Granta Medical Practices

Updated 20 November 2019

Granta Medical Practices consists of five sites and are a large partnership formed from the merger of four local practices over a three-year period from 2016 to 2018. They are a provider at scale for the delivery of healthcare to their local population. They cover a 25 mile by 10-mile practice area and deliver services from;

• Sawston Medical Centre London road, Sawston, Cambridge, CB22 3HU Previous rating outstanding 2015.
• Linton Medical Centre, Coles Lane, Linton, CB21 4JS. (merge 2016). Previous rating compliant 2013.
• Barley Surgery, High Street, Barley, Royston, Hertfordshire, SG8 8HY (merge 2017). Previous rating good 2016.
• Market Hill Surgery, Market Hill, Royston, Hertfordshire, SG8 9JN. (merge 2017). Previous rating good 2016.
• Shelford Medical Centre, Ashen Green, Great Shelford, Cambridge, CB22 5FY. (merge 2018) Previous rating good (requires improvement in safe) 2018.

The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury. These are delivered from all sites. The practice offers dispensing services to those patients eligible for them from all sites excluding Great Shelford and Market Hill Surgery.

Granta Medical Practices are situated within the Cambridge and Peterborough Clinical Commissioning Group (CCG) and provide services to 43,500 patients under the terms of a general medical services (GMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

Granta Medical Practices due to the size of their population are recognised as a Primary Care Network and offer services such as extended hours appointments, first contact physio appointments and social prescribing.

The provider is a partnership of 12 GPs who have overall responsibility for the management of the practices and they employ 165 staff members. Clinical care is provided by a team of 73 people, this includes 33 GPs, five advance nurses’ practitioners, three emergency care practitioners, 16 practice nurses, 13 healthcare assistants and phlebotomists and two clinical pharmacists.

The internal centralised management team includes a practice manager, human resource manager, strategy director, finance director, IT systems manager, and director of dispensing and medicines. There are heads of department including, project manager, communications manager, admin team manager, secretarial manager, premises and facilities manager and reception team lead co-ordinator. They are supported by a team of department leads for different sites and for dispensaries. In additional there is a team of reception secretarial staff and dispensary staff and two social navigators.

There are higher than average number of patients over the age of 65 years. The National General Practice Profile states that 95% of the practice population is from a White background with a further 5% of the population originating from asian, black, mixed or other non-white ethnic groups. Information published by Public Health England, rates the level of deprivation within the practice population group as ten, on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male life expectancy is 82 years compared to the national average of 79 years. Female life expectancy is 85 years compared to the national average of 83 years.

Updated 20 November 2019

We carried out an announced comprehensive inspection at Granta Medical Practices on 14 October 2019 as part of our inspection programme.

We carried out an inspection of this service due to the length of time since the last inspection. Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions, safe, effective, caring, responsive and well-led.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Outstanding overall. The population group for older people, people with long term conditions and working age people (including those recently retired and students) as good. The population group for families, children and young people, people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia) as outstanding.

We found that:

• The practice demonstrated outstanding leadership as senior clinicians and all staff worked in a clear and cohesive patient centre approach to providing primary care to their patients.
• People were protected by a strong comprehensive safety system and a focus on openness, transparency and learnings when things went wrong.
• The practice worked with patients to deliver high quality, accessible health care, meeting the challenge of extended opening times and providing a team approach utilising clinical skill mix to deliver safe and effective care to patients.
• There was a truly holistic approach to assessing, planning and delivering care and treatment to all patients who used the services.
• The practice had identified areas where gaps in provision of services and support networks locally and had taken steps to address them.
• There was a strong person-centre and open culture in which safety concerns raised by staff and patients was highly valued as being integral to learning and improvement.
• Patients were supported and treated with dignity and respect and were involved partners in their care.
• The leadership, governance and culture of the practice promoted the delivery of high-quality person-centre care.

We rated the practice as outstanding for providing responsive services because:

• People’s individual needs and preferences are central to the delivery of tailored services.
• There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.
• There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that meets these needs, which is accessible and promotes equality. This includes people with protected characteristics under the Equality Act, people who may be approaching the end of their life, and people who are in vulnerable circumstances or who have complex needs.
• People who use the service and others were involved in regular reviews of how the service managed and responded to complaints. The service could demonstrate where improvements had been made because of learning from reviews and that learning was shared with other services.
• Investigations were comprehensive, and the service used innovative ways of looking into concerns, including using external people and professionals to make sure there is an independent and objective approach.

We rated the practice as outstanding for providing well-led services because:

• The clinically driven leadership, governance and culture was used to drive and improve the delivery of high-quality person-centred care. There was inclusive and effective leadership at all levels. Leaders at all levels demonstrated the high levels of experience, capacity and capability needed to deliver excellent and sustainable care.
• The practice ensured strong and consistent clinical leadership and listened to and gave staff protected time to ensure they were able to proactively manage patients, systems and processes.
• There was clear joint working between the clinical team members with GPs supporting and leading education and development with the wider team.
• The leaders had a deep understanding of issues, challenges and priorities in their practice and in the wider health system.
• There was a systematic and integrated approach to monitoring, reviewing and providing evidence of progress against strategy and plans.
• Staff were proud of the practice as a place to work and spoke highly of the culture. There was a strong team-working and support across all areas and a common focus on improving the quality and sustainability of care and patient’s experience.
• There was a demonstrated commitment to best practice performance and risk management of systems and processes.
• The practice processes and systems to ensure patients and staff were kept safe from harm demonstrated good practice.
• There was demonstrated commitment at all levels to sharing data and information safely to drive and support decision making including system wide working and improvement.

The population group for older people, working age people (including those recently retired and students) are rated as good. The population group for families, children and young people, people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia) as outstanding.

We also rated the practice as good for providing safe and effective and caring services because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.

Whilst we found no breaches of regulations, the provider should:

• Monitor the newly revised system and process to ensure all emergency equipment is safe to use.
• Monitor and embed the system and process to ensure all near misses, reviews and actions taken are identified and fully documented to identify trends to mitigate further occurrences.
• Monitor and ensure risks assessments are recorded to provide safe delivery of medicines.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Updated 20 November 2019

Updated 20 November 2019

Updated 20 November 2019

Updated 20 November 2019

Updated 20 November 2019

Updated 20 November 2019