Grange Medical Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At the inspection in November 2022, the practice was rated requires improvement in the key question effective. Concerns involved the management of patients with long-term conditions, and actioning of safety alerts and updates. Following this assessment the rating has changed to good, as we saw that patients with long term conditions were effectively managed.

Patients were involved in assessments of their needs. Staff reviewed assessments taking account of patient’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff had access to training and learning opportunities to support them in their role. The practice engaged with other services and supported patients to manage their health and wellbeing. Staff made sure patients understood their care and treatment to enable them to give informed consent. Processes were in place to support patients to make informed decisions about their future, and to review patients at the end of their lives.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were aware of the needs of the local community and checked patients’ health and wellbeing needs. Staff could refer patients with specific needs, such as those experiencing poor mental health, to social prescribers and other services. Patient’s accessibility and communication needs were taken into account and they were supported accordingly.

There was a clinical triage policy in place. The practice had a palliative care register of 12 patients and these patients were supported to make informed decisions about their future. A review of clinical records showed that management of patients with some long-term conditions including chronic kidney disease and hypothyroidism was effectively managed as they had all received appropriate monitoring within the required timescales. We also found there were 900 patients on the practice’s asthma register, of which 57 had been prescribed 2 or more courses of rescue steroids. We reviewed records for 3 of these patients and found that although there had been an adequate assessment undertaken at the time of prescribing, information recorded at this point and during annual patient reviews was sometimes limited, and the practice did not identify patients requiring steroid emergency treatment cards. After the assessment the practice told us that action had been taken to address the issues identified.

Furthermore, we found 825 patients registered with diabetes, of which there were 172 patients with a latest HbA1c of more than 74mmol/l. We reviewed records for 2 of these patients and found that they had not been compliant with requests for attendance for monitoring. The practice told us they had considered reducing the supply of medication in response to non-compliance for one of these patients but had decided that it was not in the patient’s best interest, however they would continue to review the situation. They also told us that the second patient was now keen to improve compliance and that their reviews would be audited regularly.

Clinical staff told us they followed best practice guidance when carrying out their work. The practice had systems and processes in place to keep clinical staff up to date with current evidence-based practice. Staff told us they had access to training and learning opportunities and were supported with their professional development. We saw several examples of this, including a member of staff undertaking a nursing course, and another member of staff being supported to become a health care apprentice.

Clinical records we saw demonstrated care was generally provided in line with current guidance. However, as part of our clinical searches we reviewed records for 5 patients prescribed methotrexate (a disease-modifying anti-rheumatic drug) and found that 4 of these prescriptions did not specify the day of the week the medication was to be taken, in line with Medicines and Healthcare products Regulatory Agency (MHRA) guidance. After the inspection the practice reviewed these patients and took appropriate action.

Staff had access to the information they needed to appropriately assess, plan, and deliver patient’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. Staff and leaders told us how they managed information sharing with other providers, including out of hours teams. They also told us that they regularly engaged with members of the primary care network.

The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported initiatives to improve population health. This included referral to social prescribers and weight management services, and encouraging patients to attend for cancer screening. Leaders were taking steps to improve uptake rates for cervical screening.

There were processes in place to invite patients for relevant health checks. In the last 12 months 1,238 patients were eligible for an NHS health check. Of these, 75 had been completed. There were also systems in place to identify patients in need of extra support, for example those with a learning disability. The practice had 45 patients on their learning disability register. Of these, 41 had received a health check in the last 12 months. The practice had also identified 195 patients as carers. Information to support patients was available around the practice and on the practice website.

The service routinely monitored patient’s care and treatment.

The GP Patient Survey for 2024 showed that 57% of patients felt they had enough support from local services or organisations to manage long-term conditions, compared to the national average of 68%.

The practice’s cervical screening uptake rate at June 2023 was 61%, which was below the 80% national target. More recent and unverified data provided by the practice indicated an uptake rate above 80%. The practice had met the 90% minimum uptake rate for all 5 routine childhood vaccinations indicators, including 2 indicators which met a World Health Organisation (WHO) recommended uptake rate of 95%.

Staff we spoke with could clearly outline the systems in place to recall and review patients and understood their role in this process.

Our review of clinical records showed that patients with long-term conditions were largely well managed. The practice took steps to encourage patients to attend for cervical screening and childhood immunisations, for example by sending regular recalls, having an in-house cancer champion, opportunistic promotion, and engagement through community events. Appropriate registers were held to ensure effective monitoring of specific groups such as those receiving palliative care.

Staff told us how they dealt with consent and how they helped patients make decisions about their care, including the use of relevant guidelines and recording consent.

There was a consent policy in place which covered areas such as capacity and use of consent forms. Carers and advocates were involved in consultation processes where required. Processes were in place to support patients to make informed decisions about their future, and to review patients at the end of their lives. Staff also told us how they worked with patients, and their carers, to support them to understand their options regarding Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) decisions. We saw that DNACPR and Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms were completed in line with guidance and with the input of patients, and when necessary, their carers.