Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Grange Medical Centre on 2 September 2015. The practice was rated as good overall; however it was rated as requires improvement in relation to providing effective services to all the population groups it serves. In addition whilst the practice was found to be good in relation to providing responsive services, there were some areas which we informed the practice should be improved.

Following on from this inspection the practice provided us with an action plan and supporting evidence which detailed the improvements they had made to their services to ensure that these were effective and met the needs of the population it serves. This evidence was examined via a desktop review and focused inspection of the practice carried out on 12 December 2016. This report reflects the findings of this review and inspection into the effective and responsive delivery of services within the practice.

The full comprehensive report which followed our inspection in September 2015 can be found by selecting the ‘all reports’ link for The Grange Medical Centre on our website at www.cqc.org.uk

Our key findings from the review we carried out were as follows:

• The practice had put in place a programme of clinical audits into subject areas which included minor surgery, anticoagulation and cancer – non two weeks waits. Some audits had been carried out over a number of cycles. This enabled the effectiveness of actions to be monitored and progress to be tracked. Audits followed a consistent format and fully recorded outcomes and recommendations for improvement.

• The practice had put in place a system for monitoring and controlling hypnotic medication prescribing (hypnotics are a class of medications whose primary function is to induce sleep and are used in the treatment of sleeplessness and insomnia). From January 2016 to October 2016 we saw evidence to show that prescribing for one form of these medications had been reduced by 13%.

• Nurse appointments were scheduled with the appropriate length of time for the activity in line with the Royal College of Nursing guidance. This was monitored via audit to assure compliance.

• Multidisciplinary team meetings had been formally and comprehensively minuted and recorded details of actions to be taken and responsibilities with regard to who was to lead in the delivery of these actions.

• The practice had developed new processes and approaches to improve patient contact and access. This included the installation of a new telephone system to enable calls to be handled in a more efficient and effective manner.

• Staff kept patients informed if appointments were running late via the telephone tannoy system and a white board located in the waiting room.

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 The Grange Medical Centre on 2 September 2015. Overall the practice is rated as good.

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

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles.
• There were systems in place to reduce risks to patient safety, for example infection prevention and control procedures and health and safety assessments.
• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents, near misses and any identified safeguarding issues.
• Information about services and how to complain was available and easy to understand.
• The practice sought patient views how improvements could be made to the service, through the use of patient surveys and the practice’s patient representation group (PRG).
• Urgent appointments were available for patients the same day as requested, although not necessarily with a GP of their choice.
• Patients said they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.

We saw an area of outstanding practice:

• Patients were referred to an exercise and health service to ensure that health and emotional needs were met. A gymnasium was provided for patients at no cost at the Kinsley practice under a programme of exercise on prescription.

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

• Ensure applicable two cycle audits are carried out with all relevant staff involved and action taken as a result. Minor surgery and National Institute for Health and Care Excellence (NICE) guidelines audits should be undertaken annually.
• Ensure hypnotics prescribing is monitored and rationale documented.
• Ensure the appointments system is easily accessible by phone and support people to access appointments
• Ensure patients are kept informed if appointments are not running to time.
• Ensure nurse appointments are the appropriate length of time for travel vaccinations in line with Royal College of Nursing guidance.
• Ensure multi-disciplinary team (MDT) and joint meetings with health visitors are minuted formally to record actions and responsibilities.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We focused the majority of our inspection at The Grange Medical Centre but also visited Kinsley Medical Centre and Greenview Medical Centre.

We saw that steps had been taken to encourage patient feedback as the practice had an established patient reference group. Feedback from the patient reference group meetings was available at all three sites.

During our inspection we were able to meet with four members of the patient reference group who were happy with the service they received from the practice. Comments included:

“Care has improved as you have a choice of GPs (General Practitioners).”

“There is a lower area at the side of reception which is important. My husband is a wheelchair user.”

We spoke with five patients following our inspection who were generally happy with the service; however concerns were raised regarding the length of time to an appointment and the attitude of some of the reception staff. Comments included:

“If you are ill that day or you’ve got a problem and they say you’ve got to wait two weeks or nine days it’s not good enough.”

“Sometimes I’m waiting weeks to get an appointment with the doctor.”

We saw that issues with the appointment system had been identified by the practice following a review of complaints and the practice were exploring different options to improve access to appointments.