St James Surgery

Updated 1 December 2016

St James Surgery is located in a purpose built building near the centre of the market town of Devizes, in Wiltshire. All of the consulting rooms are on the ground floor. The practice has a registered population of approximately 6,600 patients. Data shows minimal income deprivation among the practice population. There are a higher number of patients aged over 45 than the national average.

There are three GP partners and one salaried GP. Two are female and two are male. There is a nurse manager, two practice nurses, two health care assistants and a phlebotomist. (A phlebotomist takes blood samples.) The practice manager is supported by a team of nine staff. The practice is a training practice and at the time of our inspection they had one GP trainee working with them. The practice is registered as a partnership between the three partner GPs.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments with GPs are from 8.30am to 11.30am and 2pm to 6pm. Extended surgery hours are offered from 6.30pm to 7.45pm on Mondays only. The practice has opted out of providing out of hours services to their patients. The out of hours service is provided by MEDIVIVO and is accessed by calling NHS 111. This practice had not been previously inspected. On the day of our inspection the practice registration under the CQC (Registration) Regulations 2009 was incorrect. One of the partners was registered as the registered manager but not as a partner. The practice had been doing surgical procedures and had not realised they were not registered for this. We were told they would not be conducting any further minor surgery until they were registered for this and we saw evidence that the practice was in the process of making the necessary changes to their registration.

The practice delivers its services from St James Surgery, Gains Lane, Devizes, Wiltshire, SN10 1QU.

Updated 1 December 2016

Letter from the Chief Inspector of General Practice

In February 2016, during an announced comprehensive inspection of St James Surgery, we found issues relating to the practice’s control and assessment of its risk of legionella. Legionella is a harmful bacteria which can grow in some water systems, if the environmental conditions are right.

During the inspection, the practice was unable to produce a legionella risk assessment. This was in breach of the Health and Social Care Act 2008 Regulations. As a result the practice was rated as requires improvement for safe, and good for effective, caring, responsive and well led. The practice had an overall rating of good.

We carried out a focused inspection of the practice in September 2016. The provider sent us a risk assessment of their management of legionella. The practice also provided a written scheme evidencing the control for legionella. The written scheme of control explained how the risk of legionella would be managed within the practice.

We found the practice had made improvements since our last inspection in February 2016, and that it was now meeting the regulation relating to assessing the risk of legionella, which had previously been breached.

Following this focused inspection we have rated the practice as good for providing safe services. The overall rating for the practice remains good.

This report should be read in conjunction with the full inspection report of 9 February 2016. A copy of the full inspection report can be found at www.cqc.org.uk.

At this inspection we found that:

• The practice had instructed an independent company to assess the risk of legionella in the practice.
• Using the legionella risk assessment, completed by an independent company, the practice had produced a legionella risk assessment.

• Based on the legionella risk assessment, the practice had produced a written scheme of control for legionella.
• The practice was now able to provide evidence that it was following its own legionella risk assessment, and outlined any intended steps it would take to reduce the risk of legionella.

Systems were now in place to reduce and minimise the risk of legionella to both staff and patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 April 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.

• Nationally reported data showed the diabetes indicators were higher than average. For example, 99.6% of patients on the register with diabetes had a flu vaccination in the period August 2014 to March 2015 compared to the national average of 94%.

• 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 complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 22 April 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.

• 77% of patients on the register with asthma had a review in the last twelve months (04/2014 to 3/2015), compared to the national average of 75%.

• 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.

• 95% of women on the register aged 25 to 64 had a cervical screening test in the preceding five years (4/2014 to 3/2015), compared to the national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 22 April 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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice had worked with the clinical commissioning group and four other local practices to employ an emergency care practitioner to do urgent home visits. This was a new initiative which has been running for a couple of months. The impact was unclear at the time of the inspection.

• Dementia assessments are provided by the practice.

Updated 22 April 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 had a triage system for managing same day appointments with a duty GP, which allowed them to be flexible to the needs of working patients. Where appropriate, GPs conducted telephone consultations.

• 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 offered extended opening hours for appointments on Monday and Tuesday from 6.30 to 7.30pm.

Updated 22 April 2016

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

• 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (4/2014 to 3/2015), which was higher than the national average of 84%.

• 100% of patients with a psychosis had their alcohol consumption recorded in the preceding 12 months (4/2014 to 3/2015), which was higher than the national average of 90%.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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.

• The practice was able to refer patients to the Wiltshire psychological service which offered weekly appointments at the surgery.

Updated 22 April 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 multi-disciplinary teams in the case management of vulnerable people.

• 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.