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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grafton Square Surgery on 11 May 2016. Overall the practice is rated as good.

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.

• 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.
• Risks to patients were not always adequately assessed or well-managed.
• 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.
• 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 not clear leadership structure and staff felt supported by management.
• 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.

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.

In addition the provider should:

• Ensure that there is a clear system in place for reporting and recording significant events and monitoring actions taken to improve safety in the practice, ensuring all staff are recording and following the same process.

• Ensure that there is a robust system in place for following up urgent two week referrals made by the practice.

• Ensure that all staff have an appraisal completed annually.

• Ensure that there is effective communication with all staff via regular site meetings and that comprehensive minutes are kept.

• 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.

• Ensure that the staffing structure, including roles and responsibilities are clearly defined, so that governance arrangements are more robust.

• Review provisions of bookable appointments for patients on demand.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice