Archived: Dr Adolfo Gracia Also known as Ship Street Surgery

Updated 7 August 2017

Dr Adolfo Gracia is based at The Ship Street Surgery in the city centre of Brighton, East Sussex. The practice serves approximately 2,700 patients living in Brighton.

Dr Adolfo Gracia is a single handed GP. He employs a part time female GP (started in December 2016), a practice nurse, a health care assistant, a practice manager and five reception staff.

Data available to the Care Quality Commission (CQC) shows the practice serves a higher than the national average number of patients between the ages of 26 and 39. There are lower than average numbers of patients over the age of 65. Income deprivation affecting older people is higher than average. The practice is open from 8.30am until 1pm and from 2pm until 6pm on Monday, Tuesday, Wednesday and Friday and from 8.30am until 1pm on a Thursday. The telephone lines are open from 8am. Extended access is available every Wednesday until 7.30pm for patients who cannot attend during normal working hours. Appointments can be booked over the telephone, on line or in person at the practice. When the practice is closed, patients are advised on how to access the out of hour’s service on the practice website, the practice leaflet or by calling the practice. Out of hours calls are handled by a local primary care service.

The practice provides a full range of NHS services and clinics for its patients including asthma, diabetes, cervical smears, childhood immunisations, travel immunisations, family planning and new patient checks.

The practice provides services from the following location:

• 65-67 Ship Street, Brighton, East Sussex BN1 1AE

Updated 7 August 2017

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

Updated 5 December 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Practice performance against indicators for the management of long term conditions was better than the local and national averages. For example the percentage of patients on the diabetes register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 95% compared to the clinical commissioning group (CCG) average of 82% and the national average of 78%.
• Longer appointments and home visits were available when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met.
• The practice cared for a large proportion of patients with human immunodeficiency virus (HIV). The GP had developed a special interest in this area of medicine and attended regular training to equip him with the skills and knowledge required to provide high quality care to this patient group. All of these patients received an annual review to check their health and medicines needs were being met.

Updated 5 December 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.
• Immunisation rates for all standard childhood immunisations were variable. This was due to the transient nature of the population and parental choice.
• The practice provided a range of family planning services and cervical screening.
• The number of women aged between 25 and 64 who attended cervical screening in 2014/2015 was 77% compared to the clinical commissioning group (CCG) average of 81% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked closely with midwives and health visitors.

Updated 5 December 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the of older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• As part of the clinical commissioning group’s proactive care programme the practice worked with health and social care providers in the locality to identify patients at risk of avoidable, unplanned admission to hospital and ensured that they had a plan of care in place in to help prevent this.

Updated 5 December 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example extended access was provided every Wednesday evening until 7.30pm.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 5 December 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the clinical commissioning group (CCG) average of 82% and the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• 90% of patients with a severe and enduring mental health problem had a comprehensive, agreed care plan documented in the record, in the preceding 12 months compared to the CCG average of 91% and the national average of 90%.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 5 December 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice had identified patients living in vulnerable circumstances which included those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.