Archived: St James Medical Centre

Updated 18 February 2016

St James Medical Centre provides primary medical services to approximately 3600 patients in the local community. The practice is part of a corporate partnership and four salatied GPs (two male and two female) worked part time at the practice. The GPs are supported by an advanced nurse practitioner (ANP), a practice nurse and one health care assistant. The non-clinical team consists of an administrative and reception staff and an acting deputy practice manager. The acting deputy practice manager was new to the role and is being supported by a practice manager from a nearby location that was part of the corporate partnership.

The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care. The practice also provides some directed enhanced services such as minor surgery, childhood vaccination and immunisation schemes. Enhanced services require an enhanced level of service provision above what is normally required under the core GP contract.

The practice opening times are 8.30am to 6.30pm Monday to Friday with the exception of Thursdays when the practice closes at 1pm and does not re-open during the afternoon. The practice provides an extended hours service on Tuesdays when it is open from 6.30pm to 7.30pm.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by the external out of hours service provider when the practice is closed including Thursdays when the practice closed for the afternoon.

Home visits are available for patients who are unable to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and book new appointments without having to phone the practice. The corporate provider has developed a smart phone application for making appointments and requesting repeat prescriptions as well as to provide feedback of their experience.

The practice treats patients of all ages and provides a range of medical services. This includes specialist consultant led clinic to manage complex cases for diabetes. The practice also provides an integrated care model for urology services at the practice that is consultant led from a local hospital.

Updated 18 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St James Medical Centre on 9 December 2015. Overall the practice is rated as good.

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

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. Most information about safety was recorded, monitored, appropriately reviewed and addressed. However, we saw evidence that this process was not robust to record all incidents.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Most patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. However, some comment cards and patients we spoke with also told us that they found it difficult to get an appointment at times.

• 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.

We saw one area of outstanding practice:

The the practice offered a model of integrated care in the community for patients with diseases of the urinary tract. This service was accessible for all patients registered with the corporate provider as well as other patients within the community. This reduced referral to hospital by 65% as patients were managed more effectively in the community.

The areas where the provider should make improvement are:

• Ensure all incidents are recorded to ensure learning.

• Formal spot checks should be in place to ensure effective cleaning.

• All staff should be aware of all business continuity procedures

• Efforts should be made to register all carers and to ensure relevant information is available for them so that this group can access further help when required.

• Ensure an appropriate system are in place to respond to complaints timely.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 February 2016

The practice is rated as good for the care of people with long-term conditions. The practice nurse and the advanced nurse practitioner had lead roles in chronic disease management. Patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met. For those patients with the most complex needs, the clinicians worked with relevant health and care professionals to deliver a multidisciplinary package of care. This included specialist clinics for complex patients with diabetes as well as services for those disorders of the urinary system.

The GP had an interest in urology and the practice offered an integrated care in the community model service for patients with diseases of the urinary tract. This service was available for all patients in the community and not just for patients registered with the practice or the corporate provider. Data we looked at showed that as a result of the service there was a 65% reduction in referral to hospital as patients were managed effectively in the community.

Updated 18 February 2016

The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk and regular multidisciplinary team meeting with the health visitors. The practice ran baby clinics with immunisations. Appointments were available outside of school hours and children were given appointments as a priority. The premises were suitable for children and babies and could be accessed by parents with pushchairs.

Updated 18 February 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice had carried out reviews of patents over the age of 75 who were taking eight or more medicines.

Updated 18 February 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice offered online services and telephone consultations as well as a full range of health promotion and screening that reflected the needs of this age group. For example, the provider had developed a smart phone application where patients could use to make appointments, order repeat prescriptions, access self-help guides as well as provide real time feedback.

Updated 18 February 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). We saw that there were 52 patients on the mental health register and the practice carried out annual physical health checks for these patients. Double appointments were available for those with complex needs and the practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice utilised local services for counselling support. Patients were also signposted to a variety of groups and voluntary organisations for self-referral. Those with more complex mental health needs were referred into the local community mental health services. There was a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 18 February 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients with learning disability and offered annual health checks. There was a flexible approach to the way appointments were offered with longer appointments for people with a learning disability. Vulnerable patients were discussed at regular practice meetings as well as monthly multidisciplinary meetings. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.