Archived: St Johns House Surgery Also known as Dr RA Ingles and Partners

Updated 6 February 2017

St Johns House Surgery is located in Worcester. It moved to new purpose built premises two years ago. The practice is a partnership and had 13,271 patients registered at the time of our inspection. The practice is located in a semi-urban area with some pockets of deprivation. There are a large number of elderly patients, 11% of the patient list are aged over 75 (above the national average of 8%). This includes 150 patients who live in six care homes, 109 of whom have severe frailty.

The practice has a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

St John’s House Surgery has three partner GPs (female), along with two salaried GPs (one male and one female) and a GP seconded from the local Healthcare Trust (male). There are also two practice nurses (nurse practitioners who are able to prescribe) and three healthcare assistants. They are supported by a clinical pharmacist, a practice manager and administrative and reception staff. One of the reception staff also works as a care navigator and at the time of our inspection the practice was about to employ a second clinical pharmacist. The practice manager was recently appointed and was shared with another local practice and this had allowed close working between the two practices to begin. There were plans to develop this in the future.

The practice is open from 8.15am to 6pm during the week. Appointments are available throughout those times. Telephone lines are open from 8am to 6.30pm. Extended hours appointments are available on weekdays from 7am to 8am and from 6.30pm to 7.30pm.

When the practice is closed, patients can access out of hours care provided by Take Care Now located in Worcester through NHS 111. The practice has a recorded message on its telephone system to advise patients. This information is also available on the practice’s website.

Home visits are available for patients who are unable to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and book new appointments without having to telephone the practice. Telephone appointments are available for patients who are unable to reach the practice during normal working hours and a 48 hour call back system is available for patients with non-urgent queries.

The practice treats patients of all ages and provides a range of medical services. This includes minor surgery and disease management such as asthma, diabetes and heart disease.

St Johns House Surgery is an approved training practice for doctors who wish to be become GPs. A GP registrar is a qualified doctor who is training to become a GP through a period of working and training in a practice. Only approved training practices can employ GP trainees and the practice must have at least one approved GP trainer. However, at the time of our inspection, the practice was not operating as a training practice due to constraints on GP’s time.

Updated 6 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Johns House Surgery on 29 November 2016. Overall the practice is rated as good.

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

• There were clearly defined processes and procedures to ensure patients were safe and an effective system was in place for reporting and recording significant events.
• The practice had a clear vision which had quality and safety as its top priority. This was regularly reviewed and discussed with staff.
• Patients said they were treated with dignity, respect and compassion. Patients were involved with decisions about their care and treatment.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care delivered in line with current guidelines. Staff had the appropriate skills, knowledge and experience to deliver effective care and treatment.
• Urgent same day patient appointments were available when needed. The majority of patients we spoke with and those who completed comment cards before our inspection said they were always able to obtain same day appointments, although a small number said it could be difficult to get an appointment at times.
• Information about how to complain was available and easy to understand.
• Patients said GPs gave them enough time and treated them with dignity and respect.

We saw several areas of outstanding practice including:

• The practice employed a clinical pharmacist and at the time of our inspection was about to employ a second clinical pharmacist. They provided advice on areas such as prescribing, medicine reviews, repeat prescribing and hospital discharge reviews. This included patients who lived in the care homes served by the practice. This reduced GP’s workload. Close working had been developed with the clinical commissioning group (CCG) pharmacist.

• One partner GP dealt exclusively with care home work. This enabled a consistent approach to be taken and a close working relationship to be developed with the care homes, care home staff and patients concerned. Learning was shared with other practices and the CCG. Some families had been given a mobile telephone number and/or email address for this GP to allow direct contact to be made. Since implementing this, there had been a reduction in patient falls and fractures and in unplanned hospital admissions.

• The practice had formed a learning network with the CCG, the local healthcare trust, Worcestershire County Council and locally based housing associations. This was still being developed at the time of our inspection. One of the primary aims of this network was to explore external funding opportunities for improving local healthcare.

• A staff member had received specialist training to work as a care navigator within the practice. Patients were referred to this staff member for help and advice on both healthcare and social care matters within the charitable and professional sectors. This enabled patients to access services they might otherwise be unaware of.

The area where the provider should make improvements are:

• Continue work already in progress to identify more patients who were carers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 6 February 2017

The practice is rated as good for the care of people with long-term conditions.

• The practice had a register of patients with long term conditions to enable their health to be effectively monitored and managed.

• Patients with more than one long term condition were reviewed annually in a ‘multi-chronic disease’ clinic to reduce the number of reviews needed by each patient.

• Longer appointments and home visits were available when needed.

• Patients had a named GP and a review every 12 months to monitor their condition and ensure they received correct medicines. This also included carers if the patient had one. The frequency of the review depended on the severity of the patient’s condition.

• All patients who had been prescribed eight or more medicines had had a medicines review within the last 12 months.

• The practice employed a clinical pharmacist. They provided advice on areas such as prescribing, medicine reviews, repeat prescribing and hospital discharge reviews.

• The practice achieved a 100% influenza vaccination record for diabetes patients during 2015/16. This was above the CCG average of 97% and the national average of 94%.

Updated 6 February 2017

The practice is rated as good for the care of families, children and young people.

• A total of 78% of eligible patients had received cervical screening in the last 12 months. This was below the CCG average of 83% and the national average of 82%.

• There were appointments outside of school hours and the practice building was suitable for children and babies.

• Outcomes for areas such as child vaccinations were in line with the national average.

• We saw positive examples of joint working with midwives and the local health visitor. Antenatal and postnatal appointments were available at the practice every week.

• A monthly multi-disciplinary team meeting was held with the midwife and health visitor. The child protection register and non-attendance for immunisations and checks were reviewed at this meeting.

• A full range of family planning and sexual health services were available.

Updated 6 February 2017

The practice is rated as good for the care of older people.

• Care plans were in place with the most vulnerable older patients (2% of the practise patient list) and used with multi-disciplinary teams to reduce unplanned hospital admissions. These patients had an alert placed on their patient records to ensure clinical staff were aware.

• The practice worked closely with the Clinical Commissioning Group (CCG) Proactive Care Team to provide integrated care for patients within the community.

• Older patients were given personalised care which reflected their needs.

• One partner GP dealt exclusively with care home work. This enabled a consistent approach to be taken and a close working relationship to be developed with the care homes, care home staff and patients concerned. Learning was shared with other practices and the CCG. Some families had been given a mobile telephone number and/or email address for this GP to allow direct contact to be made.

• Over the last 12 months all patients aged 75 and over had been invited for a health check. This included blood tests, fracture assessment, frailty assessment, and checks for depression and dementia. From those checks, the practice identified patients who needed further investigation and referred them appropriately.

• Home visits were offered to patients who could not reach the practice.

• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

Updated 6 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice ensured it provided services to meet the needs of the working age population, For example, extended hours appointments were available on weekdays from 7am to 8am and from 6.30pm to 7.30pm.

• On-line access was available for booking appointments and ordering repeat prescriptions.

• Telephone consultations were available for patients who were unable to reach the practice during the day. Non-urgent call backs could be requested within 48 hours.

• The practice used the CCG Clinical Contact Centre to handle some patient enquiries and provide a triage service. This enabled patients to receive non-urgent telephone advice when they were unable to reach the practice.

• Regular reviews of the appointment system were held to ensure patients could access the service when they needed to. This had recently resulted in additional telephone appointments being made available.

• A full range of services appropriate to this age group was offered, including travel vaccinations and smoking cessation.

Updated 6 February 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice had a register of patients with poor mental health to enable their health to be effectively monitored and managed.

• The practice worked with multi-disciplinary teams to provide appropriate care for patients with poor mental health. This included patients with dementia.

• Patients were signposted to appropriate local and national support groups.

• Staff demonstrated a good working knowledge of how to support patients with mental health needs and dementia.

Updated 6 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice had a register of patients who were vulnerable to enable their health to be effectively monitored and managed. This included patients with a learning disability.

• The practice participated in the learning disability enhanced service and offered comprehensive reviews by clinical staff who had undertaken relevant training.

• The practice supported vulnerable patients to access various support groups and voluntary organisations.

• Longer appointments were available for patients with a learning disability.

• The practice worked with other health care professionals to provide care to vulnerable patients, for example, the district nursing team and community matron. Vulnerable and complex patients were discussed at the monthly multi-disciplinary team meeting.

• Staff could recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities to share appropriate information, record safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.