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• Ensure safe medicines management systems are followed as out of date medicines were not identified and removed.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.