Archived: St John's Street Surgery

Updated 24 March 2016

St Johns St Surgery provides a range of primary care services from its location at 16 St Johns St, Bedford. It is a purpose built surgery and has good disabled access. The practice serves a population of approximately 5385 patients, with higher than average male and female patients aged 0 to 9 years and lower than average for patients aged 65 to 85 and over.

The clinical staff team consists of a male GP partner, a female GP partner, two practice nurses and a health care assistant (HCA). Two regular GP locums are used. The team is supported by a practice manager, a reception manager and a team of administrative and reception staff. The practice holds a General Medical Services contract for providing services and is not a training practice.

The practice is open between 8am and 6.30pm Monday to Friday and offered additional appointments until 7.45pm on Tuesdays and Thursdays. Out of hours care is provided by Bedford on Call.

Updated 24 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Johns Surgery on 17 November 2015. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• 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.
• 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.
• 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.
• 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 March 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management, and patients at risk of hospital admission were identified as a priority.
• Performance for three diabetes related indicators was higher than the national average. For example, the percentage of patients on the diabetes register with a record of having had a foot examination and that had been risk classified within the preceding 12 months was 90% where the national average was 83%.
• The practice ran a virtual diabetic clinic, working closely with the community diabetic specialist nurse to assist with managing complex patients.
• 77% of patients diagnosed with asthma on the register had received an asthma review in the last 12 months compared to the national average of 75%.
• Hospital admissions for asthma patients were monitored and all patients were contacted within one week for review. Pneumonia immunisation status for these patients was checked and rescue medicines were given to relevant patients.
• Longer appointments and home visits were available when necessary.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 24 March 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, for example, children and young people who had a high number of A&E attendances. Immunisation rates were comparable to the CCG average for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• 74% of patients had cervical screening comparable with CCG and national averages.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors. The midwife was provided with space for a twice weekly clinic.

The practice educated parents regarding management of asthma and urgency of seeking medical attention.  

Updated 24 March 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Any patient aged over 75 who had not been seen was invited for an annual health check, including blood tests and care planning. Those patients who did not attend were contacted by their named GP to discuss any problems they may be experiencing. If they did not respond the practice would contact the patient to check on their wellbeing.
• Admissions and A&E attendances were monitored for actions.
• The practice had developed good relationships with the community matron and referred patients regularly.
• Referrals were regularly made to occupational therapy for required aids and adaptations for patients.

Updated 24 March 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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. Early morning appointments and reserved appointments at end of day were available and telephone consultations.
• Flu clinics were available on Saturday mornings.
• The practice offered electronic prescribing. Fax and/or post prescriptions were available when requested.
• Early morning phlebotomy appointments were available.
• Health checks were offered to those aged between 40 – 74.
• The practice offered sexual health advice and health checks.
• Patients in this group were offered vaccination against meningitis if an appropriate age and the practice saw patients as temporary residents when home from university.
• A room for was provided for a counsellor so that patients were able to receive counselling on site. Patients from elsewhere within the area were also seen.

Updated 24 March 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 100% of patients diagnosed with dementia whose care had been reviewed in a face to face meeting in the last 12 months, which is above the national average.
• 100% of patients experiencing poor mental health had received a documented care plan in the preceding 12 months, which was above the national average.
• The practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 24 March 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 living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.
• Access to translation service was available and the practice website was available in all languages.
• Vulnerable patients were identified at data entry and considered for care planning.
• A room was available to the local community drug and alcohol provider for patient consultations.

The practice worked with the outreach team to assist them with patients who were  difficult to engage with.  Short notice appointments were available for administration of medication on the premises