Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St James Medical Practice Limited on 30 March 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice held regular meetings where all staff members were invited and practice achievements and targets were discussed.
• Patients we spoke with 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 completed a number of risk assessments to ensure patient safety including a fire risk assessment and a legionella assessment.
• 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. There was an active patient participation group who was engaged in how the practice was run.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements and shared learning and outcomes with relevant staff members.
• The practice was clean and tidy and had regular infection control audits and had carried out the actions identified as a result.
• The management team maintained a training matrix and all staff had completed their mandatory training.
• We reviewed examples of care plans and found learning disabilities and dementia care plans were not comprehensive.
• Results from the national GP patient survey showed patients did not always feel they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. However the practice carried out its own patent survey that had more positive results and had put actions in place for improvement.
• Childhood immunisation rates were below the national averages.

The areas where the provider should make improvement are:

• Review the systems and templates used for care planning to ensure they are fit for purpose.

• Continue to work to improve patient satisfaction with services provided.

• Continue to work to improve the uptake of childhood immunisation rates and bowel screening.

• Ensure all relevant staff members are competent in the use of the vaccine fridge data logger.

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 Practice Limited on 30 March 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice held regular meetings where all staff members were invited and practice achievements and targets were discussed.
• Patients we spoke with 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 completed a number of risk assessments to ensure patient safety including a fire risk assessment and a legionella assessment.
• 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. There was an active patient participation group who was engaged in how the practice was run.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements and shared learning and outcomes with relevant staff members.
• The practice was clean and tidy and had regular infection control audits and had carried out the actions identified as a result.
• The management team maintained a training matrix and all staff had completed their mandatory training.
• We reviewed examples of care plans and found learning disabilities and dementia care plans were not comprehensive.
• Results from the national GP patient survey showed patients did not always feel they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. However the practice carried out its own patent survey that had more positive results and had put actions in place for improvement.
• Childhood immunisation rates were below the national averages.

The areas where the provider should make improvement are:

• Review the systems and templates used for care planning to ensure they are fit for purpose.

• Continue to work to improve patient satisfaction with services provided.

• Continue to work to improve the uptake of childhood immunisation rates and bowel screening.

• Ensure all relevant staff members are competent in the use of the vaccine fridge data logger.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

At our inspection of St James Medical Practice on 10 March 2014, we identified that there were serious inadequacies in infection control as well as deficiencies in building layout, design and maintenance.

At this visit, which was a follow-up inspection, we found that the heating and hot water was now working. All the fabric covered chairs in the waiting areas and consultation rooms for patients had been replaced with easy to clean seating. An infection prevention and control audit had been undertaken and issues raised had been addressed or were about to be attended to within the next two months.

Regular meetings were taking place with relevant organisations to redevelop the practice. We were shown plans which identified an improved layout and design of the practice as well as increased space and facilities for staff and patients. However, although progress had been made, there were were no reasonable timescales in place for completion of the necessary stages that needed to be undertaken to enable the major rebuilding work, which would make the building safe and suitable for patients.

Staff had basic infection control arrangements in place and on the day of the visit the service looked visibly clean. But there were shortfalls because the very fabric of the building, including its flooring, walls and furniture, did not allow for effective deep cleaning to prevent or minimise the risk of infection. As a result people were not reasonably protected from the risk of infection.

The provider had not taken steps to provide care in an environment that was suitably designed and the building was not fully accessible to people with disabilities. The building had not been well maintained over many years by the maintenance company and as a result it was in need of significant updating and refurbishment.

The building was owned by a private company (Curtis Medical). Responsibility for the buildings maintenance was with NHS Property Services.

The provider had raised serious concerns about infection control and the safety and suitability of premises with the appropriate national and local bodies including the Care Quality Commission (CQC).

The provider and managers said that over many years, a number of attempts had been made to obtain approval for funding to improve or redevelop the premises. Decanting to a Porto cabin in the nearby car park and moving to a new building were options that had been considered, but neither had materialised. Since then, a number of changes and reorganisations had taken place at a national NHS level and it appeared that this had impacted on the ability of the service to get clarity about its future and agreement about the funding of the building works.

The concerns raised in this report about infection control and safety and suitability of premises were also relevant to community health services who operate separately, but share the location address with St James Practice. Community services carried out a range of treatments including blood tests, health visiting and a baby clinic from the building.