St Johns Medical Centre

Updated 8 June 2017

St Johns Medical Centre provides primary medical services to approximately 15,083 patients. This compares to the NHS South West Lincolnshire Clinical Commissioning Group practice average of 6916 patients and national average of 7324 patients. It is not a dispensing practice.

The practice demographics are similar to those of other practices in the CCG and those nationally, excepting that there are fewer older people aged 65 or over registered as patients at this practice than the average. The practice is in the fifth less deprived decile and numbers of people in work or full time education are higher than both the CCG and national averages.

At the time of our inspection the practice had seven GP partners (which equated to 5.72 whole time equivalent -WTE), one salaried GP (0.75 WTE), three nurse practitioners, one diabetes

nurse specialist( who was also the lead practice nurse) one complex care co-ordinator, four practice nurses and three health care assistants. They are supported by a business manager, a practice manager, and a range of administration and reception staff. The GPs consisted of five males and three females.

The practice has a General Medical Services Contract (GMS). The GMS contract is the contract for delivering primary care services to local communities.

The practice has one location registered with the Care Quality Commission which is St John’s Medical Centre, 62 London Road, Grantham, Lincolnshire NG31 6HR. Patients were seen on the first and second floor of the building, which has a passenger lift.

Patients have telephone access to the practice from 8am to 6.30pm Monday to Friday. The practice doors open from 8.30am to 6pm Monday to Friday.

Appointments were from 8.50am to 10.40 am and 3.30pm to 5.40pm.

Extended hours pre-booked appointments were offered on a Tuesday evening from 6.30pm to 8.30pm and every Saturday from 9.30 am to 12 noon.

Phone call consultations with a GP and urgent appointments with a nurse practitioner were available on the day for people that needed them. Appointments with GPs could be booked on-line up to four weeks in advance.

The practice is located within the area covered by NHS South West Lincolnshire Clinical Commissioning Group (SWLCCG). The CCG is responsible for commissioning services from the practice.

.The practice has a website which we found has an easy layout for patients to use. It enabled patients to find out a wealth of information about the healthcare services provided by the practice.

When the practice is closed, GP out-of-hours services are provided by Lincolnshire Community Health Services NHS Trust which is accessed by the NHS 111.

Updated 8 June 2017

Letter from the Chief Inspector of General Practice

On 14 July 2016 we carried out an announced comprehensive inspection at St John’s Medical Centre. The practice was found to be inadequate in safe and well-led, requires improvement in effective and good in caring and responsive.

The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on that inspection can be found by selecting the ‘all reports’ link for St John’s Medical Centre on our website at www.cqc.org.uk.

As a result of that inspection we issued the practice with a warning notice. This was in respect of the governance of the practice as we found there were inadequate systems to monitor patients subject to safeguarding concerns, to manage infection prevention and control, the recall of patients with long term conditions and the management of patients in receipt of medicines that could pose a higher risk in some circumstances. We also had concerns regarding the process for managing serious events and the management of the practice.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 2 March 2017. Overall the practice is now rated as ‘Good’.

Our key findings 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, for example as a result of healthcare associated infections were assessed and well managed.
• 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.
• The practice was responsive to the needs of patients and tailored its services to meet those needs.
• Patients prescribed high risk medicines were well managed and there was an effective re-call system in place for patients with long term conditions.
• 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 there was continuity of care, with quick and easy access to GPs and nurses.
• 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.

The areas where the provider should make improvements are:

• The practice should continue to take positive steps to identify carers on its patient list.

• The practice should continue to plan for the future by reviewing its current information technology provision.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 June 2017

The practice is rated as good for patients with long term conditions.

• The practice employed an in house diabetes nurse specialist.

• It was part of the pilot scheme pre-diabetes register.

• The practice utilised automated patient recall software to help manage patients in this group.

• Patients in this group had individualised care plans.

• Self-management plans were in place to assist patients in managing their condition.

• There was an effective medicines management system for patients in this group.

• If requested the practice provided patients with a print out of their medication to take with them on holiday in case they needed to seek medical help when they did not have access to the practice.

Updated 8 June 2017

The practice is rated as good for families, children and young people.

• The practice offered maternity services.

• The full range of childhood immunisations were offered.

• Baby change facilities were available on both floors of the surgery.

• Comprehensive reversible contraceptive services were available.

• On the day appointments were available. Unwell children were seen on the day.

• Self- testing for sexually transmitted infections for 16-25 year olds was offered.

• The practice held monthly meetings with health visitors.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 84%, which was comparable to local and national averages.

Updated 8 June 2017

The practice is rated as good for older patients.

• Patients over 75 years of age had a named GP.

• The practice employed a care co-ordinator, who was a nurse, to manage the healthcare needs of this group of patients.

• The healthcare co-ordinator contacted all patients within three days of hospital discharge to ensure their healthcare needs were being met.

• Home visits including medication reviews and phlebotomy were available for patients who were unable to attend the surgery.

• The practice undertook opportunistic dementia screening for patients in this group.

• The computer system in use by the practice alerted staff if the patient was a carer.

Updated 8 June 2017

The practice is rated as good for patients of working age (including those recently retired and students)

• Tuesday evening and Saturday morning appointments were available to meet the needs of these patients.

• Telephone consultations were available.

• There was online access to appointments and repeat prescriptions.

• The practice was part of the electronic prescribing scheme.

• The practice gave advice and direction of lifestyle and health promotion.

Updated 8 June 2017

The practice is rated as good for patients experiencing poor mental health including people with dementia.

• The practice offered an in house counselling service and a consultant psychiatrist attended the practice and ran a weekly clinic.

• The care co-ordinator attended the admission avoidance meetings.

• The practice offered dementia screening.

• The practice kept a register of patients pursuant to the Depravation of Liberty safeguards.

• All staff had received in the Mental Capacity Act and health awareness.

• Patients experiencing poor mental health were offered extended appointments and an annual physical health check.

• Of those patients diagnosed with dementia 94% had their care plan reviewed in a face-to-face review in the preceding 12 months. This was 5% higher than the CCG and 10% higher than the national average.

Updated 8 June 2017

The practice is rated as good for patients whose circumstances may make them vulnerable.

• The practice had effective systems in place to safeguard people from abuse.

• Patient records to alerted staff to the patient being a vulnerable child or adult.

• Annual physical health checks were offered to patients with a learning disability.

• There were regular adult and children’s safeguarding meetings.

• The practice had developed good working relationships with other agencies such as social services, children’s services and East Midlands Ambulance Service and the CCG Federated Safeguarding Team.

• There was an open registration policy to meet the needs of the homeless and the travelling community.