St John's 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 assessed all quality statements from this key question. At our last assessment, we rated this key question as good. At this assessment, the rating remains the same. We found that leaders supported learning and innovation and promoted an open, fair culture. Overall, staff we spoke to told us they felt supported, and the service was actively engaged with initiatives to address health inequalities within the local community.
However, the service was in breach of regulations in relation to good governance. This is because governance processes at the service were not being followed by staff. The results of the last GP patient survey showed that the practice scored significantly below the national average in several areas and there was no evidence to indicate improvements had been made.
 

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a shared vision, strategy and culture. Staff we spoke to said they contributed to the development of the practice vision and strategy, which was kept under review. The strategy was in line with health and social priorities across the region. The provider planned the service to meet the needs of the local population. The provider monitored progress against delivery of the strategy.

The service 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 were approachable and responded to any concerns raised. We saw the leadership team were engaged in the development of primary care services within the local area and helped to create initiatives to promote equity in health.
 

The service fostered a positive culture where people felt they could speak up and their voice would be heard. There was freedom to speak up policy in place at the service. Staff told us they understood how to raise concerns and were confident that the leadership of the organisation would act on them.

The staff we spoke to demonstrated that the service valued diversity in their workforce. Policies and procedures to promote diversity and equality were in place. Adjustments had been made to ensure all staff were valued, for example alternative IT equipment had been made available to support staff when needed.

The service had procedures in place to monitor high-risk medicines, however they were not always followed. Data reviewed as part of our assessment showed that not all prescribed medicines were being monitored in line with the services own policies and procedures or national guidelines. The service was undertaking audits, although they were not able to provide multiple cycle audits. They told us that audits of prescribing, and Arden searches (the clinical searches undertaken by CQC at this assessment) were being undertaken, but they had not identified the lack of monitoring that some patients had received, including those who were taking higher risk medications. We also found one site did not hold some of the recommended emergency equipment and the service was not able to provide a formalised risk assessment. The results of the last GP patient survey showed that the practice scored significantly below the national average in several areas and there was no evidence to indicate improvements had been made.
Managers met with staff regularly to complete appraisals and performance reviews. Staff knew where to access all required policies and procedures. Managers held regular practice meetings with staff, during which they discussed clinical concerns and emerging risks. Managers clearly recorded any actions arising from these meetings and ensured they shared these with staff. Staff we spoke to demonstrated that they took patient confidentiality and information security seriously.
Leaders and managers supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. However, staff we spoke to said there was sometimes a delay in receiving support when requested.
 

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborated for improvement. The service established a specialist team that focussed on hospital referrals to ensure that patients received an appointment and to follow up on patients who did not attend.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people.
The practice had a quality improvement plan in place to help drive improvements in services. This focussed on improving patient experience. The service initiated an audit of patients with HIV who were admitted to hospital. Complaints and significant events were reviewed, and learning shared within the practice and externally. The service also identified areas for improvement relating to patient access and formed an action plan. This included improvements to the telephone system, making the service website more user friendly, and creating a triage system to better utilise appointment slots.