Archived: Grainger Medical Group

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grainger Medical Group on 15 October 2015. Overall the practice is rated as requires improvement.

Our key findings were as follows:

• The provider, Intrahealth Limited, took over the practice in February 2015. Since that time the provider had experienced a number of difficulties, including high levels of sickness absence and patients reporting difficulties accessing the service.

• Clinical staffing levels were low, the practice was actively recruiting but this had impacted on the ability to carry out patient reviews and meet quality targets.

• The practice is working with NHS England and has developed an ‘Implementation and Transition Plan’ which sets out how these concerns will be addressed over the following two years.

• The practice carried out assessments and treatment in line with relevant and current evidence based guidance and standards.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

• Patients said they were generally able to get an appointment with a GP when they needed one, with urgent appointments available the same day, although many commented that it was difficult to get through to the practice on the telephone.

• The practice had good facilities and was well equipped to treat patients and meet their needs, although some concerns had been raised about the branch surgery following a recent infection control audit.

• Staff had not received all of the training necessary to carry out their roles effectively.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Put effective systems in place to manage and monitor the prevention and control of infection. This must include putting in place and adhering to policies that will help to prevent and control the spread of infections.
• Review staffing levels within the clinical and non-clinical staff teams to ensure sufficient staff are deployed.
• Ensure that staff receive appropriate support, training, professional development, supervision and appraisal to enable them to carry out the duties they are employed to do.
• Improve the telephone system so patients are able to speak to a receptionist on a timely basis.
• Update the patient group directive (PGD) for meningitis C and ensure all PGDs are authorised by a practice signatory.

In addition the provider should:

• Take steps to ensure staff are aware of any necessary action to be taken following receipt of national safety alerts.
• Continue to develop their approach to quality improvement/clinical audit and ensure that clinical audits include at least two cycles. The practice should aim to demonstrate an on-going audit programme where they can show that they have made continuous improvements to patient care in a range of clinical areas as a result of clinical audit.
• Improve the privacy for patients in the waiting rooms and in some consultation rooms at the branch surgery.

Where a practice is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected within six months after the report is published. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice