Background to this inspection
Updated
28 December 2018
The Locality Health Centre CIC is the registered provider of Graham Road Surgery. The Locality Health Centre CIC is a community interest company based in Weston Super Mare which also provided up to recently two other GP services in the local area. This changed in the week before this inspection at Graham Road Surgery as the providers contract ended at another location. This had impacted upon the delivery of the service as some staff who worked across all of the locations transferred to the new provider.
Graham Road Surgery is provided from one address, 22 Graham Road, Weston Super Mare, BS23 1YA and delivers a personal medical service to approximately 8,631 patients. The practice is situated in an adapted building in a residential area, with limited parking. Information about Graham Road Surgery can be found on the practice website www.grahamroadsurgery.co.uk.
At the time of this inspection the provider was in the process of reviewing the services it provides with the possible merging the patient lists from the providers other location, Clarence Park Surgery to one location at Graham Road.
According to information from Public Health England the practice area population is in the second most deprived decile in England – the lower the number the most deprived population group. The practice population of children aged 18 and under is below local and national averages at 16%. The practice population of with a working or in full time education was at 49% which is below local 66% and national averages at 62%. Unemployed patients made up 9% of the practice population, 3% being the local average and national average 5%. The practice population of patients living with a long-term condition was above the local and national averages at 67%, the local being 53% and national being 54%. Of patients registered with the practice, 96% are White or White British, 1.3% are mixed race, 2.3 % are Asian or Asian British, 0.7% are Black or Black British, and Other 0.3%.
The provider has told us the practice team is made up of eight salaried GPs one being the Clinical Lead for the provider, which means overall the practice has the equivalent of 4.75 WTE (whole time equivalent) GPs at the practice. Two advanced nurse practitioners (ANP) equivalent to 2 WTE, two practice nurses equivalent to 1.6 WTE and one health care assistant(HCA). The practice also employed a full time assistant practitioner (extended HCA role) and a clinical pharmacist. The registered manager (RM), who is the RM for both locations is the Chief Executive of the organisation. The practice manager and the deputy manager are supported by a team of administrators, secretaries, and reception staff.
When the practice is not open patients can access treatment via the NHS 111 service.
The practice provides family planning, surgical procedures, maternity and midwifery services, treatment of disease, disorder or injury and diagnostic and screening procedures as their regulated activities.
Updated
28 December 2018
This practice is rated as Requires improvement. (Previous rating under a different provider February 2016 – Good, but the domain of safe was rated as requires improvement).
The key questions at this inspection are rated as:
Are services safe? – Requires improvement
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Requires improvement
We carried out an announced comprehensive at Graham Road Surgery on 7 November 2018 as part of our inspection programme.
At this inspection we found:
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
- The practice were aware of their patient population needs with high deprivation, the practice’s performance on quality indicators for long term conditions, mental health and dementia show they were in line with local and national averages.
- Childhood immunisation uptake rates were below the target percentage of 90%. The practice had systems in place to try to encourage uptake. Nursing staff took any opportunistic chance to provide immunisations if the child attended the practice and had visited patients in their own home to ensure they were not missed.
- The practice supports patients living in rehabilitation services for drug and alcohol addiction in the local area and works closely with other local addiction support services when patients leave residential services.
- Staff, on the whole, involved and treated patients with compassion, kindness, dignity and respect. Some patients said they had experienced rudeness of staff.
- Patients found it difficult at times to access an appointment but reported that when they obtained an appointment they received the treatment and care they needed in a timely way.
The areas where the provider must make improvements are:
- The recruitment process must ensure that all the necessary information is obtained such as a current Disclosure and Barring Service (DBS) check before a new member of staff is employed.
- The provider must ensure a good oversight of the training achieved and the training required for staff.
- Ensure safe medicines management systems are followed as out of date medicines were not identified and removed.
- The provider must ensure they continue with the development of the overarching health and safety management including fire safety.
- The provider needs to continue to develop how it records significant event management and complaints to monitor themes and trends and to ensure that actions put in place are effective to prevent reoccurrence.
The areas where the provider should make improvements are:
- The provider should continue with developing a central oversight of staff’s immunisation status to ensure that staff and patients were protected from the spread of infection.
- The provider should continue with developing an effective monitoring system so that out of date information and instructions such as patient group directions for the provision of immunisations are removed and replaced when required.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
Please refer to the detailed report and the evidence tables for further information.