Archived: St Georges Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Georges Surgery, Weston-Super-Mare on 7 January 2016. Overall the practice is rated as requires improvement.

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.
• Risks to patients were assessed and managed however, risks associated with GP staffing levels were not robust and left staff such as the health care assistant unsupported or unsupervised at times. The staffing levels also impacted on the continuity of patient care and treatment.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Most 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.
• Most patients said they found it easy to make an appointment. However, they stated appointments with a named GP and continuity of care was often more difficult due to high locum GP use. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by the practice management but less so by the provider organisation. The practice sought feedback from staff and patients, which it acted on.

We saw one area of outstanding practice:

• The practice had previously developed a list of frail older patients who lived in vulnerable or isolated circumstances. Each member of staff was allocated a number of these patients and made regular telephone contact with the patients to ensure they were safe. Any concerns identified were passed to the GPs or nurses so further action could be taken. Additionally a health care assistant visited patients at home on a social basis to ensure patient wellbeing; any concerns were highlighted to the GPs so follow up appointments could be made.

The areas where the provider must make improvement are:

• Ensure GP staffing levels are maintained to ensure the nursing team and specifically the health care assistant, have access to clinical support throughout their patient appointments and to ensure clinical advice is available should a medical emergency arise during the practice opening hours.
• Ensure practice governance arrangements consider all aspects of the practice as part of a continuous improvement process. For example, ensuring all staff receive provider identified mandatory training and an annual appraisal, and ensuring risks related to lone working are fully assessed.

The areas where the provider should make improvement are:

• Review how continuity of GP access is provided to patients.
• Review clinical support processes for permanently employed GPs.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice