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Inspection Summary


Overall summary & rating

Good

Updated 8 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St John's Medical Centre on 21 September 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to local and national average for most indicators. The practice was aware of the areas for development and had plans in place to achieve this.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Consider reviewing complaints periodically to identify trends and facilitate learning. .
  • Review the procedure for maintaining staff files to ensure that they are complete.
  • Continue to improve care for patients with long term conditions, particularly patients with Chronic Obstructive Pulmonary Disorder, and to reduce rates of patients excepted from Quality and Outcomes Framework indicators.
  • Consider ways to reduce waiting times for patients.
  • Consider developing a wider programme of audit, to improve services and outcomes for patients.
  • Review the new system for checking urgent referrals, to check that it is working as anticipated.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 November 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 8 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to local and national average for most indicators. The practice was aware of the areas for development and had plans in place to achieve this.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 8 November 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 8 November 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. The practice had signed up to provide a number of services not covered by their standard contract, for example minor surgery and joint injections, to avoid patients having to travel to hospital to receive these services.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. Several patients told us that they sometimes had to wait a long time to be seen after their appointment time, but that when they were seen, they were given plenty of time by the GP, so understood that this might result in delays.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders. There was no annual review of complaints to allow analysis of any trends.
  • The practice serves a large West African population. In 2014, the practice developed a policy for the handling of suspected cases of Ebola, based on the risk that a patient might return infected with the disease. In addition to specific instructions for staff, the practice created an isolation room and kits of protective equipment.

Well-led

Good

Updated 8 November 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a focus on continuous learning and improvement.
Checks on specific services

People with long term conditions

Good

Updated 8 November 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Data from 2014/15 showed that performance for diabetes related indicators was comparable to the national average. For example, 70% of patients with diabetes, had their HbA1c (blood sugar over time) last measured at 64 mmol/mol or less, compared to the local average of 73% and the national average of 78%.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice referred patients to education programmes to support self-management of diabetes and respiratory conditions.
  • All clinical staff members had received training in collaborative care planning.

Families, children and young people

Good

Updated 8 November 2016

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

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • The practice’s uptake for the cervical screening programme was 80%, which was comparable to the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • To support families the practice ran a ‘one stop shop’ for mothers’ postnatal and new baby checks with a GP and a health visitor. These were booked automatically based on the hospital notes.

Older people

Good

Updated 8 November 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population. 10% of patients over the age of 65 had documented care plans in place.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • 73% of patients aged over 65 received a flu vaccination in 2015/16, compared to the local average of 69%.

Working age people (including those recently retired and students)

Good

Updated 8 November 2016

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

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
  • The practice had installed a blood pressure machine in the waiting room to support patients to self-monitor their blood pressure, height and weight.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 November 2016

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

  • Performance for mental health related indicators was similar to the national average.
  • 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan; compared to the national average of 88%. Seventy four percent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 8 November 2016

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

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.