St Johns House Medical Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. There were systems and processes in place to identify patient’s’ needs and preferences. Reception staff were aware of the needs of the local community as patients were coded to highlight any specific needs such as requirement for a longer appointment or the need for a translator. The practice met the accessible information standard. For example, information was available in different languages on their website, a hearing loop was present, and interpretation services were also available. Staff could refer patients with social needs, such as those experiencing social isolation or housing difficulties to a social prescriber within the primary care network. In the latest National GP Patient Survey, 89% of respondents felt their needs were met during their last GP appointment and 90% felt the healthcare professional they saw had all the information they needed about them during their last GP appointment. These scores were slightly below the national average. However, the feedback received directly to CQC showed patients felt involved in their care and felt confident that staff understood their individual and cultural needs.

The practice planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this mostly in line with legislation and current evidence-based good practice and standards. There were systems in place to ensure staff were up to date with relevant legislation, evidence-based practice and required standards. As part of the clinical searches, we reviewed clinical records to assess if care and treatment was delivered in line with best practice. Our findings from the clinical searches showed that monitoring of patients with long-term conditions was not always followed in line with National Institute for Health and Care Excellence (NICE) guidelines. For example, one of our clinical record searches reviewed the number of patients with asthma who had been prescribed two or more courses of rescue steroids in the last 12 months. We identified a total of 58 patients and reviewed a random sample of 5 patient records. We found that 3 out of 5 patientshad not been followed up in a timely manner to check their initial response to the treatment. Out of the 3 patients that were identified as not being followed up in a timely manner, only one of these patients had their annual review.There was also not an effective system in place to distribute MHRA alerts.

The practice worked well across teams and services to support patients. Information was shared between teams and services to enable continuity of care and ensure patients only had to tell their story once when moving between different services. This was reflected in patient feedback as patients felt their referrals were dealt with in a timely manner. Staff were supportive of each other to ensure they had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other practices within the primary care network to share knowledge to improve patient care. To ensure staff were able to work together effectively, the practice adopted an open-door policy to encourage staff to speak up so that any queries were resolved to ensure a positive working environment. Each staff member knew their role and responsibilities. There was always two staff members on reception to speak directly with the patients coming into the practice, allowing the remaining reception staff to answer calls. This reduced thewaiting time for both the patient in the practice and on the telephone. Multi-disciplinary team meetings were heldto ensure staff were updated with the latest information, guidance and changes within the practice.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. They supported patients to live healthier lives and where possible, reduce their future needs for care and support by sharing advice and guidance. Patients were encouraged to take an active role in reviewing their own health and wellbeing so they would recognise changes to their health and wellbeing. Many staff members were able to assist in patients care such as the social prescriber, wellness coach and physiotherapist. Health promotion material was observed in the practice and further information could be found on their website and on their social media page that supported national priorities and initiatives to improve population health by supporting people to stop smoking and tackle obesity. Management organised external services to come into the practice to share their expertise in ways to improve health. Management also had plans to engage with external organisationsto connect with them to offer a joint care plan for patients.

Findings from the clinical search records indicated that the practice routinely monitored most people’s care and treatment to continuously improve it to ensure that outcomes met both clinical expectations and the expectations of patients themselves. Our clinical record searches identified 22 patients that had a potential missed diabetes diagnosis. We reviewed a random sample of 5 patients and found that these patients had been correctly coded.

At the time of our assessment, the latest published information from the UK Health Security Agency (UKHSA) showed that the practice did not meet the national target for the number of children immunised against various infectious childhood diseases such as children aged 5 who should have received immunisations for measles, mumps and rubella. The practice had completed 89.8% of these immunisations in comparison to the expected World Health Organisation target of 95%. The latest published information from NHS Digital showed the practice’s uptake of cervical cancer screening was below the 80% national target and was observed as 73.3%. Staff told us they were aware of these figures and had systems in place with the aim to improve the uptake. For example, they ran regular searches to identify these patients that were due their cervical cancer screening or immunisations, followed up patients who did not attend appointments and invited them opportunistically when they attended for other appointments.

The practice told patients about their rights around consent and respected these when delivering person-centred care and treatment. Staff understood and applied legislation relating to consent. Staff understood the importance of ensuring that people fully understood what they were consenting to and respected the importance of obtaining consent before they delivered care or treatment. Staff said they always obtained consent from patients or if appropriate their guardian. Patients received information about care and treatment in a way they could understand. Patient’s’ capacity and ability to consent was considered and clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. Chaperones were available upon request. This information was on display in the form of posters in the practice. We did not receive any concerns about consent from the feedback we received from the patients who use the service.