Background to this inspection
Updated
11 May 2018
The Grange is an established GP practice that has operated in the area for many years. It serves approximately 2,900 registered patients and has a general medical services (GMS) contract with NHS Cambridgeshire and Peterborough CCG.
The principle GP is the registered manager and lead GP (male), and is supported by locum GPs (one male and one female). The team includes two pharmacists, three practice nurses (female), a health care assistant, four reception staff which includes a medical secretary and a practice management team. The principle GP also leads another larger practice based in the city. A number of staff, including the lead GP and practice management team is based at the other practice most of the time. Staff work at both practice locations at times to share resources.
The opening times are Monday to Friday from 9am to 6.30pm. Appointments are available with a GP or an advanced nurse practitioner generally from 9am to 11.30am and from 3pm to 5pm daily. A duty doctor is available throughout the day for anyone who requires urgent treatment. Patients are able to book evening and weekend appointments with a GP or nurses and phlebotomists at the GP hub provided through the Greater Peterborough Network. When the practice is closed, patients receive care and support through the out of hour’s service. Patients can access this by dialling the NHS 111 service or by calling the practice.
According to information taken from Public Health England, the patient population has a slightly higher than average number of patients aged 0 to 39 years. When compared to practice average rates across England the practice has a lower than average number of patients aged 45 and over. The practice has a population group from diverse backgrounds and approximately 40% of their population are from a Pakistani background.
Updated
11 May 2018
This practice is rated as Good overall.
The Care Quality Commission (CQC) have previously carried out four inspections of the practice.
We carried out an announced comprehensive inspection at The Grange on 6 June 2016. The practice was rated inadequate overall and for providing safe, effective, and well led services, and requires improvement for providing responsive and caring services. As a result of the findings on the day of the inspection, the practice was issued with a warning notice on 18 July 2016 for regulation 17 (good governance). The practice was placed into special measures for six months.
On 2 September 2016 we carried out a second inspection visit in response to information of concern about the provider who is also the registered manager and principal GP at 3Well Medical Ltd Botolph Bridge. We found the safety and leadership of systems for managing pathology and X-ray results and dealing with repeat prescriptions were not adequate. We did not rate this inspection.
A third inspection was carried out on 4 November 2016, to check on improvements detailed in the warning notice issued on 18 July 2016, following the inspection on 6 June 2016. We found the practice had reviewed their systems and strengthened their quality monitoring but could not demonstrate this was effective. A further warning notice was issued on the 22 November 2016 as appropriate systems were still not in place to assess, monitor, mitigate risks and improve the quality of the service. We did not rate this inspection.
A fourth inspection was undertaken following the period of special measures and included a follow up of the warning notice issued on 22 November 2016. It was an announced comprehensive inspection on 28 February 2017. Overall the practice was rated as requires improvement and was removed from special measures.
The full inspection reports can be found by selecting the ‘all reports’ link for The Grange on our website at .
This inspection was an announced comprehensive inspection carried out on 19 April 2018 to confirm that the practice had carried out the improvements identified at the last inspection in February 2017. Overall the practice is rated as good.
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
At this inspection we found:
- The practice had continued to make improvements to ensure they were meeting the regulations and providing safe and effective services to patients.
- They had been able to recruit a new nursing team and pharmacist to join the practice and there had been an improvement in the retention of other staff. The provider was undertaking regular clinical sessions and regular locums were employed. Patients we spoke with and comment cards we received demonstrated they had been able to have continuity of care.
- Practice staff we spoke with told us they worked together to implement and embed the changes. They told us they had found the changes positive and said patients were receiving better service. This was confirmed by the patients we spoke with who stated the practice was more proactive in calling them in for reviews and the practice appeared calm and welcoming.
- The provider has another larger practice nearby and the management team had increased the use of technology to improve the clinical meetings and information sharing across both sites. This ensured all staff (most staff worked across both sites) were able to take part in the meetings.
- Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses and there was evidence of learning and communication with staff.
- The arrangements for managing medicines had been embedded to keep patients safe. The process for handling repeat prescriptions for high risk medicines ensured that patients were monitored regularly and that test results were checked before medicines were prescribed.
- The practice had systems and process in place to record and action safety alerts and had a system to regularly runs searches for effective monitoring.
- Risks to patients and staff which included fire, general risks and health and safety had been assessed and identified actions undertaken.
- Appropriate recruitment and induction checks had been completed for locum staff. A system was in place for recording and monitoring that mandatory training had been completed.
- 2016/2017 Quality and Outcomes Framework data showed patient outcomes had improved from the previous year and unverified 2017/18 data showed further improvements. Exception reporting had also significantly improved. Clinical audits had been carried out, and were driving improvements in patient outcomes.
- We found that some reviews and record keeping for patients experiencing poor mental health needed to be reviewed and improved. Some of the records we viewed did not contain cohesive note taking to ensure that information sharing was effective.
- The practice had a failsafe system in place for checking cervical cytology outcomes for patients and regular checks to ensure all samples were reported on.
- The appointment system was working well and patients told us they received timely care when they needed it.
- The practice had an active patient participation group (PPG) which included on line membership and members met with the practice on a regular basis.
- There was a wide variety of information displayed in the practice which had been translated into a number of languages used by patients including how to give feedback or complain.
- Governance systems had been improved, reviewed, and strengthened to ensure that the improvements could be sustained over time. The practice recognised where they needed to continue to further improve some areas and was working on these.
The areas where the provider should make improvements are:
- Review and improve the clinical record keeping in relation to annual reviews for patients who may be experiencing poor mental health.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice