Letter from the Chief Inspector of General Practice
This is a focused desk top review of evidence supplied by St James Medical Centre, for areas within the key question safe care and treatment. This review was completed on 9 November 2016.
The practice was previously inspected on 9 September 2015. The inspection was a comprehensive inspection under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). At that inspection, the practice was rated ‘good’ overall. However, within the key question safe several areas were identified as ‘requires improvement’.
At the inspection in September 2015 we found that although there were policies and procedures in place around the management of emergency drugs and equipment, these were not fully followed, Electrical equipment in the surgery had not been tested to ensure it was safe to use, and while most of the clinical equipment had been calibrated within the last 12 months to ensure it was fully functioning, some items such as vaccine fridges had not been calibrated since 2013.
The premises were observed to be clean and tidy. However, we found there were gaps in staff training around infection prevention and control.
Other issues noted during the inspection included:
- Lack of documentation around fire drills and fire marshals.
- No risk assessment or protocol around infection prevention and control risks of using carpeted consultation rooms for carrying out joint injections.
- Although some clinical audits had been carried out, these were not completed audits where improvements had been made and monitored to demonstrate improvement in patient care.
- We were informed that fire drills were carried out but the practice could not provide evidence of these.
The practice supplied a range of documents which demonstrated they are now meeting the requirements.
The practice also demonstrated improvement in the other areas identified in the report from September 2015 which did not affect ratings. These improvements have been documented in the well-led section, showing how the registered person has demonstrated continuous improvement since the full inspection.
Upon review of the documentation provided by the practice, we found the practice to be good in providing safe services. Overall, the practice is rated as good.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice