We carried out an announced comprehensive inspection at St Clements Partnership on 24 January 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. However we rated Safe as Requires Improvement.

We rated the practice as Requires Improvement for providing safe services because:

• Staff training was not fully established. We saw this was being addressed but the practice had not assured themselves that staff were using appropriate systems and processes until training had been embedded.
• Governance systems and processes were under review due to a change in practice management and not had the opportunity to be fully embedded. For example, the monitoring of professional registrations.
• Actions identified in previous risk assessments to ensure the safety of patients and staff had not been actioned, for example, identified actions from the previous legionella risk assessment.
• Learning from significant events had not been consistently documented and disseminated to relevant staff since November 2018

We have rated the population group for people whose circumstances make them vulnerable as Outstanding because:

• The practice carried out bespoke health clinic sessions at the local homeless centre. We saw evidence of the practice supporting patients in improving their housing and financial situations, as well promoting and improving their health and emotional well-being.

We have rated the population group for working-aged people (including those recently retired and students) as Requires Improvement because:

• The practice was below the 80% national target for the uptake by eligible patients for cervical screening, as well as the local and national averages.

We found that:

• The practice was in transition due to the introduction of a new management structure and systems and processes needed more time to be fully embedded.
• Areas for improvement had been identified by the practice and we saw evidence of actions plans in place to drive these improvements.
• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• 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 saw evidence of comprehensive clinical audits which demonstrated improvements in clinical care.
• The training of staff was encouraged but the documentation of completed staff training was not fully embedded due to changes in the training provider and a new recording system.
• Staff at the practice felt supported and listened to by managers.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

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

The areas where the provider should make improvements are

• Improve the identification of carers to enable this group of patients to access the care and support they need.
• Review how the practice monitors all patients receiving high-risk medicines.
• Continue to improve the uptake for cervical screening to achieve the national target of 80%.
• Continue to improve the uptake of childhood immunisations to achieve the national target of 90% in the two remaining indicators.
• Continue to review patient feedback in relation to accessing appointments and practice waiting times.

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 Clements Partnership on 15 November 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice held formal monthly meetings where these were discussed.

• Risks to patients were assessed and well managed. For example, legionella checks were in place.
• 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 provided time and resource opportunities for staff development.
• 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 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. Plans were underway to relocate to new bespoke premises by 2018.
• 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 practice had an active patient participation group.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice worked closely with a local day centre (the Trinity Centre) for homeless people. Practice GPs visited the centre and provided clinics four days a week. Three of the practice GPs had special interests in alcohol and drug dependency. The practice discussed how to develop their liaison with the day centre at their annual away day.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice