St Johns Wood Medical Practice

Updated 4 October 2017

St Johns Wood Medical Practice provides primary medical services through a General Medical Services (GMS) contract to around 16,000 patients in the St Johns Wood, Primrose Hill, Maida Vale areas of North West London. The practice has an open list, increasing by net around 1000 per annum due to the closure of a local practice. The patient population includes a cross-section of socio-economic and ethnic groups. There is a spread of age groups served by the practice of which about 8% are children under 5, 14% patients over 65, 7% over 75 and 2.5% over 85.

The practice is based within The Hospital of St John & St Elizabeth in St Johns Wood and has access to services at the site including cleaners, porters, maintenance and St Johns Hospice.

The practice team is made up of seven GP partners (four male and three female), a locum GP (female), three part-time nurses (female), two health care assistants (one male, one female), the practice manager, reception manager, administration manager and a team of administrative and reception staff.

The practice is open between 8am to 6.30pm Monday to Friday. On Thursday the practice closes between 1pm and 1.45pm. Appointments are from 8.20am to 6pm daily except when closed on Thursday between 1pm to 1.45pm. There is weekend GP appointment availability at a neighbouring practice.

The practice had out-of-hours (OOH) arrangements in place with an external provider. Patients could also visit a neighbouring practice in Maida Vale at weekends. They were advised that they could also call the 111 service for healthcare advice.

The practice is registered to carry on the following regulated activities:

Diagnostic and screening procedures

Family planning

Maternity and midwifery services

Surgical procedures

Treatment of disease, disorder or injury

Updated 4 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Johns Wood Medical Practice on 25 November 2014. The overall rating for the practice was good, however the rating for providing safe services was requires improvement. The full comprehensive report on the November 2014 inspection can be found by selecting the ‘all reports’ link for St Johns Wood Medical Practice on our website at www.cqc.org.uk.

This inspection was undertaken to check the provider had taken the action we said they must and should take and was an announced comprehensive inspection on 3 August 2017. Overall the practice is still rated as good and the rating for providing safe services has improved from requires improvement to good.

Our key findings 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 taken the action we said it should take at our November 2014 inspection to record in the minutes of governance meetings evidence of discussion of and the communication of lessons learned from, significant events and complaints.

• The practice now had clearly defined and embedded systems to minimise risks to patient safety. It had taken the action we said it should take at our November 2014 inspection in relation to medicines management. However, we identified some shortcomings in the arrangements for vaccine stock management and prescription security.
• 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. The practice had taken the action we said it must take at our November 2014 inspection to address gaps in training and appraisal and ensure staff training records were fully completed.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and improvements were made to the quality of care as a result of complaints and concerns.
• 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 adequate facilities and equipment 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• Appropriate governance arrangements were in place and the practice had taken the action we said it should take at our November 2014 inspection to review all practice policies and procedures, including the practice’s business continuity plan, to ensure they remain up to date and relevant.

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

The provider should:

• Ensure a record is kept of serial numbers of batch numbers of prescriptions, to secure full monitoring of their use; and ensure prescriptions left in printers are appropriately secured.
• Raise staff awareness of the practice’s infection control policy.
• Continue with efforts to improve uptake of childhood immunisations in relation to national targets.
• Improve staff understanding of practice values and ensure consistency in the documentation of the mission statement.
• Consider how best to ensure staff were aware of and understood updated practice policies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 October 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• QOF performance for diabetes related indicators was above the CCG and the same as national averages: 90% compared to 80% and 90% respectively.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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.
• Longer appointments were made when patients required them or asked for them.
• The practice had bespoke Asthma plans and Diabetic plans for patients with these conditions.

Updated 4 October 2017

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 (A&E) attendances or who did not attend for GP and hospital appointments.
• All staff were trained in child protection at the appropriate levels.
• Immunisation uptake rates for the standard childhood immunisations were below national targets based on the latest published data. The practice recognised improving immunisation performance was a challenge and were seeking to meet this. They were actively following up with families in an attempt to increase uptake.
• Children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 4 October 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population. Each patient over 75 had a named GP.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• Older patients had care plans, based on frailty index stratification which were actively added to and changed as circumstances change. The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• The practice ensured those over 75 on the frailty index were in contact with their GP, the care navigator, and community matron backed up by the district nursing team according to their clinical or social needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 4 October 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, nursing and healthcare assistant appointments commencing at 8am and first GP appointments at 8.20am, with a spread of appointments until 6.00pm and weekend GP appointment availability at a neighbouring practice.
• Telephone advice was available throughout the day by the doctors and nurses and the practice strived to ensure that this was at times that suit its working population.
• About 2% of the practice population were ‘out of area’ patients.
• 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.

Updated 4 October 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 85% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• QOF performance for mental health related indicators was above the CCG and just below national averages: 92% compared to 85% and 93% respectively.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia. All staff had been trained on the Mental Capacity Act, Deprivation of Liberty and informed consent.

Updated 4 October 2017

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 families and children at potential risks, those with a learning disability and serious mental health conditions.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• Patients with learning difficulties were offered longer appointments and were routinely recalled to check their physical health, acquaint them with any health promotion from which they would benefit and to check changes in their social circumstances.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
• A frailty index code was used on the practice’s computer system for vulnerable adults linked to care plans.
• There was a fail-safe system to follow up with patients who cancelled appointments.