Archived: St James Medical Centre

Updated 23 July 2015

The St James medical Centre is a GP practice located in an urban area of Tunbridge wells. It provides care for approximately 5,750 patients. The practice population is similar to national averages. It has marginally more patients under 18 years old and about a quarter more patients over 85 years than the national average.

It is not an area of high deprivation or of high unemployment. It is not in an area of income deprivation. It has nearly twice the number of nursing home patients than the national average.

There are three GP partners, two female and one male there is one female salaried GP. There are 26 GP sessions each week, one session being half a day. There is a nurse and a healthcare assistant (HCA) providing approximately 16 combined nurse and HCA sessions weekly. The practice has a general medical services (GMS) contract with NHS England for delivering primary care services to local communities. The practice is not a training practice.

Services are delivered from:

ST James Medical Centre,

11 Carlton Road,

Tunbridge Wells,

Kent

TN1 2HW

01892 541634

The practice has opted out of providing out-of-hours services to their own patients. There is information available to patients on how to access out of hours care which is provided by Integrated Care 24.

Updated 23 July 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St James Medical Centre on 10 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well led services.

It was also good for providing services for the care of older people, the care of people with long-term conditions, the care of working age people (including those recently retired and students), the care of families, children and young people, the care of people whose circumstances may make them vulnerable and the care of people experiencing poor mental health (including people with dementia).

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients, staff and to the building were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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. Some issues relating to the building were unresolved from the time of our last inspection. However the practice had a planning application lodged with the local authority to extend the premises, which would alleviate the problem.
• 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Review its auditing activity to help to ensure its effectiveness and to more closely reflect the population it serves.
• Improve its recording of patients who had, or were, carers so that they could be more easily identified on the practice computer system.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 July 2015

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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multi-disciplinary package of care.

Updated 23 July 2015

The practice is rated as good for the care of families, children and young people. There were systems 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 accident and emergency attendances. Immunisation rates were relatively high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. Parents of children who called with urgent matters were seen as soon as possible and, in any event, on the day they called.

Updated 23 July 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 23 July 2015

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 help to ensure these were accessible, flexible and offered continuity of care. The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 23 July 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Ninety four per cent of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. Where patients had been identified as having memory problems, staff telephoned them if they had missed an appointment to check if they were alright and to identify the reason why the appointment had been missed. When staff accessed the notes of patients whose illnesses which made them particularly vulnerable, for example a learning disability, dementia or end of life care a message was displayed on the computer screen to inform the staff member of the diagnosis. Thus they were better able to manage their interaction with that person by taking into account any difficulties that the patient might have, such as difficulties in communication, memory or understanding. Patients with mental health problems could ask for longer appointments.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs.

Updated 23 July 2015

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. It had carried out annual health checks for people with a learning disability and all of these patients had been offered an annual health check. It offered longer appointments for people with a learning disability. The practice used clinically recognised risk stratification tools to identify patients with complex needs to help to ensure that there were multi-disciplinary care plans documented in their case notes. The practice worked with a Street Pastors scheme, to identify and care for homeless people. The practice worked with the Street Pastors scheme, to identify and care for them. The practice worked closely with local drug and alcohol support services and had a long history of providing care to this group. Vulnerable patients who had a care plan had priority in the allocation of appointments and the computer system alerted reception staff to these patients when appointments were made.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.