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Inspection Summary


Overall summary & rating

Good

Updated 28 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St James Surgery on 18 October 2016. Overall the practice is rated as good.

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

  • Staff were aware of their responsibilities regarding safety, and reporting and recording of significant events. There were policies and procedures in place to support this.
  • The practice assessed risks to patients and staff. There were systems in place to manage these risks.
  • Processes and systems around medicines management kept patients safe. 
  • Staff used current guidelines and best practice to inform the care and treatment they provided to patients.
  • All patients said that they were treated with dignity and respect and involved in decisions about their care and treatment.
  • There was a clear and effective complaints system in place. Any comments regarding suggestions for improvements using this system were also responded to by the practice.
  • Patients told us that access to appointments was good. The practice had a system in place to try to provide continuity of care.
  • The practice was equipped to meet the needs of its patient population.
  • There was a strong leadership structure in place and staff were invested in and supported to increase their knowledge and skills.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • Where staff showed an interest in a particular clinical area, the practice supported that member of staff to gain knowledge and skill in that area. If they were unable to drive to the location the practice financially supported them to physically access the training and paid staff overtime if training took place outside of their working hours.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 November 2016

The practice is rated as good for providing safe services.

  • Staff were aware of and could explain their role and responsibilities in reporting and recording of significant events. They told us, and we found evidence to show, that following investigation of any incidents the outcome was shared with appropriate staff to ensure that lessons were learned and action was taken to improve safety in this area in the future.
  • When things went wrong involving patients, appropriate actions were taken and a full investigation completed, with the person affected, or their designated next of kin, given accurate and honest information.
  • There were processes and policies in place for the safe management of medicines.
  • There were clear safeguarding processes in place for adults and children. Staff were aware of their roles and responsibilities with regards to safeguarding and were aware of potential signs of abuse.
  • There were systems in place for the identification and assessment of potential risks to patients, staff and the premises, and plans in place to minimise these.

Effective

Good

Updated 28 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Staff had access to the latest clinical guidelines and best practice guidance and used these to assess and deliver patient care.
  • Clinical staff used a range of measures to ensure they had the skills, knowledge and experience to provide effective care.
  • We found all staff had received an appraisal and had a personal development plan.
  • The practice completed audits which were relevant to the service and demonstrated quality improvement.
  • Staff had opportunities for career progression and ongoing learning.
  • The practice had good working relationships with other health and social care staff.

Caring

Good

Updated 28 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.
  • The majority of patients told us that they were treated with dignity and respect by staff, involved in their treatment and that staff were good.
  • We saw staff treated patients with kindness and respect.
  • The practice had identified and supported a good percentage of carers on their register.

Responsive

Good

Updated 28 November 2016

The practice is rated as good for providing responsive services.

  • The latest GP survey, published in July 2016, showed the practice was rated higher than the CCG and national average with regards to satisfaction with opening hours and making an appointment generally.
  • Patients told us that access to appointments was good. The practice had a system in place to try to provide continuity of care.
  • The practice was equipped to meet the needs of its patient population.
  • There was a complaints, compliments and comments leaflet in the waiting area with a box to put them in. The practice responded to these in a timely manner.

Well-led

Good

Updated 28 November 2016

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

  • There was a clear leadership structure in place with strong governance systems.
  • The practice had policies and procedures in place, which were relevant to the practice, regularly reviewed and updated as required.
  • There were systems in place for notifying about safety incidents and evidence showed that the practice complied with the duty of candour when investigating and reporting on these incidents.
  • The practice sought feedback from staff and patients, which it acted on. There was a virtual patient participation group which provided a ‘critical friend’ view and a balanced viewpoint on the various aspects of the service provided.
Checks on specific services

People with long term conditions

Good

Updated 28 November 2016

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

  • Both GPs and nursing staff took the lead in reviews and management of patients with long term conditions.
  • The practice performance for diabetes indicators was in line with or higher than the CCG and national averages. For example, the number of patients who had received a foot examination and risk classification was higher than the CCG and national average.
  • All patients had a named GP.
  • Those patients unable to come to the practice, for example, due to being housebound, were able to access home visits, vaccination and health checks from the GP and nursing staff.
  • The practice worked with other health and social care professionals to provide coordinated care and treatment.

Families, children and young people

Good

Updated 28 November 2016

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

  • There were systems and processes in place to enable staff to identify and take appropriate action to monitor and safeguard children and young people living in disadvantaged situations. For example, where a child did not attend a booked appointment this was followed up.
  • The GP practice completed the pre-school checks.
  • Urgent same day appointments were available for babies and children.
  • Immunisation rates were above CCG and national averages for all standard childhood immunisations.
  • Appointments were available outside of school hours.
  • The premises were suitable for children and babies.

Older people

Good

Updated 28 November 2016

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

  • If patients required a longer appointment due to complex needs or multiple medical conditions this was available. 
  • All older patients had a named GP.
  • Those patients unable to come to the practice, for example, due to being housebound, were able to access home visits, vaccination and health checks from the GP and nursing staff.

Working age people (including those recently retired and students)

Good

Updated 28 November 2016

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

  • The practice offered Saturday morning pre booked appointments. These appointments could be used for a variety of reasons including travel vaccines and chronic disease management.
  • Prescriptions were sent electronically to the patients preferred chemist.
  • The practice offered online appointment booking and prescription requests.
  • The percentage of women aged 25-64 who have had a cervical screening test in the past 5 years was above the CCG and national average.
  • The practice operated a virtual patient population group (PPG) which was popular with this group.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 November 2016

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

  • The practice performance for mental health indicators was higher than the CCG and national average. For example, the percentage of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, was higher than the CCG and national average.
  • The practice worked closely with mental health professionals to deliver coordinated care in the community.
  • Longer appointments were available for patients experiencing poor mental health.
  • The practice sign-posted patients to local voluntary support services.

People whose circumstances may make them vulnerable

Good

Updated 28 November 2016

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

  • The practice was aware of those patients on their register who lived in vulnerable circumstances.
  • The practice computer system provided an alert to staff if patients had any sensory deficit and therefore may require extra support to access their appointment.
  • If patients required a longer appointment due to complex needs or multiple medical conditions this was available.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • All patients had a named GP.
  • The practice sign-posted vulnerable patients to various support groups and voluntary organisations.
  • There were established systems and processes in place to ensure patient safety and enable staff to identify and take appropriate action to safeguard patients from abuse. Staff knew how to recognise signs of abuse in vulnerable adults and children.
  • The practice had identified and supported carers on their register.