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Inspection carried out on 8 January 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St John’s Medical Centre on 8 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring responsive and well led services. It was also good for providing services for patients with learning disabilities.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • 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.
  • The practice obtained feedback from patients in many different ways such as patient questionnaires, a suggestion box, the friends and family test and surveys undertaken by medical students. They were responsive to suggestions received.
  • 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.

We saw four areas of outstanding practice:

  • The practice have introduced a system to monitor the quality of service around appointments, referral letters, scanning and telephone consults provided to the patients. It is positioned where it can be seen by all staff and is used as a staff ‘self-monitoring’ tool to encourage improvement, specifically in any areas of concern creating better access for patients.
  • One of the GPs with an interest in learning disabilities had made significant positive impacts on the lives of a specific group of patients. The GP had taken the time to explore their social environment which impacted negatively on their mental and physical conditions. The GP worked with other health and social care professionals and individuals outside of clinical environments to help integrate these patients into society and improve their quality of life.
  • The GPs met every lunch time to discuss patients they had seen since the previous day, provide peer support and share good practice. The discussions included challenge and changes in practice were made where they were felt appropriate.
  • ‘Hot clinics’ had been introduced for children under the age of 5 years and these were available both in the mornings and after school hours.

However there were areas of practice where the provider needs to make improvements.

  • Although we saw evidence of full cycle clinical audits, the practice were not proactive in completing these.
  • Although an advanced nursing practitioner had recently been employed, additional nursing hours were required to meet the needs of the practice and its patients.
  • We established that the health care assistant (HCA) was responsible for most of the checks relating to medicines management, equipment, emergency drugs and cold chain. There was no written policy in place to outline what checks were required and who was responsible for those checks in the absence of the HCA.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

CQC Insight

These reports bring together existing national data from a range of indicators that allow us to identify and monitor changes in the quality of care outside of our inspections. The data within the reports do not constitute a judgement on performance, but inform our inspection teams. Our judgements on quality and safety continue to come only after inspection and we will not make judgements on data alone. The evidence tables published alongside our inspection reports from April 2018 onwards replace the information contained in these files.