We carried out an announced comprehensive inspection at St George Health Centre on 5 March 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected

• information from our ongoing monitoring of data about services and

• information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall. We have rated the practice as Good for the provision of effective, caring, responsive and well-led care, and as Requires Improvement for the provision of safe care. All the population groups were rated as good.

We rated the practice as requires improvement for providing safe care because:

• On the day of our inspection not all emergency medicines where in date and ready to use, and there was no risk assessment to support that the practice had assessed they did not require to hold paediatric pads available for use with the defibrillator.

• On the day of our inspection the practice did not consider that training in the Mental Capacity Act or competence to give consent to be mandatory for all clinicians, as recommended in recognised guidance and there was no evidence that two clinicians had received such training.

• There was no clear system of clinical supervision and support available for nursing staff.

• There was no evidence that patients being seen by a health care assistant as part of a mental health service had been assessed by a clinician as being appropriate to be seen by the health care assistant.

We rated the practice as good for providing caring, effective, responsive and well-led care because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

• The previous provider’s exception reporting rate was reported as significantly higher than average across a range of performance measurements. However, the practice identified this as an area of improvement and unverified quality monitoring data showed significant improvement across all domains and exception reporting in 2018/19.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.

The areas where the provider should make improvements are:

• The provider should ensure that appropriate standards for the management of sharps are maintained.

(Please see the specific details on action required at the end of this report).

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St George Health Centre on 9 December 2014. Overall the practice is rated as good.

Specifically we found it good for safe, effective, caring, responsive and well led services. It was also good for providing services for older people, people with long-term conditions, mothers, babies, children and young people, working-age population and those recently retired people in vulnerable circumstances who may have poor access to primary care and people experiencing poor mental health.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and knew how to report incidents and near misses. Information about safety measures were recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed. Staff were trained and knew how to recognise signs of abuse in older people, vulnerable adults and children. Staff were aware of their responsibilities to share information and properly record documentation of safeguarding concerns.
• 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 told us they were treated with compassion, dignity and respect and that they felt involved in their care and decisions about their treatment.
• Information about the services provided and how to complain was available and easy to understand. Complaints were managed well.
• The practice had good facilities and was 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 upon.

In addition the provider should:

• There should be an overall health and safety risk assessment for the building.
• There should be a planned cycle of clinical audits that evidenced continued quality of care and treatment provided to patients was monitored and maintained good health outcomes.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice