Archived: Grafton Surgery

Updated 29 June 2018

Grafton Surgery was located within the Primary Care Centre in Canvey Island, Essex. The purpose built centre offered free parking for patients as well as a drop off point for patients with limited mobility.

At the time of our inspection, Grafton Surgery had a list size of 6,153 patients.

There were two GP partners at Grafton Surgery; one male and one female. There were two practice nurses and one health care assistant. There was a practice manager, two medical secretaries, one prescribing clerk and five receptionists.

The practice was open between 8am and 6.30pm Monday to Friday. Appointments were available between 8.30am and 12.30am every morning and between 2pm and 5.30pm every afternoon.

Grafton Surgery was a member of the local GP Alliance which offered weekend appointments to patients at an alternative location in the local area.

When the practice was closed, patients were directed to out of hours services by calling 111. These services were provided by Integrated Care 24.

Updated 29 June 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grafton Surgery on 15 June 2016. Further unannounced visits were carried out on 21 and 22 June 2016 as part of this inspection process. Overall the practice was rated as inadequate.

Our key findings across all the areas we inspected were as follows:

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, training records were incomplete and appropriate recruitment checks on staff had not been recorded.
• Many policies were out of date or missing and no infection control audits had been carried out since 2012. The business continuity plan had not been reviewed since 2010 and contained out of date information.
• Significant events had not been documented for the last 12 months.
• There were adequate arrangements in place for dealing with medical emergencies; however there was no first aid kit or accident book readily available.
• We found evidence to demonstrate that MHRA alerts had not been actioned.
• Patient Group Directives (PGDs) used by nursing staff were available but they were not all signed by a manager or prescriber.
• There was no effective system in place for repeat prescribing of high risk medicines.
• Prescriptions were stored securely but their use was not monitored.
• Due to discrepancies in data we examined, we could not be assured that patients were being consistently and appropriately recalled or reviewed.
• Improvements in patient outcomes were hard to identify as audits provided were single cycle and did not demonstrate any improvement due to actions taken.
• The practice worked with other health and social care organisations to offer a multidisciplinary care to patients with complex needs.
• Data from the national patient survey, published in January 2016, showed patient satisfaction was below local and national averages.
• Patients we spoke with told us of concerns regarding their interactions with some clinical staff and said they were not always treated with compassion or dignity. We did receive positive feedback regarding reception staff.
• The practice had only identified 0.7% of patients as carers and had not offered any additional support to these patients, although leaflets were available in the waiting area.
• The practice routinely contacted families who had suffered bereavement.
• There was a system in place for dealing with complaints. Most complaints we reviewed had been responded to appropriately; however some were incomplete. There was no evidence of sharing learning outcomes from complaints.
• The practice had recently formed a patient participation group (PPG) and had held a first meeting to gain patient feedback.
• Some staff had received appraisals on an ad-hoc basis but reported them to be ineffective.
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements. Some staff reported feeling unsupported, particularly with their training needs.

The provider of this service at the time of publication is no longer registered with the Care Quality Commission.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 June 2018

The practice was rated as inadequate for the care people with long-term conditions. The provider was rated as inadequate for providing safe, effective caring, responsive and well-led services. The issues identified as inadequate overall affected all patients including this population group.

• Nursing staff had lead roles in chronic disease management.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP.
• Due to discrepancies in data we examined, we could not be assured that patients with long-term conditions were consistently and appropriately recalled and reviewed.
• For those patients with the most complex needs, the practice had started to work with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 29 June 2018

The practice was rated as inadequate for the care of families, children and young people. The provider was rated as inadequate for providing safe, effective caring, responsive and well-led services. The issues identified as inadequate overall affected all patients including this population group.

• The practice told us they identified and followed up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were comparable to local averages for standard childhood immunisations.
• The practice told us that children and young people were treated in an age-appropriate way.
• Cervical screening rates were higher than local and national averages, although exception reporting for cervical screening was significantly higher than average. Data we examined demonstrated that some patients were inappropriately exception reported for cervical screening.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 29 June 2018

The practice was rated as inadequate for the care of older people. The provider was rated as inadequate for providing safe, effective caring, responsive and well-led services. The issues identified as inadequate overall affected all patients including this population group.

• The practice told us they were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Facilities provided were suitable for patients with poor mobility.
• Due to discrepancies in data we examined we could not be assured that the care and treatment of older people always reflected current evidence-based practice.

Updated 29 June 2018

The practice was rated as inadequate for the care of working-age people (including those recently retired and students). The provider was rated as inadequate for providing safe, effective caring, responsive and well-led services. The issues identified as inadequate overall affected all patients including this population group.

• The practice was a member of the local GP Alliance which offers appointments at weekends at an alternative location.
• Appointments could be booked online and telephone consultations were also available.
• The practice utilised WebGP, an online service for patients to request advice from their GP.
• The practice offered NHS health checks.

Updated 29 June 2018

The practice was rated as inadequate for the care of people experiencing poor mental health (including people with dementia). The provider was rated as inadequate for providing safe, effective caring, responsive and well-led services. The issues identified as inadequate overall affected all patients including this population group.

• Due to discrepancies in some data we examined we could not be assured that patients were being consistently recalled and reviewed in line with national guidance.
• The practice had started to work with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had an understanding of how to support patients with mental health needs and dementia.

Updated 29 June 2018

The practice was rated as inadequate for the care of people whose circumstances may make them vulnerable. The provider was rated as inadequate for providing safe, effective caring, responsive and well-led services. The issues identified as inadequate overall affected all patients including this population group.

• Staff understood how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. However training records could not demonstrate that all staff had received appropriate safeguarding training.
• The practice was unable to confirm how many patients with learning difficulties had received health checks and if these health checks had been followed up.
• The practice offered longer appointments for any patients who needed them.
• The practice had started to work with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.