Archived: Grafton Surgery

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• Many policies were out of date or missing and no infection control audits had been carried out since 2012. The business continuity plan had not been reviewed since 2010 and contained out of date information.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