This practice is rated as Requires Improvement overall. (Previous rating July 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at The Grange Surgery on 9 October 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The completion and recording of training by staff was not fully embedded at the practice.
• 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 participated in pilots and health promotion schemes to encourage patients to be proactive in monitoring their own health needs.
• The practice was adjusting to a new clinical arrangement following several recent retirements within the senior clinical team.
• The practice encouraged feedback and there was evidence to show the practice had acted upon it, especially with regards to patient feedback.
• There was limited evidence to show that themes were being identified by the practice in relation to complaints.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Patients were positive about the care and treatment they received at the practice.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvements are:

• Continue to improve the uptake for cervical screening to achieve the national target of 80%.
• Review how the practice records staff vaccination status.
• Review how the practice identifies themes from complaints.
• Review how the practice acts upon formal feedback provided by staff.

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.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Grange Surgery on 8 July 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice also set up and ran a Health Zone confidential drop in service for young people age 12 to 19 years of age on Wednesdays during term time from 2.30pm to 4.30pm
• The practice had amended the clinic times for older patients to fit in with new bus timetables which operated in the surrounding villages.
• Patients who attended for dressing changes were routinely screened for other health and social needs whilst their dressings were changed.
• On occasion reception staff had ensured that medicines had been delivered to housebound patients.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice