Archived: Grafton Medical Partners

Updated 27 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Grafton Medical Partners on 19 April 2016 where the practice was rated good overall. However, breaches of regulation 17(1)(2) (Good governance) and 19(2)(3) (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified, and we rated the practice as requires improvement for providing safe services.

The specific concerns from the previous inspection related to safety were:

• Not all staff had received thorough recruitment checks prior to employment.

• There was no clear system in place for reporting and recording significant events. 

• There was no clear system in place to identify action taken as a result of safety alerts.

• There was no clear system in place to adequately monitor and manage assessed risks including those relating to health and safety, control of substances hazardous to health and Legionella.

• Staff did not have access to regular mandatory training to be able to respond to emergencies, including annual basic life support training and fire safety training.

In addition to this, we found not all staff had received an annual appraisal and that multidisciplinary and clinical meetings were not always documented. Systems were not effective in identifying carers, and bereavement support information was not displayed in the waiting area. The complaints system needed to be reviewed to ensure it was clear for patients and staff, and in line with contractual obligations. The staffing structure, including roles and responsibilities were not clearly defined.

After the comprehensive inspection, the practice wrote to us with an action plan which outlined what they would do to meet the legal requirements in relation to the breaches of regulation.

We undertook this desk-based focussed inspection on 1 December 2016 to check that the practice had followed the action plan provided and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Grafton Medical Partners on our website at www.cqc.org.uk.

Overall the practice is rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing safe services.

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

• Adequate recruitment checks were undertaken prior to employment.

• The practice had a clear system in place for reporting and recording significant events.

• There was a clear system in place to identify action taken place as a result of safety alerts.

• There was a clear system in place to adequately monitor and manage assessed risks including those relating to health and safety, control of substances hazardous to health and Legionella.

• All staff had completed regular mandatory training to be able to respond to emergencies, including annual basic life support training and fire safety training.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 23 June 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.
• Performance for diabetes related indicators was mixed. For example, 68% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 74% and the national average of 78%. The practice had implemented an automatic check of specific diabetes related blood tests in all NHS health checks for those over 40-75 to aim to increase their prevalence of diabetes in the practice population.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met.
• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice looked after a number of residents in a local care home, including those with neurodisabilities and dementia, providing twice weekly visits.
• The practice provided an in-house anticoagulation monitoring service for practice patients.

Updated 23 June 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, for example, children and young people who had a high number of Accident and Emergency (A&E) attendances.
• Immunisation rates were in line with averages for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 76%, which was comparable 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.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice were able to refer to a local service for family planning treatment and information if family planning services were not accessible at one of the other Grafton Medical Partners practices.

Updated 23 June 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 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.
• The practice had a dedicated telephone line between 10am and 12pm named the ‘Blue Star Line’ for patients aged 75 and over or those on the practice’s avoiding unplanned admissions register, to ensure swift access to appointments.
• The practice employed an in-house pharmacist to assist with medicine reviews, who specifically focussed on a review of prescribing for practice patients in a local nursing home.
• An information pack for the 75’s was provided, which included a booklet produced in conjunction with the Patient Participation Group (PPG), entitled ‘Local Services for Older People’. This contained detailed information about support and welfare services, social services, voluntary organisations and support for ethnic minority groups.

Updated 23 June 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 including ‘commuter slots’ four evenings per week and on Saturday mornings.
• 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.
• The practice employed a phlebotomist who provided sessions at the practice two days per week.
• Joint injections and cryotherapy were provided at another Grafton Medical Partners practice, which patients from Upper Tooting were able to access if required.

Updated 23 June 2016

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

• 77% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average.
• Performance for mental health related indicators was in line with the CCG and national averages for the number of patients who had received an annual review at 90%; compared with CCG average of 91% and national average of 88%.
• 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.
• The practice provided access to in-house counselling, psychotherapy and group therapy at another Grafton Medical Partners practice in Tooting as well as being able to refer to local psychological therapy services.

Updated 23 June 2016

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 homeless people, carers, travellers and those with a learning disability.
• For 2015/16, the practice had identified 97 patients on the learning disabilities register and 67 had received an annual check, which was 69%.
• There were longer appointments available for vulnerable patients including those requiring translation services and those 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.
• The practice commissioned a citizens advice service weekly due to the level of social needs required by the practice’s population group.
• 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.