Archived: St John's Surgery Ltd

Updated 7 January 2016

St John’s Surgery is based in a residential area within Huyton close to local amenities in a purpose built building. The building is also occupied by other primary and community healthcare services which are run by various local primary, secondary and community care providers. There were 3000 patients on the practice list at the time of our inspection. The practice was in an area that had identified high levels of deprivation. The practice had three self-employed GPs working at the practice, one full time GP is female and the two part time GPs are male. They also have a GP who is the registered manager who occasional provides sessions at the practice, one practice nurse, a practice manager, reception and administration staff, a business manager and a data quality and performance manager.

The practice is open Monday, Wednesday to Friday from 8am to 6.30pm and Tuesday 8am with extended hours from 6.30pm-to 8pm. Outside of this time the practice uses UC 24 Urgent Care.

The practice has a General Medical Services (GMS) contract. In addition the practice carried out a variety of enhanced services such as shingles vaccinations and avoiding unplanned admissions to hospital.

Updated 7 January 2016

We carried out an announced comprehensive inspection at St Johns Surgery on the 28nd October 2015. Overall the practice is rated as good.

Our key findings were as follows:

• Clinical staff reviewed significant events to help identify and learn from events. Most staff were aware of how to access information about incidents and shared learning, especially if they did not attend a staff meeting. However we noted two staff were unaware, despite this information being stored on the practices own computer system.

• The practice had a safeguard lead and staff were aware of how to report patients considered at risk. However there were gaps in staff training where some staff had not received safeguard training for vulnerable adults. Following our visit staff in need of this update were in the process of receiving this training.

• The practice used the expertise of their own pharmacy advisor to ensure the practice was prescribing in line with current guidelines. They carried out regular monitoring and audits of medication prescribing.

• The practice had good facilities in a purpose built building with disabled access. The practice was clean and tidy.

• The clinical staff proactively sought to educate patients to improve their lifestyles by regularly inviting patients for health assessments.
• Patients spoke highly about the practice and the whole staff team. They said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice has a Patient Participation Group (PPG) who regularly met with the practice staff. They made suggestions throughout the year to help improve the service provided by the practice.
• Information about services and how to complain was available on the practices website and following our inspection it is now available within the reception area. Complaint records had detailed information to show how they had been investigated.

• Staff had delegated duties distributed amongst the team. Staff felt supported by management and they felt that since the practice manager started at the practice, it was developing in the right direction.

• Most staff were able to access the practices computer system which contained access to all policies and procedures. Following our visit the provider advised they were reviewing governance systems to ensure the monitoring and effectiveness of the staffs understanding of all relevant processes necessary for the practice.

There were areas of practice where the provider should make improvements.

Action the provider should take to improve:

• To ensure safeguard training is available and provided for all staff in regard to vulnerable adults and children and ensure staff are updated in the level of training needed for their role.

• To review the extended clinic and ensure this is risk assessed to show how this clinic is managed in safely supporting patients with this service.

• To ensure staff files have up to date evidence in place to show appropriate checks are in place for all staff.
• To ensure all serious incidents of risk and complaints are shared with all staff to help improve shared learning within the practice and to help staff understanding of any lessons learnt.
• To review training records to ensure that all staff have evidence of updated training relevant to their role.

• To review the clinical support and monitoring for staff to help ensure up to date practices throughout the staff team.

 Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment and screening programmes. The practice contacted these patients to attend regular reviews to check that their health and medication needs were being met. The practice had adopted a holistic approach to patient care rather than making separate appointments for each medical condition. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs with their community matron.

Updated 7 January 2016

The practice is rated as good for the care of families, children and young people. Immunisation rates were comparable and sometimes exceeded local CCG benchmarking for standard childhood immunisations. The practice monitored any non-attendance of babies and children at vaccination clinics and reported any concerns they had identified. The staff we spoke with had appropriate knowledge about child protection and they had access to policies and procedures for safeguarding. One GP with level 3 training took the lead for safeguarding. Staff put alerts onto a patient’s electronic record when safeguarding concerns were raised. Urgent access appointments were available for children. The practice had achieved the ‘breast feeding welcome certificate’ which ensured the environment was ‘friendly’ and that staff were trained in having a level of awareness.

Updated 7 January 2016

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu. The practice staff met with the community matron and multi-disciplinary professionals on a regular basis to provide support and access specialist help when needed. The practice carried out home visits to care homes and to patients who were house bound.

Updated 7 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).  The needs of this group 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 prescription ordering and an online appointment services. Patients could book appointments in person, on-line or via the telephone and repeat prescriptions could be ordered on-line which provided flexibility to working patients and those in full time education. The practice offered drop in clinics for services such as flu vaccinations. Health checks were offered to patients who were over 40 years of age to promote patient well-being and prevent any health concerns.

Updated 7 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients with mental health problems in order to regularly review their needs and carry out health checks.  The practice staff liaised with other healthcare professionals to help engage these patients to ensure they attended reviews. Staff were knowledgeable in regard to consent and supporting patients in obtaining consent however they had not received updated training in consent and the Mental Capacity Act 2005. The practice identified patients at risk using a stratification and case finding tool which helps them to support the identification of high risk patients who may benefit from dementia screening and referral to memory clinics.

Updated 7 January 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice was aware of patients in vulnerable circumstances and ensured they had appropriate access to health care to meet their needs. For example, a register was maintained of patients with a learning disability and annual health care reviews were provided to these patients. 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.  However they had not all received up to date safeguarding training. The practice manager and two members of the team had undertaken ‘Carers Training’ facilitated by the ‘Carers Society’ with involvement from carers in the community. Staff made notes in patient’s records so that reception staff tried to attempt to accommodate the carer’s appointments and requests.  The practice also helped carers’ to order their prescription requests over the phone to facilitate this process.