Archived: The Grange Road Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Grange Road Practice on 17 November 2015. Overall the practice is rated as inadequate.

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

• Most staff understood their responsibilities to raise concerns, and to report incidents, near misses and concerns. Although the practice carried out investigations when there were unintended or unexpected safety incidents, there was little evidence to show that lessons learned were widely communicated or that safety was improved.

• Risks to patients who used services were not always well assessed or managed to ensure that patients were kept safe. For example, basic life support training had not been completed by several staff. Processes for chaperoning, recruitment, safeguarding, fire safety and infection control, and monitoring the use of prescription pads and emergency medicines were not robust. In addition, there was no defibrillator available.

• Data showed patient outcomes were average for the locality. Audits had been carried out and we saw evidence that audits were driving improvement in performance to improve patient outcomes.

• Patients said they were not always treated with compassion, dignity and respect by staff and did not always feel involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand.

• Appointment systems were not working well and patients said that they found it difficult to access urgent and pre-bookable appointments.

• The practice had a number of policies and procedures to govern activity, but these had not been updated with practice-specific information and not all staff members were aware of how to access them.

• The practice told us they held regular meetings and issues were discussed at ad-hoc meetings; however there was limited documentation to demonstrate this. There was no documented evidence to show that GPs regularly attended multi-disciplinary meetings.

• The practice had sought feedback from staff and patients; however staff did not feel valued or supported by the practice leaders, particularly when raising concerns and dealing with aggressive patients.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff. Ensure there is a system to identify adults and children at risk, all staff are aware of the safeguarding lead, all staff complete the appropriate level of training and all safeguarding concerns are managed in accordance with the safeguarding policy.
• Ensure all staff receive mandatory basic life support and infection control training and that all staff know how to access emergency medicines.
• Ensure an infection control policy is in place.
• Ensure that patients are enabled or supported to understand care and treatment available, and patients are involved in decisions about their care.

In addition the provider should:

• Improve the availability of appointments and telephone access for patients.

• Ensure all staff have access to appropriate policies, procedures and guidance to carry out their role, and that all policies are updated to include names of relevant leads and ensure staff are aware of these.

• Ensure feedback from staff is responded to and appropriately addressed.

• Ensure there are systems in place for checking emergency medicines and oxygen, and monitoring the use of prescription pads by all staff.

• Ensure all outstanding actions from the infection control audit are addressed and dispersible Aspirin is available in the emergency medicines.

• Ensure there is leadership capacity to deliver all improvements.

• Ensure appropriate support is provided to patients who have suffered bereavement.

• Review the need for a defibrillator and review the risk assessment in relation to this.

• Conduct two-cycle clinical audits to improve the standard of care provided for patients.

• Ensure patients have access to a female GP.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice