St Johns Medical Centre

We carried out an announced inspection and site visit at St Johns Medical Centre on 16 August 2022. Overall, the practice is rated as Good.

Safe - Requires Improvement

Effective - Good

Caring - Good

Responsive - Good

Well-led - Good

The practice was also rated Good at our previous inspection on 25 November 2019.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for St Johns Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection/review

This was a comprehensive inspection undertaken as part of our comprehensive inspection programme because the practice had moved to new premises since their previous inspection in November 2019.

How we carried out the inspection/review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included

• Conducting staff interviews using video conferencing
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• Feedback from staff using questionnaires
• A site visit

Our findings

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 Good overall.

We found that:

• The practice cared for patients in a way that kept them safe and protected them from avoidable harm, this included safeguarding and management of risk. However, we saw areas, as described in the safe and effective key questions, where improvements could be made to ensure risks were identified and managed properly. These included significant incident reporting, staff immunisation and pro-active oversight of trainee clinicians. The practice assured us during the inspection that these processes would be put in place
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic and continued to do so. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We found a breach of regulation 12, Safe Care and Treatment and the provider must:

• Ensure care and treatment is provided in a safe way to patients

The practice should also:

• Improve monitoring of chronic diseases to ensure all patients receive the same service and none are missed.
• Relaunch the patient participation group.
• Assure itself that patient consent is always documented on the clinical record.
• Review patient deaths.

Whilst we identified the above improvements, we also saw areas of outstanding practice.

• The practice designed the F12 template to standardise referral documentation and this was implemented throughout the Trafford area.
• The practice had created the template for end of life care that also allowed all disciplines to have input and all medicines to be printed off so that immediate care could be administered. End of life care plans could be created automatically from the DNACPR form and information could be entered directly into the patient record to make sure that consistency was achieved. This evidenced continuity of care and co-ordination between multi disciplinary teams. There was also scope for patients preferences and wishes within the care plans. This was something that was now standardised throughout Trafford for the benefit of all patients.
• Following an audit on new pre-diabetic patients and learning that early education can significantly improve patient outcomes the practice has engaged with a health and wellbeing company to launch the My Diabetes My Way Scheme, a structured programme allowing patients to conveniently access and manage self help and care between healthcare professional appointments through various forms including small group sessions.
• The practice was a research active practice and worked with the NHS National Institute for Health Research (NIHR) to promote research and offer their patients the opportunity to take part in ethically approved research studies. The research for the practice was led by two of the GPs and they took part in research that would be of benefit to their patients and in collaboration with trusted research groups.
• When only 56% were satisfied with the general practice appointment times the practice recruited more clinical staff including practice nurses, an advanced nurse practitioner, salaried GPs and increased partner capacity with varying sessions and differing start/finish times to capture those who could not attend during core hour appointments.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services