St Pauls Practice in St Paul's Square, Carlisle 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 26th November 2019
St Pauls Practice is managed by Carlisle Healthcare.
Contact Details:
Address:
St Pauls Practice St Paul's Medical Centre St Paul's Square Carlisle CA1 1DG United Kingdom
Letter from the Chief Inspector of General Practice
This practice is rated as Requires Improvement overall. (Previous inspection - St Paul’s Practice was previously inspected in November 2014 and rated as Good. Brunswick House Medical Group (which has since merged with St Paul’s Practice) was previously inspected in November 2015 and rated as Good. Both of these inspections took place prior to the merger in October 2016.)
The key questions are rated as:
Are services safe? – Requires improvement
Are services effective? – Requires improvement
Are services caring? – Good
Are services responsive? – Inadequate
Are services well-led? Requires improvement
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Requires improvement
People with long-term conditions – Requires improvement
Families, children and young people – Requires improvement
Working age people (including those recently retired and students – Requires improvement
People whose circumstances may make them vulnerable – Requires improvement
People experiencing poor mental health (including people with dementia) - Requires improvement
We carried out an announced comprehensive inspection at St Paul’s Practice on 26 January 2018 as part of our inspection programme.
At this inspection we found:
The service had formed from the merger of three Carlisle practices in October 2016, leading to a combined patient list size of approximately 36,000 patients. This was the first practice in Cumbria to undertake a merger of this size, and while the leaders at the practice understood the challenges of working at scale and had made attempts to address them, they were aware that improvements were still needed.
The practice had systems to manage risk but some of these required improvements so that safety incidents were less likely to happen. When incidents did happen, the practice tried to learn from them and improve their processes.
Despite making efforts to meet demand, the practice continued to have difficulties to ensure that patients could access the service in a timely manner. Patient feedback regarding access via the telephone or to appointments remained below local and national averages.
Patient feedback was lower than local and national averages, and there had been a number of complaints about the attitude of some staff. On the day of inspection, however, we saw staff treating patients with compassion, kindness, dignity and respect.
There were measures in place to focus on continuous learning and improvement but these had not been fed back to patients and had not led to adequate improvements of the service.
On the day of inspection we saw that some staff had not completed annual training in the past 12 months in areas such as basic life support, safeguarding, fire safety and information governance. Furthermore, administrative and reception staff had not received annual appraisals since the practices merged in October 2016.
The three practices which make up Carlisle Healthcare had worked together prior to the merger to establish a “Frailty Team” of trained nurses who carried out visits to housebound frail patients..
The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
The practice worked closely with other healthcare professionals in the area to offer a range of services to patients.
The areas where the provider must make improvements are:
Ensure all that is reasonably practicable to mitigate the risks to the health and safety of service users receiving care or treatment is done.
Ensure systems and processes are operated effectively.
Ensure staff receive appropriate support, training, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.
For details, please refer to the requirement and enforcement notices at the end of the report.
The areas where the provider should make improvements are:
Continue to follow the improvement programmes which have led to improved patient feedback regarding being treated with kindness and compassion and being involved in their care.
Monitor the measures taken since the inspection to ensure they have led to sustainable improvements.
Continue to use media equipment and other reasonable measures to reduce the possibility of patients’ personal information being overheard in public areas of the practice sites.
Letter from the Chief Inspector of General Practice
We inspected the practice on 14 November 2014. We did not visit the branch surgery as part of this inspection. We inspected this service as part of our new comprehensive inspection programme. Overall, we rated the practice as good. Our key findings were as follows:
Patients reported they were treated with kindness and respect, and received safe care and treatment which met their needs;
Patient outcomes were either in line with, or better than average, when compared to other practices in the local Clinical Commissioning Group (CCG) area;
Practice staff provided care and treatment in line with guidance produced by the National Institute for Health and Care Excellence (NICE);
The practice was clean and hygienic, and good infection control arrangements were in place;
The practice learned from significant events and incidents and took action to prevent their recurrence;
The practice was well-led and had good governance arrangements. Staff felt well supported.
We saw areas of outstanding practice:
The practice was involved in supporting the implementation of an internet delivered self-care service that enables patients to set their own goals and, with the support of their GP, monitor their own health and wellbeing;
The practice was involved in developing and supporting the implementation of a Telehealth Scheme to monitor patients who are at higher risk of having health problems. The Scheme also provides patients with opportunities to learn more about their condition and what they can do to manage it.
This practice is rated as Good overall. (Previous rating January 2018 – Requires Improvement)
The key questions at this inspection are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Requires Improvement
Are services well-led? - Good
We carried out an announced comprehensive inspection at St Paul’s Practice on 26 January 2018. The overall rating for the practice was requires improvement. The full comprehensive report on the January 2018 inspection can be found by selecting the ‘all reports’ link for St Pauls Practice on our website at www.cqc.org.uk.
This inspection was an announced follow-up comprehensive inspection which took place on 2 and 6 November 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
At this inspection we found:
Improvements had been made since the last inspection in response to concerns raised in the inspection report.
The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
Staff involved and treated patients with compassion, kindness, dignity and respect.
Although improvements had been made, patient feedback regarding access by telephone and to appointments was still among the lowest in the local area, and well below local and national averages.
There was collaboration and support across all staff and a common focus on improving quality of care and people’s experiences.
We also saw some areas where the practice should make improvements:
Continue to make improvements to telephone access and access to appointments, and gather patient feedback to ensure these improvements are effective.
Continue to look for ways to communicate and engage with staff and patients.
Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice
Please refer to the detailed report and the evidence tables for further information.
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