Grange Surgery

Updated 30 January 2017

Grange Surgery is is a partnership practice of four GPs and is located on a residential street in Birkdale, Southport. The practice provides GP services to approximately 9,700 patients. All services are delivered under a GMS contract. Grange Surgery falls within Southport and Formby Clinical Commissioning Group (CCG). The practice is a teaching practice, hosting GP registrars.

The practice partnership is made up of three male GPs and one female GP. The partnership is supported by three salaried GPs (all female) and one regular locum GP (male) who works at the practice every Friday. The clinical team is complemented by an Advanced Nurse Prescriber (ANP) who can prescribe medicines, a practice nurse and a health care assistant.

The practice administrative team is overseen by a practice manager. The administration team is made up of an assistant practice manager who is also the practice IT administrator. There are a further 13 reception and administrative support staff and one medical secretary. The practice is open from 8am to 6.30pm each day. The practice closes on one Wednesday afternoon per month for staff training. Extended hours appointments are available every Monday evening between 6.30pm and 8pm, when a GP and a healthcare assistant are available for patient appointments.

The practice premises provide all patient services at ground floor level. The building is fully accessible at ground floor level for patients with limited mobility. Car parking is available outside the practice and there are two disabled parking spaces to the front of the building. At ground floor level there are two patient toilets, one male and one female, with the female toilet being available for use by all wheelchair users and other patients with limited mobility. There are six GP consulting room, three nurse’s rooms and one fully fitted treatment room suitable for surgical procedures and joint injections.

The practice patient population includes a significant number of older patients, with 31% of patients aged 65 or over. The list also includes 995 patients aged 80 years and over, and 320 patients who are in care or nursing homes.

When the practice is closed, patients ringing the surgery are directed by a phone message to ring NHS 111. Following review of patients, NHS 111 can refer patients to the locally commissioned out of hours service, Go to Doc.

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grange Surgery on 12 October 2016. Overall the practice is rated as good.

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. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• There were systems in place to reduce risks to patient safety, for example, premises and equipment checks, medication management and the management of staffing levels.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff felt well supported. They had access to training and development opportunities and had received training appropriate to their roles.

• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. We saw staff treated patients with kindness and respect.

• Services were planned and delivered to take into account the needs of different patient groups.

• Access to the service was monitored to ensure it met the needs of patients.

• Information about how to complain was available. There was a system in place to manage complaints.

• There were systems in place to monitor and improve quality and identify risk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 January 2017

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

• The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes.

• The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. Patients had management plans in place which empowered patients to manage their conditions. The practice aimed to ensure that patients were able to see one nurse for all of their long term conditions to reduce the need for multiple appointments.

• The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs.

• The practice worked with other agencies and health providers to provide support and access to specialist help when needed.

Updated 30 January 2017

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

• Child health surveillance and immunisation clinics were provided.

• Midwife clinics were held each week.

• Appointments for young children were prioritised.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The staff we spoke with had appropriate knowledge about child protection and all staff had safeguarding training relevant to their role.

• Staff contacted parents of children who may have missed immunisation appointments, to offer alternative clinic appointments.

Updated 30 January 2017

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

• The practice was knowledgeable about the numbers of older patients and their health needs.

• They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles.

• Each patient had a named GP to ensure continuity of care.

• The practice provided services to local nursing homes. Visits were carried out by the practice GPs.

• The practice nurse visited the nursing home to monitor long term conditions and GPs visited if a patients’ condition deteriorated and to carry out six monthly reviews of patient care. This service had led to better co-ordination of patient care and had assisted with avoiding unplanned admissions to hospital.

• The practice worked with other agencies and health providers to provide support and access specialist help when needed.

• Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients.

• The practice had worked with patients and families to record patient’s wishes on place of end of life care, whether patient’s wished to be resuscitated and whether information on their end of life care could be shared with family members.

Updated 30 January 2017

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.

• Pre-bookable telephone consultations were available to increase access to working age patients and those with caring commitments.

• The practice was proactive in offering online services such as appointment booking and ordering of repeat prescriptions.

• A full range of health promotion information and screening that reflects the needs for this age group, was available through the practice.

Updated 30 January 2017

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 30 January 2017

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

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• The practice offered longer appointments for patients with a learning disability, and any other patients whose circumstances merited this service.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice website had direct links to the carer’s centre and also provided a link for any young carers who are under the age of 18.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and ensured their carers had access to this information.

• 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.