The Care Quality Commission
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  • GP practice

Archived: St James Medical Practice Limited

Overall: Good read more about inspection ratings

St James Health Centre, 47 St Jamess Street, London, E17 7NH (020) 3233 0870

Provided and run by:
St. James Medical Practice Ltd

All Inspections

8 January 2020

During a routine inspection

We carried out an inspection of this service on 8 January 2020 following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall and good for all population groups.

We found that:

  • The practice provided care in a way that kept patients safe and protected from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • The practice organised and delivered services to meet patients’ needs.
  • Patients could access appointments in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality care.

The practice should:

  • Continue to work to improve uptake of childhood immunisations and cervical cytology.
  • Review their process for informing patients how their medical records are stored.
  • Monitor and review the new systems for sharing learning from significant events and complaints, ensuring that processes are embedded into practise.
  • Review recruitment processes in particular the system to obtain references.
  • Review the process for managing the outcomes of health and safety risk assessments.
  • Continue to work to improve patient satisfaction with services provided.

30 March 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St James Medical Practice Limited on 30 March 2017. 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 a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice held regular meetings where all staff members were invited and practice achievements and targets were discussed.
  • Patients we spoke with said they found it easy to make an appointment with a named GP and 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.
  • The practice had completed a number of risk assessments to ensure patient safety including a fire risk assessment and a legionella assessment.
  • 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. There was an active patient participation group who was engaged in how the practice was run.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements and shared learning and outcomes with relevant staff members.
  • The practice was clean and tidy and had regular infection control audits and had carried out the actions identified as a result.
  • The management team maintained a training matrix and all staff had completed their mandatory training.
  • We reviewed examples of care plans and found learning disabilities and dementia care plans were not comprehensive.
  • Results from the national GP patient survey showed patients did not always feel they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. However the practice carried out its own patent survey that had more positive results and had put actions in place for improvement.
  • Childhood immunisation rates were below the national averages.

The areas where the provider should make improvement are:

  • Review the systems and templates used for care planning to ensure they are fit for purpose.

  • Continue to work to improve patient satisfaction with services provided.

  • Continue to work to improve the uptake of childhood immunisation rates and bowel screening.

  • Ensure all relevant staff members are competent in the use of the vaccine fridge data logger.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

16 August 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St James Medical Practice Limited on 16 August 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

  • Patients found it difficult to make an appointment at a time that suited them.
  • Patients we spoke with said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Responses to these questions in the National GP patient survey were less positive.
  • Plans to improve the service in light of the national GP survey results were not robust.
  • The provider could not provide assurance that all staff had completed up-to- date mandatory training, for example in basic life support, safeguarding adults at risk and children, and infection control. Training records were incomplete.
  • There was however an open and transparent approach to safety and an effective system in place for reporting and recording significant events. There was an awareness of the duty of candour.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Information about services and how to complain was available and easy to understand. Some improvements were made to the quality of care as a result of complaints and concerns.
  • The practice was well equipped to treat patients and meet their needs.
  • The leadership structure within the practice was being developed, following an extended period of instability and disruption, and staff reported they felt increasingly supported by management.
  • The practice was strengthening its relationship with the patient participation group (PPG) to work with them to continue to improve services for patients.

The areas where the provider must make improvement are:

  • Ensure training records are maintained that provide assurance that mandatory training for all staff is up to date.

  • Ensure effective action is taken to improve patients’ timely access to appointments at a time that suit them.

  • Ensure treatment and care is designed with a view to achieving patients’ preferences, for example to see a GP they prefer and to involve patients in decisions about their care.

  • Ensure systems are in place to assess, monitor and improve the quality and safety of service at all levels within the practice.

The areas where the provider should make improvement are:

  • Clarify terms of engagement with the diabetic nurse specialist and phlebotomist, who were not included in the practice’s permanent workforce, to provide assurance that they are suitably qualified and competent, accountable to the practice and have liability insurance in place, for example.

  • Put systems in place so that portable appliance testing takes place on a regular basis.

  • Consider further ways of meeting the needs of patients with long term conditions given the comparatively high exception reporting rates in some clinical domains.

  • Enable the practice nurse to attend CCG practice nurse forum meetings and to attend the weekly clinical meetings.

  • Put in place policy and procedures to guide staff in the handling of notifiable safety incidents in accordance with the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

8 July 2014

During an inspection looking at part of the service

At our inspection of St James Medical Practice on 10 March 2014, we identified that there were serious inadequacies in infection control as well as deficiencies in building layout, design and maintenance.

At this visit, which was a follow-up inspection, we found that the heating and hot water was now working. All the fabric covered chairs in the waiting areas and consultation rooms for patients had been replaced with easy to clean seating. An infection prevention and control audit had been undertaken and issues raised had been addressed or were about to be attended to within the next two months.

Regular meetings were taking place with relevant organisations to redevelop the practice. We were shown plans which identified an improved layout and design of the practice as well as increased space and facilities for staff and patients. However, although progress had been made, there were were no reasonable timescales in place for completion of the necessary stages that needed to be undertaken to enable the major rebuilding work, which would make the building safe and suitable for patients.

10 March 2014

During an inspection in response to concerns

Staff had basic infection control arrangements in place and on the day of the visit the service looked visibly clean. But there were shortfalls because the very fabric of the building, including its flooring, walls and furniture, did not allow for effective deep cleaning to prevent or minimise the risk of infection. As a result people were not reasonably protected from the risk of infection.

The provider had not taken steps to provide care in an environment that was suitably designed and the building was not fully accessible to people with disabilities. The building had not been well maintained over many years by the maintenance company and as a result it was in need of significant updating and refurbishment.

The building was owned by a private company (Curtis Medical). Responsibility for the buildings maintenance was with NHS Property Services.

The provider had raised serious concerns about infection control and the safety and suitability of premises with the appropriate national and local bodies including the Care Quality Commission (CQC).

The provider and managers said that over many years, a number of attempts had been made to obtain approval for funding to improve or redevelop the premises. Decanting to a Porto cabin in the nearby car park and moving to a new building were options that had been considered, but neither had materialised. Since then, a number of changes and reorganisations had taken place at a national NHS level and it appeared that this had impacted on the ability of the service to get clarity about its future and agreement about the funding of the building works.

The concerns raised in this report about infection control and safety and suitability of premises were also relevant to community health services who operate separately, but share the location address with St James Practice. Community services carried out a range of treatments including blood tests, health visiting and a baby clinic from the building.