St Johns Medical Centre, 62 London Road, Grantham.
St Johns Medical Centre in 62 London Road, Grantham is a Doctors/GP specialising in the provision of services relating to diagnostic and screening procedures, family planning services, maternity and midwifery services, services for everyone, surgical procedures and treatment of disease, disorder or injury. The last inspection date here was 8th June 2017
St Johns Medical Centre is managed by St Johns Medical Centre.
Contact Details:
Address:
St Johns Medical Centre St John's Medical Centre 62 London Road Grantham NG31 6HR United Kingdom
Letter from the Chief Inspector of General Practice
On 14 July 2016 we carried out an announced comprehensive inspection at St John’s Medical Centre. The practice was found to be inadequate in safe and well-led, requires improvement in effective and good in caring and responsive.
The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on that inspection can be found by selecting the ‘all reports’ link for St John’s Medical Centre on our website at www.cqc.org.uk.
As a result of that inspection we issued the practice with a warning notice. This was in respect of the governance of the practice as we found there were inadequate systems to monitor patients subject to safeguarding concerns, to manage infection prevention and control, the recall of patients with long term conditions and the management of patients in receipt of medicines that could pose a higher risk in some circumstances. We also had concerns regarding the process for managing serious events and the management of the practice.
This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 2 March 2017. Overall the practice is now rated as ‘Good’.
Our key findings were as follows:
There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
Risks to patients, for example as a result of healthcare associated infections were assessed and well managed.
Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
The practice was responsive to the needs of patients and tailored its services to meet those needs.
Patients prescribed high risk medicines were well managed and there was an effective re-call system in place for patients with long term conditions.
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. Improvements were made to the quality of care as a result of complaints and concerns.
Patients said there was continuity of care, with quick and easy access to GPs and nurses.
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.
The provider was aware of and complied with the requirements of the duty of candour.
The areas where the provider should make improvements are:
The practice should continue to take positive steps to identify carers on its patient list.
The practice should continue to plan for the future by reviewing its current information technology provision.
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at St John’s Medical Centre on the 14 July 2016. Overall the practice is rated as inadequate. .
The purpose of this inspection was to ensure that sufficient improvement had been made following the practice being placed in to special measures as a result of the findings at our inspection on 29th September 2015 when we found the practice to be inadequate overall.
Following the most recent inspection we found that overall the practice was still rated as inadequate and although some progress had been made, further improvements were required. The ratings for providing an effective service had improved from being inadequate to requiring improvement. The rating for providing a safe and well led service remained inadequate.
Our key findings across all the areas we inspected were as follows:
The practice had a governance framework in place but the associated systems and processes did not support the delivery of their strategy.
Although the partners were positive about future plans we found that the practice was unable to demonstrate strong leadership in respect of safety.
Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents. However, the system still required improvement to ensure reviews and investigations were thorough, learning disseminated and identified actions implemented to improve safety.
Most risks to patients were now assessed and identified actions implemented.
Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
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.
Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
The practice had good facilities and was well equipped to treat patients and meet their needs.
The practice had a number of policies and procedures to govern activity, but some were overdue a review.
The areas where the provider must make improvements are:
Ensure effective processes are in place for reporting, recording, acting on and monitoring significant events, incidents, near misses and complaints in order that action is taken to remedy the situation, prevent further occurrence and improvements are made as a result.
Ensure the safeguarding system in place is effective and protects service users from abuse and improper treatment.
Protect the health and safety of patients who are prescribed high risk medicines.
Put an effective system in place for the recall of patients with long term conditions.
Clarify key roles and responsibilities within the management team.
In addition the provider should:
Ensure safety alerts are dealt with in line with the practice protocol.
Undertake actions identified from the audit of infection control.
Carry out clinical re-audits to ensure improvements have been achieved.
Continue to embed the system for the identification of carers.
Review themes and trends from complaints received.
Formalise the process in place for the summarisation of paper patient records.
Complete the patient survey, disseminate information to patients and staff and formulate an action plan if required.
This service was placed in special measures on 21 January 2016. Insufficient improvements have been made such that there remains a rating of inadequate for being safe and well led. Therefore the practice will remain in special measures and kept under review. Another inspection will be conducted within six months to ensure the required improvements have been made. If the required improvements have not been made we will take action in line with our enforcement procedures.
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at St Johns Medical Centre on 29 September 2015.
Overall we found the practice inadequate for providing safe, effective services and being well led. It was also inadequate for providing services for all the population groups. It was good for providing caring and responsive services.
Our key findings across all the areas we inspected were as follows:
Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, safeguarding, infection control, staff training, monitoring of palliative care patients.
A business continuity and recovery plan was in place to deal with a range of emergencies that may impact on the daily operation of the practice.
There was insufficient assurance to demonstrate people received effective care and treatment.
90% of patients who responded to the July 2015 national patient survey said they would recommend the surgery to others. 95% of respondents said they had confidence and trust in the last GP they saw or spoke to. 98% who responded said they had confidence and trust in the last nurse they saw or spoke to.
Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
Comment cards were positive about the standard of care received. They identified that staff were caring, polite, respectful and professional.
Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments and that it was often very difficult to get through to the practice when phoning to make an appointment.
The practice had limited formal governance arrangements.
The areas where the provider must make improvements are:
Implement effective systems for the management of risks to patients and others against inappropriate or unsafe care. This should include arrangements for recording, analysing and acting upon significant events, infection control, palliative care, staff training and review of pathology results.
Implement robust governance arrangements to ensure appropriate systems are in place for assessing and monitoring the quality of services provided. This should include audits of practice are undertaken, including completed clinical audit cycles.
Have a system in place to ensure that patients are safeguarded from abuse and improper treatment
Embed a process to ensure emergency equipment and vaccine refrigerators are checked as per the practice policy.
Have a system in place for the summarising of patient notes. Clear the backlog of paper records for new patients.
Put a system in place to ensure prescriptions are dealt with in line with national guidance
Carry out reviews for patients with a learning disability.
Put a robust system in place for the recall of patients with long term conditions and vaccination programmes.
Ensure CQC registration is up to date and correct in regard to registration of the practice
The areas where the provider should make improvement are:
Carry out a risk assessment for legionella and put a policy in place to provide guidance for staff.
Ensure that staff who undertake the role of a chaperone have a Disclosure and Barring (DBS) check.
Improve the system for the identification of carers
Embed a process to do yearly checks for Nursing and Midwifery (NMC) or General Medical Council (GMC) status.
Ensure all staff have a yearly appraisals.
Ensure learning from complaints is disseminated to all staff
I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration. Special measures will give people who use the practice the reassurance that the care they get should improve.
In addition to this I have issued a warning notice to the practice in regard to Regulation 13 Safeguarding service users from abuse and improper treatment which the practice will have had to comply with by 17 December 2015.
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