Letter from the Chief Inspector of General Practice

We first inspected Grafton Road surgery on 20 September 2016 as part of our comprehensive inspection programme. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Grafton Road surgery on our website at www.cqc.org.uk. During the inspection in September 2016 we found the practice required improvements two areas. Following the inspection the practice wrote to us to say what they would do to meet the regulations.

This inspection was an announced focused inspection carried out on 15 June 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. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Overall we found improvements had been made to the concerns raised at the previous inspection and as a result of the inspection findings the practice is now rated as Good.

Our key findings were as follows:

• Patients’ needs were assessed and care was planned and delivered following evidence based guidance. At the previous inspection in September 2016 we found an historic safety alert received from the Medicines and Healthcare Products Regulatory Agency (MHRA) had not been actioned. At this inspection we found that the practice had implemented a clear and defined system to action alerts and minimise risks to patient safety, which the clinical commissioning group (CCG) had shared with other local practices as an example of good practice.

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. Patients and staff were protected by comprehensive safety policies and procedures and we found there was a thorough analysis and review of events which were discussed at staff meetings. Since the last inspection the practice had also started to report incidents and events through the National Reporting and Learning System (NRLS), which is a central database of patient safety incident reports to share learning.
• We found at the previous inspection that there was limited evidence of quality improvement including clinical audit. The practice had introduced a programme of clinical audits to monitor the quality of the services provided and ensure patient needs were being met.

• The practice had identified that there were patients over the age of 75 years of age who lived alone and were vulnerable to the risk of isolation. The practice with the support of Contact the Elderly; a registered charity, provided tea parties every three months to offer advice and support and build friendships within the group. Representatives from Age Concern and Solihull Carers also attended to ensure patients were aware of what services were available.

• Emergency medicines were available and all staff were aware of their location. At the inspection in September 2016 we found that the GPs used the medicines for home visits which reduced the stock available in practice and no risk assessments were in place to mitigate the risk. At this inspection we found risk assessments had been completed and a policy was in place.

• At the previous inspection we identified an area that had not been actioned from the infection control audit that had been completed in July 2015. At this inspection we found this had been actioned and 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. At the previous inspection we found the practice manager received minimal support from the GP partners and due to staff shortages the manager was required to cover reception duties whilst continuing with their own role and responsibilities. At this inspection, we found the manager was receiving support and the shortage of staff had been addressed.
• We found at the previous inspection that team meetings were not regular due to the shortage of staff. At this inspection we saw evidence to confirm that monthly team meetings were being held and these were governed by agendas and meetings were clearly minuted.

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 road surgery on 20 September 2016. Overall the practice is rated as Requires Improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. However, we did find an historic medicine alert that had not been actioned for a combination of medicines used to treat cardiac disease and 21 patients taking the medicines had not been reviewed. Since the inspection we have received evidence to confirm that this alert has now been actioned.
• The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
• There was limited evidence of quality improvement including clinical audit.
• Emergency medicines were available and all staff were aware of their location. We found that the GPs used the medicines for home visits which reduced the stock available in practice.
• 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.
• The practice worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs. For example the practice had joined Contact the Elderly national charity to support older people and all staff had become dementia friends.
• The practice had good facilities and was well equipped to treat patients and meet their needs and we observed the premises to be visibly clean and tidy.
• Patients could access appointments and services in a way and at a time that suited them and 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.
• Notices in the patient waiting room told patients how to access a number of support groups and organisations and the practice had worked closely with Solihull Carers group.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result. The provider was aware of and complied with the requirements of the duty of candour.
• There was a clear leadership structure and generally staff felt they were supported by the practice manager, however staff told us that the support from the GPs was not as effective, which could impact on their work schedule. The practice proactively sought feedback from staff and patients, which it acted on.

However there were areas of practice where the provider must make improvements:

• Ensure an effective system is in place to ensure emergency medicines are available at all times.

There were also areas of practice where the provider should make improvements:

• Monitor staffing levels to ensure appropriate cover is in place to reduce impact on the day to day management of the practice.
• Continue to proactively identify registered carers
• Review infection control actions and action appropriately.
• Review quality improvement activity to ensure performance is proactive.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice