St Johns House Medical Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment, we rated this key question as good. At this assessment, the rating has changed to requires improvement.

This service scored 62 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. All staff had contributed to the development of the practice vision and strategy, which was kept under review. The practice promoted a positive, compassionate, listening culture that supported trust and understanding between staff and patients using the service. Learning and development were supported. Staff expressed how the practice was a happy, friendly and supportive place to work. Staff shared a common aim to do the best they could for patients and strived to provide safe, high-quality care. Leaders told us they encouraged staff to make suggestions to enhance the vision, values and strategy. A suggestions box was available for staff to use and open discussions were held in wider team meetings.

The practice had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. Staff told us leaders in the practice were approachable, responded to all concerns raised and modelled the values of the practice. We saw the leadership team worked with other practices in the primary care network and were engaged in the development of primary care services within the local area.

The practice fostered a positive culture where people felt they could speak up and their voice would be heard. The practice had established Freedom to Speak up arrangements with other practices in the primary care network. Staff were aware of how to raise concerns and felt confident they would be dealt with appropriately.

The practice valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them. There were policies and procedures to promote diversity and equality. Staff had completed equality and diversity training. Staff feedback about the culture of the practice in the context of workforce equality was positive. Leaders made reasonable adjustments to support staff to carry out their roles well.

Our clinical records review identified that not all systems and processes for medicines management and long-term conditions were operating effectively. For example, some patients diagnosed with asthma were not monitored and reviewed in line with best practice as some did not have follow up appointments, putting patients at risk. Some patients diagnosed with hypothyroidism were also not monitored in line with best practice as some did not have the appropriate blood tests completed, putting these patients at risk. Some patients diagnosed with chronic kidney disease were also not monitored in line with best practice and some patients were incorrectly coded. For those patients that were reviewed, some of the review notes did not have sufficient detail to clarify what had been reviewed and discussed. Although there was no formal documentation of prescribers checking whether a patient had been reviewed before prescribing the medication again, the practice have assured us that each patient is reviewed on a case by case basis.

Systems and processes were not effective when acting upon Medicines and Healthcare Products Regulatory Agency (MHRA) alerts as not all patients were informed about the risks when prescribed Clopidogrel with Proton Pump Inhibitor (PPI). These findings are a result of poor governance as not all medicine management systems and processes were embedded due to lack of oversight.

Staff told us they were clear about their responsibilities, roles and systems of accountability. The provider had established governance processes that were appropriate for their service. Staff had access to policies and procedures and knew who to talk to if they had concerns or questions. Clinical concerns and emerging risks were discussed during team meetings and the minutes were shared with staff to ensure the relevant information and actions were acknowledged and addressed. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff. Staff took patient confidentiality and information security seriously.

The practice understood their duty to collaborate and work in partnership to support care provision enabling services to work seamlessly for patients. Staff and leaders engaged with people, communities and partners to share learning with each other and to promote continuous improvement. Working alongside practices in the primary care network, enabled the practice to identify new or innovative ideas that could lead to better outcomes for people. For example, the practice offered extended access, flu and covid vaccinations and child immunisations.

The practice focused on continuous learning, innovation and improvement across the organisation. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research. Staff learned from significant events and complaints to continually improve the service they provided. All staff were encouraged to put forward and test out new ways of working. The practice shared their innovative ideas. For example, the practice regularly updated their social media pages with health reminders and patient feedback responses, highlighting the improvements made within the practice. The practice engaged with the local community and invited services like Alzheimer's UK to share information with patients. The practice shared their future initiatives with us. They intend to create a walk-through video of the practice to enable patients to familiarise themselves with the building to ease the experience for patients with autism. They also intend to hold a breast cancer awareness event.