The Grange Medical Centre

Updated 21 April 2017

The Grange Medical Centre is a practice in the town of Nuneaton. The practice operates under a General Medical Services (GMS) contract with NHS England. A GMS contract is one type of contract between general practices and NHS England for delivering primary care services to local communities. The practice was established as a small partnership in the 1950s and now operates from premises repurposed in 1997 and subsequently extended. The building is equipped with accessible facilities for patients with additional needs such as wheelchair access and disabled toilets.

The Grange Medical Centre has a patient list size of 10,317, with lower than average levels of social deprivation. There is a significantly higher than average population aged over 45 on the practice’s patient list, with lower than average numbers under this age. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients. For example, the practice offers minor surgery, services for patients with learning disabilities, rotavirus and shingles immunisation, analysing and preventing unplanned admissions and facilitating timely support and diagnosis for people with dementia.

The clinical team includes three male and one female GP partners and one male salaried GP. There are also three practice nurses and two healthcare assistants. The team is supported by a practice manager and 16 administrative and reception staff. The Grange Medical Centre is a training practice which has qualified junior doctors working under the supervision of the GPs. At the time of the inspection there were three trainee GPs in place. There are also two apprentice non-clinical staff. The practice further directly employs three cleaners and one maintenance worker.

The Grange Medical Centre is open from 8am to 6.30pm from Monday to Friday. The practice phone lines are diverted to an automated message between 1pm and 2pm, during which patients are directed to dial another number if the matter is urgent. There is always a GP on site during this time. Outside of opening hours there are arrangements in place to direct patients to out-of-hours services delivered by West Midlands Ambulance Service through NHS 111.

Updated 21 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Grange Medical Centre on 6 October 2016. Overall the practice is rated as good.

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

• There was a system to report and record significant events. All incidents were investigated and if patients were affected they were offered support.
• Arrangements to deal with emergencies and major incidents were adequate and staff were equipped to follow them.
• The practice had a system for managing and circulating safety alerts received from external agencies.
• Measures had been implemented to safeguard patients from abuse, and these reflected relevant legislation and local requirements. Staff had received training on safeguarding children and vulnerable adults relevant to their role and understood their responsibilities.
• Staff underwent annual appraisal meetings to review professional development and identify learning needs. Staff we spoke with during the inspection told us they had access to appropriate training to cover the range of requirements of their role.
• The practice worked with other services and health and social care professionals to share relevant information and assess and meet the needs of patients. Multidisciplinary care team meetings were held every three months.
• We spoke with ten patients during the inspection. All ten patients said they were treated with dignity and respect. We also received 42 Care Quality Commission patient comment cards. Thirty of these were positive about the service experienced and 12 were mixed.
• Information for patients about the services available was easy to understand and accessible.
• Results from the National GP Patient Survey showed that patients’ satisfaction with how they could access care and treatment was similar to local and national averages. Satisfaction with waiting times was lower than average, and the practice had introduced GP telephone triage to help reduce waiting times for patients attending urgent appointments.
• The practice had an effective system in place for handling complaints and concerns. Information about how to make a complaint was available to patients and learning from complaints was used to develop improvements.
• The premises were adapted for access by patients with different needs such as those with a disability.
• We verified that staff had a good understanding of what their roles required of them and who was responsible for clinical and non-clinical areas within the practice. Staff told us the partners and the practice manager were professional, helpful and approachable.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice sought feedback from patients, the public and staff and used this to involve patients in how the service was delivered.
• The practice demonstrated an interest in continuous learning and improvement.

The area where the provider should make improvement is:

• Maintain a record of verbal complaints, comments and suggestions.
• Continue to take action to improve timely access to appointments and reduce waiting times in the practice when patients attend for appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 April 2017

• The practice kept registers of patients who had long-term conditions and used them to monitor and contact patients.
• There were lead roles for chronic disease management within the clinical team.
• Performance for diabetes related indicators was similar to or higher than CCG and national averages. For example, 84% of patients with diabetes had a blood pressure reading within the target range in the preceding 12 months compared with the CCG average of 79% and the national average of 78%. Exception reporting was 2% for this indicator, compared with the CCG and national averages which were both 6%. Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.
• For atrial fibrillation (an irregular heart rhythm), 91% of patients at high risk of suffering a stroke had been treated with anti-coagulation therapy (blood thinning medicines), compared with the CCG average of 85% and the national average of 87%. The practice had exception reported 8% of patients for this indicator. This was below the CCG average of 9% and the national average of 10%.
• The practice offered longer appointments, disease management clinics and health checks for patients with long term conditions. The practice was also able to offer 24 hour blood pressure self-monitoring to patients.
• Clinicians participated in quarterly multidisciplinary team (MDT) meetings and worked with community healthcare professionals to support patients in receiving a complete package of care. For example, the practice was being assisted by a community diabetes nurse in the management of patients with diabetes who had a high risk of complications.

Updated 21 April 2017

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

• Childhood immunisation rates for the vaccinations given were higher than average. For example, for the vaccinations given to under two year olds the practice had achieved an overall score of 9.9 out of 10, compared with the national average score of 9.1. 
• Children were offered appointments on the same day or out of school hours where they needed them.
• The premises facilitated children and babies. For example, a separate room was available for breast feeding and there was space for baby changing in the patient toilets.
• Children at risk were flagged in patient records so that they could be easily identified by staff. The practice had appointed a GP as the lead for children’s safeguarding. The lead GP met with health visitors to share information and reported concerns on behalf of the practice where appropriate.
• A full range of family planning services were available.

Updated 21 April 2017

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

• Clinicians offered personalised care to older people at the practice and had participated in a local initiative to carry out frailty and lifestyle checks on over 75s the previous year.
• Older patients could access home visits where they were unable to travel to the practice. On the day consultations and longer appointments were able available for those who required them.
• The practice had older patients in two nursing homes and one residential home where the GPs made regular visits.
• A range of services were accessible to older patients through the practice, such as the over 75s NHS health check. Patients aged over 75 could also receive the flu vaccination at the practice.

Updated 21 April 2017

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

• The practice offered extended hours appointments on weekdays and on every other Saturday to accommodate working age people.
• Telephone appointments were available for patients who found it difficult to attend the practice premises during working hours, for instance those who commuted to work.
• The practice offered online access to appointment booking and repeat prescription ordering. Over 40% of the practice’s patient list had setup online access to these services.
• Patients aged 40 to 74 were invited to have a health check. The practice had completed 487 of these during the previous 12 months.
• Abdominal aortic aneurysm (AAA) screening was carried out at the practice for male patients over the age of 65.

Updated 21 April 2017

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

• Quality Outcomes Framework (QOF) data showed that the practice was performing in line with or lower than local and national averages in its care of patients with dementia. For example, 78% of patients diagnosed with dementia had a face to face care review in the past 12 months, compared with the CCG average of 86% and the national average of 84%. The practice told us they were improving in this area but had experienced some impact after one of the practice nurses who carried out mental health checks had left the practice the previous year. Exception reporting for this indicator was 4%, compared with the CCG and national averages which were both 7%.
• Performance for mental health related indicators was higher than the CCG and national averages. For instance, 96% of patients with a form of psychosis had a comprehensive, agreed care plan documented in the preceding 12 months, compared to the CCG average of 95% and the national average of 89%. Exception reporting was 21%, higher than the CCG average of 15% and the national average of 13%. The practice said this had also been affected by the loss of one practice nurse the previous year who was involved with mental health.
• The practice liaised with multidisciplinary teams in the management of patients experiencing poor mental health. Care plans were in place for those with dementia.

Updated 21 April 2017

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

• The practice held a register of vulnerable adult patients which was used to monitor their care and alert staff members to their circumstances. There were 229 patients on the register at the time of the inspection.
• The practice offered longer appointments and annual health checks to patients with a learning disability. There was a register of 46 patients with a learning disability.
• The practice did not have any homeless patients registered when we carried out the inspection but was equipped to provide care to these groups as required.
• Safe Place Scheme for people with a learning disability and victims of hate crime. This meant there was a logo displayed identifying the practice building to people who needed assistance or were experiencing fear.
• As part of a recent project the practice had written to patients with patients who suffered with conditions which caused them difficulty in communicating to ask whether there were any adjustments they could offer to improve their experience. All requests had been added to the individual patient records as alerts.
• Staff had received safeguarding training and knew how to recognise signs of abuse in children and adults. Some members of staff had also completed IRIS (Identification and Referral to Improve Safety) training in domestic violence.
• The premises had disabled access, a hearing loop and information about available translation services was displayed in the patient waiting area. The practice also had a staff protocol specifically aimed at improving access and communication for patients with hearing difficulties.
• The practice had a system to identify carers. Written information was available to direct carers to the various avenues of support available to them. Carers could access additional services such as an annual flu vaccination. At the time of the inspection the practice was beginning to hold a monthly carers drop-in clinic with the help of a local carers service, to support patients who required assistance with arrangements such as respite care and social benefits. The practice hoped to develop a carers’ café once the drop-in clinic had been established.