Archived: St James's Surgery

Updated 19 September 2016

St James's Surgery is located close to the city centre of Bath with good transport links. The practice also has a branch surgery, Junction Road Surgery at Oldfield Park, providing medical services to patients on the south side of the city. During our inspection we visited St James surgery and did not visit the branch surgery.

The practice has a higher than average patient population in the age group 40 to 60 years. The practice is part of the Bath and North East Somerset Clinical Commissioning Group and had approximately 11,500 registered. The area the practice serves has relatively low numbers of patients from different cultural backgrounds and is in the low range for deprivation nationally; however there are pockets of high range deprivation within the practice boundaries.

The practice is managed by six GP partners, three male and three female. The partnership is supported by three female salaried GPs, three practice nurse and an administrative team led by the practice manager. St James Surgery is a training practice providing placements for GP registrars and medical and nursing students.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available from 8.10am to 11.30am every morning and from 2.30pm to 6pm every afternoon. Extended surgery hours were offered on Monday evenings from 6.30pm to 7.10pm and Saturday mornings between 9am and 12pm. In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments were also available for patients that needed them.

When the practice is closed patients are advised, via the practice website and an answerphone message, to ring the NHS 111 for advice and guidance. Out of hours services are provided by Bath and North East Somerset Doctors urgent care (BDUC).

The practice has a Primary Medical Services contract to deliver health care services; the contract includes enhanced services such as minor surgery and childhood vaccines. This contract acts as the basis for arrangements between the local NHS Commissioning Board and providers of general medical services in England.

St James's Surgery is registered to provide services from the following locations:

Northampton Buildings, Bath BA1 2SR

and

8 Junction Road, Oldfield Park, Bath BA2 3NQ

This inspection is part of the CQC comprehensive inspection programme and is the first inspection of St James Surgery.

Updated 19 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St James's Surgery on 4 August 2016. 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, with the exception of fire escape signage not being clear.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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.
• 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.

We saw areas of outstanding practice:

• The practice had initiated a walking group called “Walk away from Medicine”. GPs and other members of staff joined patients on a walk around the local area on the first Wednesday of each month. The practice reported that this had had a positive impact on the mental health of some patients, had strengthened links with their community and enhanced patient relationships.
• Receptionists from the practice had initiated and produced information packs for patients that could benefit from additional support to prevent potential medical problems related to social isolation. Examples of these included those new to the UK and newly retired men. The packs contained information such as social groups and activities in the local area as well as health and wellbeing information.

The areas where the provider should make improvements are:

• Ensure fire escape signage in the practice is clear for service users.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 September 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 diabetes related indicators was better than local and national averages. The percentage of patients with diabetes, on the register, in whom the last blood test was within target range in the preceding 12 months (2014 to 2015) was 83% compared to a local average of 81% and a national average of 78%.

• Longer appointments and home visits were available when needed.

• 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.

• Patients with a number of chronic diseases were able to have their conditions reviewed at a single visit to the practice to save patients having to attend on several occasions.

Updated 19 September 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 relatively high 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.

• The practice’s uptake for the cervical screening programme was 81%, compared to the local average of 85% and the national average of 82%. The practice had recognised the lower than average uptake of cervical screening and had been proactive in educating and encouraging patients to attend screening programmes.

• 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 and school nurses.

Updated 19 September 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.

• The practice had proactively engaged with a clinical commissioning group (CCG) initiative called the Active Aging Health Visiting service, a programme aimed at identifying and managing older patients unknown to the surgery with underlying problems.

• The practice provided medical services for two nursing homes. A GP visited the nursing homes weekly. Feedback received from the care home manager highlighted the exemplary care that residents received and the support given to the staff by the practice.

Updated 19 September 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.

• Extended hours surgeries were offered both on Monday evenings and on a Saturday morning.

Updated 19 September 2016

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

• The percentage of patients with a serious mental illness who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014 to 2015) was 92% compared to a local average of 91% and a national average of 90%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice were proactive in identifying patients with dementia and this had resulted in the practice having a higher diagnosis rate than the national target and a higher than average diagnosis rate within the CCG.

• 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.

• A community psychiatric nurse attended multi-disciplinary team meetings. The practice had found this very effective in supporting patients with complex needs, where low level mental health issues were often a problem.

Updated 19 September 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. A nominated GP and nurse undertook the learning disability health checks to ensure continuity of care and familiarity for the patient.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.

• All staff had undertaken training to raise awareness and confidence in dealing with domestic violence.