Archived: Grafton Medical Partners

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grafton Medical Partners on 4 May 2016. Overall the practice is rated as Requires improvement.

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

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses, however the system for reporting and recording significant events was not fully effective.
• Risks to patients were not always adequately assessed or well-managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services was available and easy to understand.
• Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day, however some patients reported difficulty with getting through to the practice on the telephone.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There were governance systems in place and staff felt supported by leaders and managers in the practice.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice:

• The practice commissioned a citizens advice service weekly for all Grafton Medical Partners’ Wandsworth patients, due to the level of social needs required by the practice’s population group.
• The practice employed an in-house pharmacist to assist with medication reviews, who specifically focussed on a review of prescribing for practice patients in two local nursing homes.
• The practice provided the over 75s with an information pack which included a booklet produced in conjunction with the Patient Participation Group (PPG), entitled ‘Local Services for Older People’. This contained detailed information about support and welfare services, social services, voluntary organisations and support for ethnic minority groups.

The areas where the provider must make improvement are:

• Ensure that medicines management procedures are robust to include recording of vaccine refrigerator temperatures every day that the practice is open, tracking and monitoring the use of prescription pads within the practice and monitoring un-collected prescription scripts.
• Ensure that there are effective systems in place to adequately assess, monitor and manage risks including those relating to health and safety, fire safety and control of substances hazardous to health.
• Ensure that there is a clear system in place for reporting and recording significant events and a system for monitoring actions taken to improve safety in the practice.
• Ensure that there is a system in place to identify action taken as a result of safety alerts.
• Ensure that staff have access to regular mandatory training to be able to respond to emergencies, including annual basic life support training and fire safety training.

In addition the provider should:

• Ensure that adequate recruitment checks are undertaken prior to employment for locum staff and documentation kept.
• Ensure that there is a robust system in place for monitoring receipt of all urgent referrals made by the practice.
• Ensure that all multidisciplinary and clinical meetings are documented in order to record discussions, actions and to monitor patients effectively.
• Ensure that the practice further refines practice systems to identify carers.
• Review the complaints system to ensure it is clear for patients, staff and in line with contractual obligations.
• Ensure that the staffing structure, including roles and responsibilities is defined, so that governance arrangements are more robust.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice