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Inspection Summary


Overall summary & rating

Good

Updated 4 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Grafton Medical Partners on 11 May 2016. The overall rating for the practice was Good. However a breach of legal requirements was found relating to the Safe domain. This was because the medicines management procedures did not include recording of vaccine refrigerator temperatures every day that the practice was open. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The full comprehensive report can be found by selecting the ‘all reports’ link for Grafton Medical Partners on our website at www.cqc.org.uk.

This inspection was a focused desk-based review carried out on 14 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 11 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Following the focussed inspection, we found the practice to be good for providing safe services.

Our key findings were as follows:

  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety. The medicines management procedures were now effective to include recording of vaccine refrigerator temperatures every day that the practice was open. We saw evidence of daily loggings of refrigerator temperatures over a four week period. We also saw a refrigerator temperature monitoring audit over a three month period.

We also reviewed the areas we identified where the provider should make improvements:

  • Since the initial inspection the practice had reviewed their significant event process. We saw that the significant event policy had been updated. We saw two significant events had been reviewed with learning outcomes.

  • The practice had an effective system in place for following up urgent two week referrals made by the practice. We saw evidence that a revised policy had been completed in September 2016.

  • All staff had completed an appraisal annually. We saw evidence of an appraisal log which showed all staff employed for 12 months and longer had an appraisal completed.

  • The practice had an effective system for communicating with all staff. We saw evidence of detailed minutes from clinical and all staff meetings.

  • All staff had access to regular mandatory training to be able to respond to emergencies, including annual basic life support training and fire safety training. We saw certificates confirming staff had received training.

  • There was clear staffing structure, we saw evidence of a management structure diagram detailing who the partners and practice managers were.

  • The practice had a process in place to review bookable appointments for patients on demand. The practice had installed a new phone system, which facilitated automated booking of appointments, they also had a number of appointments bookable in advance. In addition a GP was returning from leave, and would now do all their sessions at Grafton Square surgery, which would increase the capacity for bookable appointments.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 May 2017

The practice is rated as good for providing safe services.

  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety. The practice had been consistently checking fridge temperatures.

Effective

Good

Updated 14 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for most staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs, although clinical and multidisciplinary meetings were not always documented effectively.

Caring

Good

Updated 14 September 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 14 September 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.

  • 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.

  • We received 24 patient Care Quality Commission comment cards and 18 were positive about the service experienced. Six were negative and related to difficulty in getting appointments.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. For example the practice had a special modified lift to facilitate wheelchair users or parents with pushchairs.

  • Information about how to complain was available and easy to understand. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 14 September 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings, which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • Staff felt well-supported by managers and leaders in the practice, however boundaries between the four practices in the group were blurred across two Clinical Commissioning Groups (CCGs); consequently staff were not always clear about their roles.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and however this information was not always shared with staff to ensure appropriate action was taken.

  • The practice proactively sought feedback from staff and patients, which it acted on. The Patient Participation Group was active.

  • There was a focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 14 September 2016

The practice is rated as good for the care of people with long-term conditions.

  • Salaried GPs, and GP partners had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators was comparable. For example, 78% of patients had well-controlled diabetes, indicated by specific blood test results, comparable to the Clinical Commissioning Group (CCG) average of 74% and the national average of 78%.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • The practice provided an in-house anticoagulation monitoring service for practice patients.

Families, children and young people

Good

Updated 14 September 2016

The practice is rated as good for the care of families, children and young people.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of Accident and Emergency (A&E) attendances.

  • Immunisation rates were in line with averages for all standard childhood immunisations.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • The practice’s uptake for the cervical screening programme was 74%, which was comparable to the Clinical Commissioning Group (CCG) average of 80% and the national average of 81%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies

Older people

Good

Updated 14 September 2016

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice had a dedicated telephone bypass line between 10am and 12pmnamed the “Blue Star” for elderly patients aged 75 and over or patients identified as being at high risk of admission, to ensure prompt attention to patients’ needs.

Working age people (including those recently retired and students)

Good

Updated 14 September 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care including ‘commuter slots five evenings per week and on Saturday mornings.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 September 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice carried out advance care planning for patients with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff had a good understanding of how to support patients with mental health needs and

    dementia.

  • The practice provided access to in-house counselling, psychotherapy and group therapy at one of the other practices sites in the group, which all Grafton Medical Partners patients in Lambeth Clinical Commissioning Group (CCG) were able to access, as well as being able to refer to local psychological therapy services.

People whose circumstances may make them vulnerable

Good

Updated 14 September 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

  • For 2015/16, the practice had identified 5 patients on the learning disabilities register and all 5 had received an annual review.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked 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.

  • Staff knew 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.