Letter from the Chief Inspector of General Practice

Our previous inspection at Dr Adolfo Gracia on 7 October 2016 found a breach of regulation relating to the well-led delivery of services. The overall rating for the practice was good. Specifically, we found the practice to require improvements for the provision of well-led services. It was good for providing safe, effective, caring and responsive services. Consequently we rated all population groups as good. The previous inspection report can be found by selecting the ‘all reports’ link for Dr Adolfo Gracia on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 13 July 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 7 October 2016. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. At our inspection on the 13 July 2017 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the practice is rated as good.

Our key findings were as follows:

• The practice had demonstrated improvements in the governance arrangements. Staff we spoke with on the day of inspection also informed us they had noticed improvements in the last six months.
• The practice had carried out a health and safety risk assessment and introduced regular checks to ensure safety in the premises.
• The practice had carried out five clinical audits in the last six months and an audit plan was in place to carry out future audit cycles.
• The practice had carried out an internal patient satisfaction survey in April 2017.
• The practice had taken steps to develop a virtual patient participation group.
• The practice had taken steps to identify carers to enable them to access the support available via the practice and external agencies. The practice had redesigned a new patient questionnaire to identify carers at the time of new registrations. All staff had attended a relevant training session. Written information was available for carers to ensure they understood the various avenues of support available to them.
• The practice had carried out an audit of the previous carers register and identified most of the carers were incorrectly Read coded, for example, on some occasions parents had been coded as carer just because they were a parent. There were also some patients identified that had historically been a carer but were no longer a carer at the present time (often as person they were caring for had passed away). In both scenarios the patient’s status was able to be corrected and updated. We noted as a result of this analysis the practice register of patients who were carers or supported by carers had decreased from 92 (4%) patients to 17 patients (0.6% of the practice patient population list size).
• The practice provided facilities to help patients be involved in decisions about their care and information leaflets were available in easy read format to support patients who may benefit from this, such as patients with visual impairment. Staff were trained to print the relevant material in specific format from online sources if required.
• A hearing induction loop was not available on the day of inspection. However, we saw evidence that an order was placed to purchase a hearing induction loop on 3 July 2017.
• We saw the practice was monitoring childhood immunisation programme and demonstrated improvement in childhood immunisation rates. For example, childhood immunisation rates for the vaccines given to under two year olds were 90% and childhood immunisation rates for vaccines given to under five year olds were 70%.

The areas where the provider should make improvements are:

• Continue to establish a system of audit cycles and identify processes for clinical improvement.

• Ensure all staff had completed health and safety training.

• Review the system in place to further improve the process of identifying carers to enable them to access the support available via the practice and external agencies.

• Continue to monitor low rates of childhood immunisation rates for under five years old children.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Adolfo Gracia on 7 October 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and 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 and how to complain 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider must make improvement is:

• Conduct a health and safety risk assessment of the premises.
• Ensure that plans to re-establish the patient participation group and undertake regular surveys of patient views are implemented.
• Develop an on-going audit programme that demonstrates continuous improvements to patient care in a range of clinical areas. Ensure there are at least two cycles of a clinical audit.

The areas where the provider should make improvements are:-

• Ensure that information is accessible for all patients. For example, the introduction of a hearing loop in reception for patients with hearing difficulties and the production of information in large print and braille for those with visual impairment.
• Encourage the identification of carers on the practice list so that they can be directed towards the various avenues of support available to them. Ensure that information about the support available to carers is publicised in the waiting area.
• Keep low rates of childhood immunisation under review and identify and implement actions to help improve current rates.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice