We carried out an announced comprehensive inspection at St Paul’s Practice on 10 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 and good for all population groups, apart from for older people which we rated as outstanding.

We rated the population group of older people as outstanding due to the innovative approach the practice had taken with regard to management of leg ulcers, including the installation of foot sinks in its treatment rooms. The approach had led to improved healing rates and had reduced the recurrence of future leg ulcers.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• 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.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• 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 but the implementation of the recommendations from these audits was not consistently shown.
• The training of staff was encouraged but the documentation of completed staff training was not fully embedded.
• Staff at the practice felt supported and listened to by managers.
• Leadership at the practice was appropriately structured, strong and well-embedded.

Whilst we found no breaches of regulations, the provider should:

• Improve the identification of carers to enable this group of patients to access the care and support they need.
• Improve the process for the recording of completed staff training to include recent training modules.
• Review the practice’s programme for audits to drive improvement in clinical care.
• Continue to monitor the impact of changes in practice through the use of audits.
• Continue to improve the uptake for two-week wait cancer referrals and cervical screening to achieve the national target of 80%.
• Continue to review patient feedback in relation to accessing appointments.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This was a comprehensive inspection of St Paul’s Practice and was carried out on 28 October 2014.The practice was well led by the GP partners and the practice manager. We rated this practice as good overall. We found good practice in the way the practice responded to the needs of people with long term conditions, providing them with effective care and treatment. The practice had responded to the needs of working patients and those patients who had barriers to accessing GP services such as those living in care homes.

Our key findings were as follows:

• The practice was rated highly by patients who described the overall experience of the practice as good or very good.
• The practice provided GP appointments at times that met the needs of their patients.
• The practice was able to offer specialist clinics to patients to avoid the need to attend hospital.
• There were effective infection control procedures in place and the practice building appeared clean and tidy.
• The practice manager had actively sought feedback from all staff about the practice, the training for their role, their expectations of a practice manager and suggestions for improvements to the practice.

 We saw areas of outstanding practice including:

• The practice continually audited their service to improve the service they offered to patients. This included the weekly auditing of appointments with a constant review of staffing levels to reduce the waiting time for routine appointments.
• There was a system of regular whole staff training and weekly role specific training.

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

The provider should:

• Ensure that all equipment which may be needed in an emergency such as syringes and needles are in date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice