Letter from the Chief Inspector of General Practice

This is a focused desk top review of evidence supplied by St James Medical Centre, for areas within the key question safe care and treatment. This review was completed on 9 November 2016.

The practice was previously inspected on 9 September 2015. The inspection was a comprehensive inspection under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). At that inspection, the practice was rated ‘good’ overall. However, within the key question safe several areas were identified as ‘requires improvement’.

At the inspection in September 2015 we found that although there were policies and procedures in place around the management of emergency drugs and equipment, these were not fully followed, Electrical equipment in the surgery had not been tested to ensure it was safe to use, and while most of the clinical equipment had been calibrated within the last 12 months to ensure it was fully functioning, some items such as vaccine fridges had not been calibrated since 2013.

The premises were observed to be clean and tidy. However, we found there were gaps in staff training around infection prevention and control.

Other issues noted during the inspection included:

• Lack of documentation around fire drills and fire marshals.
• No risk assessment or protocol around infection prevention and control risks of using carpeted consultation rooms for carrying out joint injections.
• Although some clinical audits had been carried out, these were not completed audits where improvements had been made and monitored to demonstrate improvement in patient care.
• We were informed that fire drills were carried out but the practice could not provide evidence of these.

The practice supplied a range of documents which demonstrated they are now meeting the requirements.

The practice also demonstrated improvement in the other areas identified in the report from September 2015 which did not affect ratings. These improvements have been documented in the well-led section, showing how the registered person has demonstrated continuous improvement since the full inspection.

Upon review of the documentation provided by the practice, we found the practice to be good in providing safe services. Overall, the practice is rated as good.

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 comprehensive inspection at St James Medical Centre on 9 September 2015. Overall the practice is rated as good.

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.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received clinical training appropriate to their roles and we saw that further training needs had been identified.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Any risks to patients were assessed and well managed. However, we found that the procedures for managing emergency drugs and equipment that were in place had not been robustly followed.
• Staff lacked appropriate training around infection prevention and control and electrical equipment had not been tested to ensure it was safe to use. Records showed that the thermostats in fridges used to store vaccines had not been calibrated in the previous two rounds of equipment calibration.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it difficult to make an appointment with a GP, but we saw that the practice was taking steps to address this. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• A range of clinical audits were being undertaken to inform practice, and an audit plan was in place to ensure full audit cycles were completed to maximise learning and service improvement.
• 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 several areas of outstanding practice including:

• We saw an audit relating to the coding of frailty fractures in osteoporosis. This resulted in a coding reference aid being drawn up to ensure that patients were being appropriately identified on the practice’s electronic system to ensure correct treatment was being offered.
• In response to difficulties recruiting new GP partners, the practice had introduced ‘Pathway to Partnership,’ a mentoring scheme to support salaried GPs to move towards partnership.

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

Importantly the provider should

• Ensure the practice’s emergency drugs and equipment policy is routinely followed.
• Ensure staff access appropriate training around infection prevention and control.
• Any minor surgical procedures undertaken should take place in the treatment room rather than the carpeted consultation rooms.
• Ensure all electrical and clinical equipment is tested and calibrated regularly to ensure it is fit for purpose.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St James’ Medical Centre on 18 December 2018 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 and good for all population groups, with the key question of safe rated as requires improvement.

We found that:

• The practice provided care in a way that kept patients protected from avoidable harm.
• Patients received effective care and treatment that met their needs.
• The practice had embedded a comprehensive programme of quality improvement activity, including clinical audit.
• Cancer screening rates were consistently higher than local and national averages.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Patient feedback was positive about the care and treatment they had received at the practice.
• The practice organised and delivered services to meet patients’ needs. Patients we spoke with told us they could access care and treatment in a timely way.
• The practice was responsive to both patient and staff feedback.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

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

• While we saw systems were in place to manage and mitigate many risks, there were some gaps in these systems. For example the practice did not have a documented fire risk assessment and managerial oversight of staff training around fire safety was lacking.
• Learning outcomes from significant event analyses were not always maximised and changes as a result of incidents and near misses not always effectively communicated to staff.

The areas where the provider must make improvements are:

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

In addition, the provider should:

• Establish a patient participation group as an additional means of gathering patient views and feedback about the service.
• Review complaint response letters to include details of how patients can escalate their complaints should they be unhappy with the practice’s reply.
• Maintain a log of safety alerts received and action taken as a result to improve managerial oversight of their implementation.
• Formalise the process for gaining assurance that staff working in advanced roles are doing so within their competencies.

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

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice