinical staffing capacity, Members were informed that there were around 16,500 individuals registered with the practice at present, with three GP Partners, four salaried GPs, six nurses, two advanced clinical practitioners, and three healthcare assistants (HCAs) employed.  The Committee asked if the intended Business Manager had been appointed and heard that an Operations Manager was instead recruited to work alongside the Practice Manager but was no longer in post (the plans to make the PPG more representative of the patient list had therefore not been implemented yet).  Additionally, Members noted the issues raised by the CQC around shortfalls in skills to administer vaccinations – the practice stated the individual in question did have the required training, though evidence was not to hand.  HR processes had since been changed to ensure there would not be a repeat incident.

The Committee asked how supportive the NHS North East and North Cumbria Integrated Care Board (NENC ICB) had been in helping the practice address the concerns identified by the CQC.  The Interim Practice Manager confirmed that offers of support had been forthcoming, and taken up, from the ICB and others (e.g. LMC / PCN / H&SH), with ICB officers who were also in attendance at this meeting commenting that Norton Medical Centre understood the seriousness of the situation and had made promising changes as a result.  Members were reminded of the new ‘You and Your GP’ Patient Charter which enabled views to be submitted either directly to practices or via the ICB – the latter would liaise with a practice should any feedback be received (no comments had yet been sent to the ICB about Norton Medical Centre).

A final question for the ICB concluded this item, with the Committee enquiring what options it had if Norton Medical Centre did not make the required improvement.  Support would continue to be given, and there were plans for the development of a general practice improvement programme – the practice would be given an opportunity to engage with this.  In-hours closures could also be facilitated to enable training and development to be undertaken.  From a contracting perspective, the ICB would continue to monitor progress of actions needed to address concerns, along with the information that had to be submitted evidencing this.

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