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Dr William Porter Good Also known as St James's Medical Practice

Reports


Review carried out on 8 January 2020

During an annual regulatory review

We reviewed the information available to us about Dr William Porter on 8 January 2020. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 13 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We previously inspected Dr William Porters practice on 2 August 2016. As a result of our inspection visit, the practice was rated as requires improvement. Specifically, the practice was rated as inadequate for providing safe services and requires improvement for providing effective and well led service. A requirement notice was issued to the provider. This was because we identified regulatory breaches in relation to regulation 12, Safe care and treatment, regulation 17, Good governance and regulation 18, Staffing. We identified some areas where the provider must make improvements and some areas where the provider should make improvements.

We carried out an announced comprehensive inspection at Dr William Porters practice, also known as St James’s Medical Practice on 13 June 2017. This inspection was conducted to see if improvements had been made following the previous inspection in 2016. You can read the reports from our previous inspections, by selecting the 'all reports' link for Dr William Porter on our website at www.cqc.org.uk.

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

  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse. We noted improvements with regards to the management of safety alerts during our most recent inspection and evidence demonstrated that clinicians received and acted on alerts when needed.

  • Significant events and audits were used as opportunities to drive improvements. Some audits were completed in response to the findings from our previous inspection, including audits focussing on the effectiveness of failsafe systems for cytology results.

  • When we inspected the practice in 2016 we found that some areas of monitoring high risk medicines required improvement. During our most recent inspection we saw that patients prescribed high risk medicines were monitored and reviewed.

  • We noted significant improvement to staff files during our most recent inspection. The files showed that appropriate recruitment checks had been undertaken prior to employment, overall we found that the files were organised. A locum induction pack was also implemented following our previous inspection.

  • Most recently we saw that more formal supervision was in place for the practice nurse prescriber, with support from the practice GP. The nurse had also attended prescribing updates relevant to the areas they prescribed in.

  • We observed the premises and medical equipment to be visibly clean. Previously we found that records were not kept to reflect the cleaning of specific medical equipment. Most recently we saw records to demonstrate that the equipment used for ear irrigation was cleaned, but there were no records in place to support the cleaning of other medical equipment.

  • Although the practices cervical screening uptake had improved by 2% since our previous inspection, cervical screening and bowel cancer screening rates remained below local and national averages.

  • When we inspected the practice in 2016 we found some patients at risk of hospital admission did not have personalised care plans in place. During our most recent inspection we saw evidence to support that adequate care plans were in place and there was an effective recall system in place for patients needing medication and general health reviews.

  • Since 2016, the practices carers register had increased from 18 to 26 carers; this was 1% of the practices list. Although there was some support in place for carers, there was no information available to take away or on display in the practice to support carers.
  • There was information about how to complain on the practice website and the practice displayed this information in the waiting area following our inspection.
  • During our most recent inspection we saw improvements in governance, risk management and record keeping across areas including the management of the cold chain (for the safe storage and handling of vaccinations).

The areas where the provider should make improvements are:

  • Continue to focus on improving cancer screening rates overall.

  • Ensure that carers are able to easily access supportive information and continue to identify carers in order to offer them support where needed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 2 August 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr William Porters practice, also known as St James’s Medical Practice on 2 August 2016. Overall the practice is rated as requires improvement.

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

  • We observed a strong patient-centred culture and we saw that staff treated patients with kindness and respect, and maintained confidentiality. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • There were adequate arrangements in place to respond to emergencies and major incidents. We saw that significant events were regularly discussed with staff during practice meetings and the practice used these as opportunities to drive improvements.

  • The arrangements for managing medicines and vaccinations were not always effective enough to ensure that patients were kept safe. There was a system in place for the prescribing of high risk medicines. However, we found that some areas of monitoring high risk medicines required improvement.

  • We found that in some areas governance arrangements were not robust. During our inspection we found gaps in the record keeping to support that adequate infection control measures were in place. The infection control lead was unable to demonstrate how they kept up to date with infection control guidelines and best practice.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. Although the practice had systems in place to identify and assess patients who were at high risk of admission to hospital we found that some of these patients did not have personalised care plans in place.

  • One of the nurses had qualified as a nurse prescriber and could therefore prescribe medicines for specific clinical conditions. The nurse was unable to demonstrate how they stayed up to date with prescribing and best practice guidelines for the areas that they prescribed in.

  • Uptake for cervical screening was below average, during our inspection we also found that the practice did not consistently follow an effective failsafe system for cervical screening tests to ensure that test results had been received for every sample sent by the practice.

  • We found many gaps in the record keeping for staff files. Records were not in place to provide assurance that appropriate recruitment checks had been completed for both non-clinical and clinical members of the practice team. We also found that there were no records of completed DBS checks for members of the nursing team

  • We found that essential training such as infection control principles was not included in the induction programme. Additionally, the practice did not have an induction pack for locum clinicians to use when working at the practice.

  • Staff spoken with demonstrated a commitment to providing a high quality service. Throughout our inspection there was a strong theme of positive feedback from staff and staff commented that they felt valued and part of a close practice team. The practice encouraged a culture of openness and honesty.

The areas where the provider must make improvements are:

  • Improve the overall management of Human Resources; ensure that the appropriate disclosure and barring (DBS) and recruitment checks have been completed for staff as required, prior to working at the practice.

  • Ensure that that all relevant staff have oversight of patient safety alerts and updates (such as medicines and medical device alerts) and implement a system to ensure that action has been taken for all patients who are affected.

  • Ensure that an effective process is followed with regards to monitoring all high risk medicines.

  • Ensure that an effective failsafe system is well embedded for cervical screening tests, to ensure that test results had been received for every sample sent by the practice.

  • Improve governance arrangements in relation to infection control; ensure that actions are taken to address improvements identified through completed infection control audits and risk assessments associated with infection control; such as legionella. Maintain cleaning records for medical equipment.

  • Ensure that locum GPs receive a full induction with appropriate reference material and that ongoing support is made available during their period working with the practice.

The areas where the provider should make improvements are:

  • Ensure that adequate support and mentorship is in place for the nurse prescriber to ensure that they stay up to date with prescribing and best practice guidelines for the areas that they prescribe in.

  • Ensure that records are well maintained to reflect emergency protocols such as fire drills.

  • Ensure that record keeping for the management of cold chain reflects national guidance.

  • Continue to work on personalised care plans for patients who are at high risk of hospital admission; in line with treatment and needs.

  • Continue to identify carers and ensure that all carers are captured on the computer system, in order to provide further support where needed.

  • Continue to explore ways to engage with patients who do not attend for cervical screening, in order to ensure screening is taking place as appropriate.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 16 July 2013

During a routine inspection

On the day of our inspection we spoke with five patients and five members of staff. One patient said, �He is a perfect gentleman, he went out of his way to help my wife." The patients we spoke with said they were able to obtain appointments at a time to suit their needs and that they did not have to wait long once they arrived at the practice.

We saw that patient's views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. One patient told us, �I have never had any reason to make a complaint." We saw that patients experienced care and treatment that met their needs. Patients told us and we saw that care was delivered in a clean environment.

There were good systems in place to ensure patient's medication was reviewed regularly. The patients we spoke with said that good explanations of their medication were always given.

There were good systems in place to assess and monitor the quality of service that people received.