We carried out an announced comprehensive inspection at St Johns Medical Centre on 04 February 2019 as part of our inspection programme. The practice was previously inspected in January 2015 when they were rated good overall.

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.

We found that:

• Patients received effective care and treatment that met their needs.
• 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.

We rated the practice as Requires Improvement for providing safe services because there were gaps in systems to assess, monitor and manage risks to patient safety such as:

• Monitoring of high risk drugs was taking place but was not failsafe. The inspection team were provided with evidence after the inspection that this was being addressed.
• Alerts to identify vulnerable adults were not consistently highlighted within the clinical record system.
• Fire safety in an outside building had not been assessed. The inspection team were provided with evidence after the inspection, that this had been fully addressed.
• Medication review consultations were coded as having taken place without documented evidence.
• Emergency medicines did not have risk assessments for some missing items.
• Data and exception reporting was high and not monitored by the practice
• Staff were not all aware of the practice incident and reporting protocol.

The provider must:

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

In addition, the provider should:

• Review the carers list to ensure that carers and those cared for are separately identified whilst increasing the number of carers identified within the practice list.
• Consider specific and formal training for any clinician in a lead role, such as infection control.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St John’s Medical Centre on 8 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring responsive and well led services. It was also good for providing services for patients with learning disabilities.

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.
• Risks to patients were assessed and well managed.
• 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 said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• The practice obtained feedback from patients in many different ways such as patient questionnaires, a suggestion box, the friends and family test and surveys undertaken by medical students. They were responsive to suggestions received.
• The practice had good facilities and was well 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 on.

We saw four areas of outstanding practice:

• The practice have introduced a system to monitor the quality of service around appointments, referral letters, scanning and telephone consults provided to the patients. It is positioned where it can be seen by all staff and is used as a staff ‘self-monitoring’ tool to encourage improvement, specifically in any areas of concern creating better access for patients.
• One of the GPs with an interest in learning disabilities had made significant positive impacts on the lives of a specific group of patients. The GP had taken the time to explore their social environment which impacted negatively on their mental and physical conditions. The GP worked with other health and social care professionals and individuals outside of clinical environments to help integrate these patients into society and improve their quality of life.
• The GPs met every lunch time to discuss patients they had seen since the previous day, provide peer support and share good practice. The discussions included challenge and changes in practice were made where they were felt appropriate.
• ‘Hot clinics’ had been introduced for children under the age of 5 years and these were available both in the mornings and after school hours.

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

• Although we saw evidence of full cycle clinical audits, the practice were not proactive in completing these.
• Although an advanced nursing practitioner had recently been employed, additional nursing hours were required to meet the needs of the practice and its patients.
• We established that the health care assistant (HCA) was responsible for most of the checks relating to medicines management, equipment, emergency drugs and cold chain. There was no written policy in place to outline what checks were required and who was responsible for those checks in the absence of the HCA.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice