The Grange Practice

Updated 14 June 2017

The Grange Practice is situated in Ramsgate, Kent and has a registered patient population of approximately 11,900. Patient areas are on the ground floor and are accessible to patients with mobility issues as well as parents with children and babies.

The practice staff consist of eight GP partners (four male and four female), one female nurse practitioner, three female nurses, one female phlebotomist, two female health care assistants, one practice manager as well as administration and reception staff. The practice is a training practice (training practices have GP trainees and newly qualified doctors).

The practice has a general medical services contract for delivering primary care services to the local community.

The Grange Practice is open Monday to Friday between the hours of 8am to 6.30pm. Extended hours appointments are offered on two evenings per week from 6.30pm to 8pm, on one morning per week from 7am to 8am and also on Saturday mornings from 8.30am to 10.15am.

Primary medical services are available to patients via an appointments system. There are a range of clinics for all age groups as well as availability of specialist nursing treatment and support.

Services are provided from:

The Montefiore Medical Centre

Dumpton Park Drive

Ramsgate

Kent CT11 8AD.

There are arrangements with other providers (Primecare) via the NHS 111 system to deliver services to patients outside of the practice’s working hours.

Updated 14 June 2017

Letter from the Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Grange Practice on 29 September 2016. The overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for The Grange Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 May 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. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had systems and processes to ensure appropriate recruitment checks were undertaken in line with national guidance.
• The process to record significant events had been updated and provided an audit trail of actions taken and outcomes of investigations.
• Arrangements to identify risks had been updated and risks were acted upon and monitored.
• There was a system for monitoring staff training to ensure this was up to date. .
• The process to record complaints had been updated and provided an audit trail of actions taken and outcomes of investigations.
• The process for recording minutes of meetings had been updated to identify actions required and when these were met.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 January 2017

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.

• 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 held a register for patients suffering from long term conditions and a nominated member of staff coordinated annual recalls.

• Home visits were available for housebound patients to receive their annual review.

• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c blood test was 64 mmol/mol or less in the preceding 12 months was 75% compared to the clinical commissioning group (CCG) average of 78% and the national average of 78%.

• Longer appointments and home visits were available when needed.

• The practice was keen to develop and improve services for diabetic patients and had recently appointed a GP lead for diabetes and recruited a practice nurse who was being trained in diabetes management.

• The practice offered health screening for cardio vascular disease.

• The practice patient participation group (PPG) offered a monthly coffee and chat group for those who may be isolated.

Updated 19 January 2017

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

• There were systems 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• Baby immunisation clinics were scheduled to avoid school run times in response to patient feedback.
• There were systems for reminding parents about immunisation and the practice conducted a joint mother and baby check at eight weeks post-natal.
• The practice offered a full family planning service. The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 82% compared to the clinical commissioning group (CCG) average of 83% and the national average of 82%.
• We saw positive examples of joint working with midwives and health visitors.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice duty doctor system facilitated same day appointments for all children where clinically relevant and also on a parents’ request. The practice sent a congratulations card to all parents on the birth of a child enclosing a practice registration form.
• The practice offered a private room for nursing mothers to breastfeed.
• The practice had a policy of registering family members with the same GP.

Updated 19 January 2017

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 and for flu vaccination.

• The practice provided and maintained equipment for a local nursing home to support patient assessments and reduce hospital admissions.

• The practice provided training for staff in nursing homes.

• The practice referred patients to two beds in a nursing home which it utilised to prevent unnecessary admission to hospital, provide respite care and care and support for particularly vulnerable patients. Each admission was for a two week period with extensions available in exceptional circumstances.

• The practice offered individual care plans which were shared with the relevant out of hours provider.

• A tissue viability leg ulcer service was delivered by the practice nurses, health care assistants and where appropriate, the district nurses.

• The carer support service offered a weekly advice clinic located at the practice.

• The patient participation group (PPG) offered a monthly coffee and chat group for those who may be isolated.

Updated 19 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.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered telephone triage and telephone consultations every day.
• The practice offered online booking of appointments, prescription requests via email and smartphone sharing of health data was also available.
• The practice offered extended hours appointments on two evenings, one weekday morning and Saturday mornings for people who worked and found it difficult to attend during normal opening hours.
• The practice placed alerts on patient’s records for those who found it difficult to attend in normal hours. This highlighted the need for flexibility with staff.
• Flu clinics were held on Saturday mornings.
• The practice promoted healthy lifestyles through a healthy walking programme and weight reduction services.

Updated 19 January 2017

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

• 86% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the clinical commissioning group (CCG) average of 85% and the national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 92% compared to the CCG average of 88% and the national average of 90%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had had a comprehensive, agreed care plan documented in their record in the preceding 12 months was 88% compared to the CCG average of 88% and the 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 and staff had a good understanding of how to support patients with mental health needs and 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 to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• The practice offered on site counselling services.
• There was a follow up protocol for people with a new diagnosis of depression.
• The practice offered telephone access and support for people who were agoraphobic.
• The practice supported social prescribing and referred patients to the healthy walks service from the Montefiore Medical Centre (The Grange Practice) every Thursday.

Updated 19 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 homeless people and those with a learning disability.
• Patients whose circumstances made them vulnerable were permitted to remain registered with the practice if they moved away from the usual catchment area. This provided better continuity and support for the patient. The practice offered longer and flexible appointments for patients with a learning disability and also for those whose lifestyles warranted it.
• 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.
• Guide dogs and assistance dogs were welcomed at the practice.
• The practice supported a local charity that worked closely with people who had housing problems or were homeless. It provided the facilities for a weekly drop in clinic on a Wednesday and a monthly tea and chat event where patients could meet others in similar situations, and receive advice and support.
• There was a hearing loop and a quiet room available.
• Interpreter services were available.
• The carer support service provided a drop in clinic every Friday.
• The practice patient participation group (PPG) offered a monthly coffee and chat group for those who may be isolated.
• The practice held a quarterly multidisciplinary palliative care meeting