We carried out a review of the data available to us about St Pauls Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about St Pauls Practice, you can give feedback on this service.
We carried out an announced focused inspection at St Paul’s Practice (known as Carlisle Healthcare) on 11 October 2019. This was to check the practice had made the improvements we said they should when we last inspected the practice in November 2018.
At the last inspection, we rated the practice as requires improvement for providing responsive services. We said the provider should:
At this inspection, we found that the provider had acted to address these areas.
We based our judgement of the quality of care at this service on a combination of:
We rated this practice as good overall. (Previous rating December 2018 – Good).
We rated the practice as good for providing responsive services because the practice had:
We recommend that the practice should:
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
This practice is rated as Good overall. (Previous rating January 2018 – Requires Improvement)
The key questions at this inspection are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Requires Improvement
Are services well-led? - Good
We carried out an announced comprehensive inspection at St Paul’s Practice on 26 January 2018. The overall rating for the practice was requires improvement. The full comprehensive report on the January 2018 inspection can be found by selecting the ‘all reports’ link for St Pauls Practice on our website at www.cqc.org.uk.
This inspection was an announced follow-up comprehensive inspection which took place on 2 and 6 November 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
At this inspection we found:
We also saw some areas where the practice should make improvements:
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
Please refer to the detailed report and the evidence tables for further information.
This practice is rated as Requires Improvement overall. (Previous inspection - St Paul’s Practice was previously inspected in November 2014 and rated as Good. Brunswick House Medical Group (which has since merged with St Paul’s Practice) was previously inspected in November 2015 and rated as Good. Both of these inspections took place prior to the merger in October 2016.)
The key questions are rated as:
Are services safe? – Requires improvement
Are services effective? – Requires improvement
Are services caring? – Good
Are services responsive? – Inadequate
Are services well-led? Requires improvement
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Requires improvement
People with long-term conditions – Requires improvement
Families, children and young people – Requires improvement
Working age people (including those recently retired and students – Requires improvement
People whose circumstances may make them vulnerable – Requires improvement
People experiencing poor mental health (including people with dementia) - Requires improvement
We carried out an announced comprehensive inspection at St Paul’s Practice on 26 January 2018 as part of our inspection programme.
At this inspection we found:
The service had formed from the merger of three Carlisle practices in October 2016, leading to a combined patient list size of approximately 36,000 patients. This was the first practice in Cumbria to undertake a merger of this size, and while the leaders at the practice understood the challenges of working at scale and had made attempts to address them, they were aware that improvements were still needed.
The practice had systems to manage risk but some of these required improvements so that safety incidents were less likely to happen. When incidents did happen, the practice tried to learn from them and improve their processes.
Despite making efforts to meet demand, the practice continued to have difficulties to ensure that patients could access the service in a timely manner. Patient feedback regarding access via the telephone or to appointments remained below local and national averages.
Patient feedback was lower than local and national averages, and there had been a number of complaints about the attitude of some staff. On the day of inspection, however, we saw staff treating patients with compassion, kindness, dignity and respect.
There were measures in place to focus on continuous learning and improvement but these had not been fed back to patients and had not led to adequate improvements of the service.
On the day of inspection we saw that some staff had not completed annual training in the past 12 months in areas such as basic life support, safeguarding, fire safety and information governance. Furthermore, administrative and reception staff had not received annual appraisals since the practices merged in October 2016.
The three practices which make up Carlisle Healthcare had worked together prior to the merger to establish a “Frailty Team” of trained nurses who carried out visits to housebound frail patients..
The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
The practice worked closely with other healthcare professionals in the area to offer a range of services to patients.
The areas where the provider must make improvements are:
Ensure all that is reasonably practicable to mitigate the risks to the health and safety of service users receiving care or treatment is done.
Ensure systems and processes are operated effectively.
Ensure staff receive appropriate support, training, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.
For details, please refer to the requirement and enforcement notices at the end of the report.
The areas where the provider should make improvements are:
Continue to follow the improvement programmes which have led to improved patient feedback regarding being treated with kindness and compassion and being involved in their care.
Monitor the measures taken since the inspection to ensure they have led to sustainable improvements.
Continue to use media equipment and other reasonable measures to reduce the possibility of patients’ personal information being overheard in public areas of the practice sites.
Chief Inspector of General Practice
We inspected the practice on 14 November 2014. We did not visit the branch surgery as part of this inspection. We inspected this service as part of our new comprehensive inspection programme. Overall, we rated the practice as good. Our key findings were as follows:
We saw areas of outstanding practice:
Chief Inspector of General Practice
St Paul’s Practice is a busy city centre practice with 14,900 patients. As part of this inspection we visited the main practice site located in St Paul’s Square in Carlisle. It is registered with the Care Quality Commission to provide the following regulated activities: treatment of disease, disorder and injury; diagnostics and screening procedures; family planning; maternity and midwifery services and surgical procedures.
We carried out an announced inspection on 29 April 2014. During the inspection we spoke with patients and staff. We also reviewed four completed patient comment cards. Feedback from patients was mainly positive. They told us they were satisfied with the care and treatment they received.
We found patients were not always protected against the risk that they might receive incorrect medicines because the provider’s arrangements for checking that prescriptions issued against hospital discharge and advisory letters, were inaccurate. We have set a compliance action under Regulation 10(1)(2)(c) of the Regulated Activities Regulations (2010).
Patients’ care and treatment achieved good outcomes and was seen to be based on the best available evidence. Patients were seen to be treated with compassion, kindness, dignity and respect with services organised wherever possible to meet their needs.
The way the practice was managed promoted an open and fair culture which showed a commitment to providing safe patient care.
There was a strong and visible leadership team with a clear vision and purpose. Governance structures were, overall, robust and there were systems in place for managing risks.
The practice had made arrangements to provide care and treatment that was tailored to patients’ individual needs and circumstances. For example, arrangements had been made to provide older patients with an accountable GP. Patients with long term conditions were provided with access to a regular patient care review which monitored their condition, provided them with on-going treatment and advice, and helped them to better manage their own condition. Arrangements had been made to safeguard children and vulnerable patients from abuse or harm, including the provision of training for practice staff. The main practice was open until 18:30pm each week day and on some week days, late surgeries were offered to help provide working age patients with easier access to appointments.