The Care Quality Commission
  • Doctor
  • GP practice

St John's Medical Practice Also known as Dr K E Hull & Partners

Overall: Requires improvement read more about inspection ratings

39 St John's Hill, Sevenoaks, Kent, TN13 3NT

Provided and run by:
St John's Medical Practice

All Inspections

11July 2022

During a routine inspection

We carried out an announced inspection at St John’s Medical Practice between 7-11 July 2022. Overall, the practice is rated as Requires Improvement.

Set out the ratings for each key question

Safe - Requires Improvement

Effective – Requires Improvement

Caring - Good

Responsive – Requires Improvement

Well-led – Requires Improvement

Following our previous inspection on 23 August 2016, the practice was rated Good overall but Requires Improvement for providing safe services.

We carried out a desk-based review on 11 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we idnentified at the inspection on 23 August 2016. We found that significant improvements had been made by the practice and the practice was therefore rated as Good for providing safe services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for St John’s Medical Practice on our website at www.cqc.org.uk

Why we carried out this inspection

This was an announced comprehensive inspection to provide the practice with an up to date rating.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit

Our findings

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 Requires Improvement overall

We found that:

  • 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.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • The provider was aware of published performance data for childhood immunisation uptake rates and was continuing to take action to improve uptake.
  • The provider was aware of published performance data for cervical cancer screening and was continuing to take action to improve uptake.
  • The practice always obtained consent to care and treatment in line with legislation and guidance.
  • Staff had the information they needed to deliver safe care and treatment.
  • The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.
  • Complaints were listened and responded to and used to improve the quality of care.

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

  • Improvements were required to the systems, practices and processes to ensure that people were kept safe.
  • The practice’s system to learn and make improvements was not always effective.
  • The arrangements for managing medicines did not always keep patients safe.
  • Improvements were required to infection prevention and control systems and processes.

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

  • Patients needs were assessed but care and treatment was not always delivered in line with current legislation, standards and evidence based guidance.
  • Performance for some childhood immunisations and some cancer screening required improvement.
  • Clinical audit activity was limited and did not demonstrate improvement to quality and safety.
  • Not all staff were up to date with essential training.
  • Staff had some skills, knowledge and experience to carry out their roles. However, improvements were required.

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

  • Patient feedback, including information CQC had received and the latest National GP Patient Survey results showed that the practice was performing lower than local and national averages for several indicators regarding access to the practice.
  • People were not always able to access care and treatment in a timely way.

We rated the practice as Requires Improvement for providing well-led services because:

  • Processes for managing risks, issues and performance required improvement.

We found two breaches of regulations. The provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

11 January 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St John’s Medical Practice on 23 August 2016. The overall rating for the practice was good but was rated as requires improvement for providing safe services. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for St John’s Medical Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 11 January 2017 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 on 23 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

At our previous inspection on 23 August 2016, we rated the practice as requires improvement for providing safe services as not all clinical staff had received training on safeguarding vulnerable adults which was relevant to their role and appropriate recruitment checks had not been undertaken prior to employment of new staff. At this inspection we found that all clinical staff had received and completed safeguarding vulnerable adults training that was relevant to their role and that systems and processes had been implemented to ensure appropriate recruitment checks were completed before new staff were employed at the practice.

Additionally, the practice provided evidence to show that they had taken action to address the areas where they should make improvements.

  • A system had been implemented in order to help ensure that expiry dates of single use items were being routinely monitored and recorded.

  • The written audit trail of complaint investigations had been improved.

  • The minutes of meetings held at the practice had been improved in order to ensure they were fully auditable.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

23 August 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St John’s Medical Practice on 23 August 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 a system for reporting and recording significant events.
  • Risks to patients were not always assessed and well managed. In that not all staff had received the appropriate training in safeguarding vulnerable adults and recruitment checks prior to employment had not been carried out.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. The majority of staff had received relevant training to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • 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 GP and there were routine and urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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 provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • The practice proactively called extraordinary multiagency professionals meetings at any time that it was considered necessary to discuss any patient requiring urgent or prompt review and/or additional care planning, risk management or support in relation to that patient or his or her family. Such meetings were called as and when required and were not subject to regular scheduling.

The areas where the provider must make improvement are:

  • Ensure that all appropriate recruitment checks are undertaken prior to employment of staff.
  • Ensure that staff receive adult safeguarding training and/or updates that are appropriate to their role.

In addition the provider should:

  • Revise the system for significant event reporting, in order to ensure that the Duty of Candour is automatically considered as part of the incident record.
  • Revise significant event and complaints investigation process, in order to ensure there is a fully recorded audit trail in relation to the actions taken and the outcomes of such investigations.
  • Revise the process for recording minutes of routinely held meetings at the practice, in order to ensure they are auditable.
  • Revise the stock control systems, in order to ensure they incorporate the checking of stock expiry dates.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice