Archived: The Grange Practice

Updated 25 July 2016

• The Grange Practice is located in the Allerton area of Bradford under a Personal Medical Services (PMS) contract. The practice has on-site parking and disabled access.
• The practice has:-
  • Three GP partners, (two male, one female), three Salaried GPs, one GP Registrar, two HCAs, and 14 other staff.
• Opening time and appointment times:
  • Extended hours are provided on a Monday mornings from 7.15am and Monday evenings until 7.40pm
  • The practice offered a ‘rapid access’ urgent same day appointment phone call system every morning from 8.30am to 11.40am and afternoons from 3.10pm to 5pm.
  • Out of hours care is provided by Local Care Direct and is accessed via the practice telephone number or patients can contact NHS 111.
• The practice serves 7722 patients mainly working age population.

The practice has a mainly white British population with 3.7% mixed, 26.4% Asian, 2.7% black, 1.4% other non-white ethnic groups. The patients’ age demographics are similar to those of the general population nationally, with the 15-44 age range having the most patient numbers.

Updated 25 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Grange Practice

on 1 June 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• While the practice had safety records, incident reports and patient safety alerts it was not clear how the lessons from such incidents were shared in order to improve the safety in the practice.

We saw areas of outstanding practice:

• The practice had a website that give a “virtual tours” of the surgery and has medical staff explaining matters about common ailments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 July 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.
• The practice showed that 82% of the patients on the practice’s diabetes register were reviewed in the 12 months to April 2015. This compared with the national average of 79%.
• Longer appointments and home visits were available when needed for people with learning disabilities.
• 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.
• All (100%) of the patients on the practice’s diabetes register on 1 August 2016 had been immunised for influenza in the period between April 2014 to March 2015.  This compared with the national average of 95%.

Updated 25 July 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 A&E attendances. Immunisation rates were average 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.
• Appointments were available outside of school hours on Monday morning and Monday evening. The surgery premises were suitable for children and babies.
• We were told about positive examples of joint working with midwives, health visitors and school nurses.

Updated 25 July 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 integrated care team met quarterly to discuss complex patients.
• The practice had a monthly ward round to patients in residential and nursing homes.

Updated 25 July 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.
• 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 was open every Monday morning and Monday evening to meet the needs of patients who found it difficult to access the practice on weekdays.

Updated 25 July 2016

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

• 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 87%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 97% compared to 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.
• 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 25 July 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, travellers and those with a learning disability.
• The practice offered longer appointments for patients 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.
• 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.