Archived: The Grange Road Practice

Updated 1 December 2016

The practice operates from one site in Bermondsey, London. It is one of 45 GP practices in the Southwark Clinical Commissioning Group (CCG) area. There are approximately 5,025 patients registered at the practice. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, and treatment of disease, disorder or injury.

The practice has an alternative provider medical services contract with the NHS and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include admissions avoidance, childhood vaccination and immunisation, extended hours access, dementia, influenza and pneumococcal immunisations, and patient participation.

The practice has an above average population of male and female patients aged from patients aged 20 to 50 years. Income deprivation levels affecting children and adults registered at the practice are above the national average. Of patients registered with the practice, 82% are white, 10% are Asian, 4% are black and 4% are from a mixed or other ethnic background.

The practice underwent a change of contract in May 2016 and the provider Nexus Health Group (at Bermondsey and Lansdowne Medical Mission on 6 Decima Street, London SE1 4QX) began caretaking for The Grange Road Practice in May 2016. The Care Quality Commission (CQC) has since accepted applications from The Bermondsey and Lansdowne Medical Mission and The Grange Road Practice to cancel their registrations with the CQC, and The Grange Road Practice is now a branch surgery of a new provider the Nexus Health Group (which was formed from The Bermondsey and Lansdowne Medical Mission).

The clinical team includes a male GP partner that provides one clinical and three non-clinical sessions per week to oversee the practice’s process and overall governance, two male GP partners, a male long term locum GP and a female long term locum GP. The GPs provide a total of 20 combined clinical sessions per week. There are two female practice nurses, and a female health care assistant that is providing cover for a female health care assistant on maternity leave. The clinical team is supported by a practice manager, four receptionists, a secretary, an information technology (IT) administrator and a clinical supervising officer.

The practice is open from 8.00am to 6.30pm Monday to Friday and is closed on bank holidays and weekends. Extended hours appointments are available from 6.30pm to 8.00pm on Mondays and Tuesdays. Appointments with GPs and nurses are available at various times throughout the day.

The premises operates from a purpose built building. On the ground floor there are three consulting rooms and a treatment room, two waiting areas, a reception area and two administrative rooms. There is wheelchair access throughout the ground floor, and baby changing facilities are available on the first floor. There is a lift available for patients with mobility problems.

The practice directs patients needing urgent care out of normal hours to contact the OOH number 111 which directs patients to a local contracted OOH service or Accident and Emergency, depending on the urgency of patients’ medical concerns.

Updated 1 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Grange Road Practice on 16 August 2016. Overall the practice is rated as good.

We had previously conducted an announced comprehensive inspection of The Grange Road Practice on 17 November 2015, and their inspection report was published on 18 February 2016. As a result of our findings during that visit, the practice was rated as inadequate for being safe, caring and well-led, and as requires improvement for being effective and responsive; this resulted in a rating of inadequate overall. We found that the provider had breached regulations of the Health and Social Care Act 2008 (Regulated Activities); Regulation 9 (3) person-centred care, Regulation 12 (1) safe care and treatment, Regulation 13 (1)(2)(3) safeguarding and Regulation 18 (2) staffing. We issued warning notices against the provider and the registered manager for the breach of Regulation 17 (1) good governance and placed the practice in special measures.

Practices placed in special measures are inspected again within six months of the publication of their inspection report; if they have not made sufficient improvements we will take action to begin the process of preventing the provider from operating the service. The two previous partners of The Grange Road Practice left the practice in April 2016. In May 2016 a new provider The Bermondsey and Lansdowne Medical Mission took over the practice; they submitted an action plan to us to tell us what they would do to make improvements. We undertook this inspection to check that they had followed their plan, and to confirm that they had met the legal requirements. The Care Quality Commission (CQC) has since accepted applications from The Bermondsey and Lansdowne Medical Mission and The Grange Road Practice to cancel their registrations with the CQC, and The Grange Road Practice is now a branch surgery of a new provider the Nexus Health Group (which was formed from The Bermondsey and Lansdowne Medical Mission).

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

• The practice’s recruitment arrangements included all necessary employment checks for all recently recruited staff.
• There was an open and transparent approach to safety and an effective system in place for reporting, recording and sharing learning from 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 their care and decisions about their 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 and effective leadership structure and staff felt supported and valued by the practice’s leaders.
• The practice proactively sought feedback from staff and patients, which it acted on.

The areas where we would have advised the provider to make improvement, had they still been registered with the CQC, are:

• Continue to monitor the improvements in the care of patients with long term conditions.

• Review staffing arrangements to ensure patients are able to access on-going care from female GPs.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 1 December 2016

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

• A GP had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• All patients with a long-term condition, including cancer, had a named GP and systems were in place to ensure that they received a structured 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.

Updated 1 December 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 attendances to Accident & Emergency.

• 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 and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 1 December 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 had registers for patients aged over 75, those in palliative care, housebound patients and those in nursing homes. There were systems in place to review and monitor the care of these patients.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 1 December 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 such as appointment booking and repeat prescription ordering.

• The practice offered as well a range of health promotion and screening that reflects the needs for this age group.

• Extended hours opening was available on Monday and Tuesday evenings until 8.00pm for patients that were unable to attend during normal working hours. Additional evening and appointments were available from local GP access hubs on weekday evening and on weekends until 8.00pm.

Updated 1 December 2016

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 1 December 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 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 provided care for residents in a local hostel and a sheltered housing facility, and 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.