Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. The practice was previously inspected on 12 October 2016 and rated Good.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at St George’s Medical Centre as part of our new methodology inspection programme.

At this inspection we found:

There was an open and honest culture in the practice which promoted a culture of learning and improvement. The practice had comprehensive systems in place and we saw evidence that these systems were improved upon through learning from incidents. Care and treatment was provided in line with evidence-based guidance and we saw many examples of the practice tailoring its service to improve the patient experience. Patients had positive views about the care they received and their interactions with practice staff. Access to the service was good and patients told us they could book routine and emergency appointments when needed. We saw many examples of continuous learning and improvement on the day of inspection.

For example:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• The practice thought about patient experience and put services in place to improve such as providing in house phlebotomy services and acupuncture.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw three areas of outstanding practice:

• The practice had eight fully trained health champions that assist patients in the surgery and provide social and well-being events. For example, the health champions greet patients in reception and encourage patients to take advantage of the blood pressure monitoring pod in the patient reception area. The health champions provide a range of events for patients including weekly walks in the local park, chair yoga held at the practice and a gardening club. The champions also provide social services such as telephone support or accompanying patients to hospital appointments. The practice conducted a patient survey and we saw evidence that on average patients overall well-being (using a five point scale) went from a three to a five.

• The practice provide an alcohol counselling service in partnership with Westminster Drug Project. The service included one to one counselling with an alcohol counsellor, group sessions, medical interventions, detox opportunities (outpatient and inpatient) and inpatient rehabilitation. We saw evidence that there was a 60% success rate for patients who participate in the service.

• The practice provide an acupuncture service, free of charge, to all registered patients. The practice conducted an audit to identify whether patients felt this treatment had helped with their conditions. Patient were treated for conditions such as tennis elbow, neck pain, shoulder pain, lower back pain, knee pain and headache. During the audit the practice contacted patients who undertook this treatment between January 2017 and November 2017, 78% of patients felt this service had reduced their pain and would recommend this treatment.

The areas where the provider should make improvements are:

• Improve the uptake of childhood immunisations.

• Improve the uptake of cervical screening in women between the ages of 25 and 64.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced focussed, desk based inspection at St George’s Medical Centre on 12 October 2016. We found the practice to be good for providing safe services and it is rated as good overall.

We had previously conducted an announced comprehensive inspection of the practice on 21 January 2016. As a result of our findings during the visit, the practice was rated as good for being effective, caring, responsive and well led, and requires improvement for being safe; which resulted in a rating of good overall. We found that the provider had breached one regulation of the Health and Social Care Act 2008; Regulation 12(1)(2)(a)(b) (g)(h) safe care and treatment.

The practice wrote to us to tell us what they would do to make improvements and meet the legal requirements. We undertook this focussed inspection to check that the practice had followed their plan and to confirm that they had met the legal requirements.

This report only covers our findings in relation to those areas where requirements had not been met at our January 2016 inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for St George’s Medical Centre on our website at https://www.cqc.org.uk/location/1-539629350.

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

• There were appropriate systems in place for the safe storage and management of vaccines.

• A fire risk assessment had taken place within the last 12 months.

• Records showed that staff had undertaken infection prevention and control training.

• The practice was undertaking periodic water temperature monitoring, in accordance with the practice’s legionella risk assessment action plan.

• An appropriately signed Patient Specific Direction (PSD) for flu immunisation was on file for the practice’s Health Care Assistant.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. The practice was previously inspected on 12 October 2016 and rated Good.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at St George’s Medical Centre as part of our new methodology inspection programme.

At this inspection we found:

There was an open and honest culture in the practice which promoted a culture of learning and improvement. The practice had comprehensive systems in place and we saw evidence that these systems were improved upon through learning from incidents. Care and treatment was provided in line with evidence-based guidance and we saw many examples of the practice tailoring its service to improve the patient experience. Patients had positive views about the care they received and their interactions with practice staff. Access to the service was good and patients told us they could book routine and emergency appointments when needed. We saw many examples of continuous learning and improvement on the day of inspection.

For example:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• The practice thought about patient experience and put services in place to improve such as providing in house phlebotomy services and acupuncture.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw three areas of outstanding practice:

• The practice had eight fully trained health champions that assist patients in the surgery and provide social and well-being events. For example, the health champions greet patients in reception and encourage patients to take advantage of the blood pressure monitoring pod in the patient reception area. The health champions provide a range of events for patients including weekly walks in the local park, chair yoga held at the practice and a gardening club. The champions also provide social services such as telephone support or accompanying patients to hospital appointments. The practice conducted a patient survey and we saw evidence that on average patients overall well-being (using a five point scale) went from a three to a five.

• The practice provide an alcohol counselling service in partnership with Westminster Drug Project. The service included one to one counselling with an alcohol counsellor, group sessions, medical interventions, detox opportunities (outpatient and inpatient) and inpatient rehabilitation. We saw evidence that there was a 60% success rate for patients who participate in the service.

• The practice provide an acupuncture service, free of charge, to all registered patients. The practice conducted an audit to identify whether patients felt this treatment had helped with their conditions. Patient were treated for conditions such as tennis elbow, neck pain, shoulder pain, lower back pain, knee pain and headache. During the audit the practice contacted patients who undertook this treatment between January 2017 and November 2017, 78% of patients felt this service had reduced their pain and would recommend this treatment.

The areas where the provider should make improvements are:

• Improve the uptake of childhood immunisations.

• Improve the uptake of cervical screening in women between the ages of 25 and 64.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice