The Care Quality Commission
  • Doctor
  • GP practice

Graham Road Surgery

Overall: Inadequate read more about inspection ratings

22 Graham Road, Weston-super-mare, BS23 1YA (01934) 628111

Provided and run by:
Pier Health Group Limited

All Inspections

20 September 2023

During an inspection looking at part of the service

We carried out an announced inspection on 20 September 2023. This inspection was conducted to follow up on Warning Notices issued on 9 June 2023. The practice was inspected, but not rated, which means we carried on the rating from the last inspection in May 2023. Overall, this practice is rated inadequate and is in special measures.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Graham Road Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out an announced comprehensive inspection at Graham Road Surgery on 18 May 2023. Overall, the practice was rated as inadequate, and the practice was placed into a Special Measures. We found breaches of Regulation 12 and Regulation 17 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and issued Warning Notices. As a result of our previous inspection on 18 May 2023, the practice was rated inadequate for the safe and well-led key questions and requires improvement for effective, caring and responsive.

We carried out this inspection on 20 September 2023 to follow up breaches of regulation from a previous inspection that resulted in Warning Notices being issued on 9 June 2023, in line with our inspection priorities This report covers findings in relation to those requirements and was not rated.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We found that:

  • The practice had taken action to implement improvements to address breaches in regulations previously identified in warning notices.
  • There was improved oversight to ensure processes were operating effectively. However, some systems were still being embedded within the practice.
  • Improvements had been made to address the previous breaches in regulation. However, there were some aspects of safety and governance that required further improvement and embedding.
  • The practice was able to demonstrate improvements in the way individual care records were managed. However, further improvements were required in relation to the management of patients with diabetes, medicine reviews and actions relating to safety alerts.
  • The practice had taken action to ensure medicines were appropriately authorised before being administered by staff.
  • Staff had received training in relation to appointment access, including identifying concerns that needed escalating to GPs.
  • The practice had taken action to manage backlogs of activity in relation to correspondence received into the practice, coding and appropriate follow up. However, incoming routine correspondence to be coded was taking 2 to 3 weeks to be processed and we saw an example of correspondence that should have been acted on more quickly.
  • There were clear processes for identifying and addressing when things went wrong, including sharing learning with staff to ensure improvements.
  • Non-medical prescribers received supervision and monitoring of their prescribing practice.
  • There were improvements to the way 2-week-wait referrals were monitored.
  • The practice were up to date in summarising patient’s care records.

We found breaches of Regulation 12 Safe care and treatment and Regulation 17 Good governance. The provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

18 May 2023

During a routine inspection

We carried out a short notice announced comprehensive at Graham Road Surgery on 18 May 2023. Overall, the practice is rated as inadequate.

The key questions are rated:

Safe - inadequate

Effective - requires improvement

Caring - requires improvement

Responsive - requires improvement

Well-led - inadequate

Following our previous inspection on 24 June 2022, the practice was rated as requires improvement overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Graham Road Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection in line with our inspection priorities.

How we carried out the inspection.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We found that:

  • The practice had not implemented necessary improvements to address breaches in regulation previously identified.
  • The practice was unable to demonstrate that individual care records were managed appropriately; and that staff had access to relevant information to ensure safe care and treatment.
  • The practice had not ensured medicines were appropriately authorised before being administered by staff.
  • Positive outcomes from GP national patient surveys remained below national averages.
  • Processes to identify learning from complaints were not embedded in practice.
  • There were no appropriate arrangements to manage backlogs of activity.
  • Oversight was not effective to ensure processes were embedded.

At this inspection we found that not enough improvements had been made to address previous breaches in regulation identified during our last inspection in June 2022. We served warning notices to the provider for breaches of Regulation 12 Safe care and treatment and Regulation 17 Good governance.

The areas where the provider must make improvements:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

I am placing this service in special measures. Services 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 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 service 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.

Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

24 June 2022

During a routine inspection

We carried out an announced inspection at Graham Road Surgery on 24 June 2022. Overall, the practice is rated as Requires Improvement.

Safe - Requires Improvement.

Effective - Requires Improvement.

Caring – Requires Improvement.

Responsive – Requires Improvement.

Well-led - Requires Improvement.

Following our previous inspection in August 2021 the practice was rated Requires Improvement overall and for all key questions but providing effective services, which was rated Inadequate.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Graham Road Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was comprehensive to follow up on:

  • Key questions inspected
  • Breaches of Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment and Regulation 17 HSCA (RA) Regulation 2014 Good Governance.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Requires Improvement overall

We found that:

  • The practice did not always provided care in a way that kept patients safe and protected them from avoidable harm, for example they did not have health and safety risk assessment in place.
  • Patients received effective care and treatment that met their needs, however there were further improvement to be made in relation to the management of long-term conditions and high-risk drugs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care, however some of the systems and processes needed improving.

We found two breaches of regulations. The provider must:

  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Whilst we found no breaches of regulation the provider should ensure:

  • All staff have mandatory training up to date and there’s an effective review of it, including staff being trained to appropriate levels in safeguarding.
  • Appropriate risk assessments and audits are in place.
  • There’s an effective systems for managing summarising of new patients notes and coding and that the backlogs are cleared.
  • Patients on high-risk medicines and with long-term conditions have appropriate monitoring and support.
  • Child immunisation and cervical cancer screening data is being monitored and steps are being taken to improve uptake.
  • Patient feedback is collected and acted on.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

19 August 2021

During a routine inspection

We carried out an announced inspection at Graham Road Surgery on 19 August 2021, the practice is rated requires improvement.

Safe - requires improvement

Effective - inadequate

Caring - requires improvement

Responsive - requires improvement

Well-led - requires improvement

Why we carried out this inspection

We undertook this inspection in response to intelligence to suggest there was emerging risk at this practice. As this inspection was the first inspection since Graham Road was registered with this new provider we completed a comprehensive inspection in order to provide this location with a rating.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently. This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing

• Completing clinical searches on the practice’s patient records system and discussing findings with the provider

• Reviewing patient records to identify issues and clarify actions taken by the provider

• Requesting evidence from the provider

• A short site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected

• information from our ongoing monitoring of data about services and

• information from the provider, patients, the public and other organisations.

We have rated this practice as Requires improvement for population groups. For people with long-term conditions and Families, children and young people we rated this practice as Inadequate. We rated the practice as Requires improvement for Working age people, People experiencing poor mental health, Older people and People whose circumstances make them vulnerable.

We found that:

  • The practice adjusted how it delivered services to meet the needs of patients during the Covid-19 pandemic, however patients had issues accessing care and treatment in timely way.
  • The practice were carrying staff vacancies which was impacting on safe and effective care and treatment to patients. However, there was a plan in place to actively recruit to roles
  • The practice had a fire procedure in place and staff were trained in fire safety, however the practice was unaware that a fire risk assessment completed by a landlord was out of date and had not completed their own risk assessment.
  • The practice followed national guidance to assess patients remotely during the Covid-19 pandemic, however not all patients with long-term conditions had regular health checks done and there was a backlog of summarising patients notes.
  • The practice was not effective in monitoring Quality of Framework (QOF) data and fell below national averages for number of conditions.
  • Performance for national prevention schemes for example child immunisation was below 90% minimum uptake.
  • Not all staff felt supported and not all of them had received regular supervision or appraisal.
  • The leadership team were in the process of identifying ways to make improvements to delivery but these changes were either in the pipeline or in their infancy and so were unable to assess whether these would result in sustainable change and improvement.
  • The leadership team were working with other organisations to seek improvements for their patients.

We found two breaches of regulations:

  • Regulation 12 HSCA (RA) Regulations 2014 Safe care and Treatment
  • Regulation 17 HSCA (RA) Regulations 2014 Good governance

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care