St James Surgery

Updated 28 November 2016

The list size of the practice at the time of our inspection was 13,215. The practice list was closed by request of the practice; however negotiations are underway to reopen the list.

There are three male and two female GP partners. There is also one male salaried GP and two sessional GPs (these are effectively regular locums). There are three practice matrons (who are able to provide many services a GP can), one female nurse practitioner, five practice nurses and five female health care assistants (HCAs). There are a number of other staff carrying out administrative duties, led by a practice manager and assistant practice manager.

The practice is open between 8.30am and 6.30pm on Mondays to Fridays and Saturdays 8.30am to 12 noon. Each partner operated their own patient list to maintain continuity of care. When all slots for the session are full then a ‘shared’ list is operated. The practice has a nurse operated triage system for appointment requests, with a few exceptions, for example children.

Appointments times are from 8.30am to 12.30pm and 1.30pm to 6pm Monday to Friday and 8.30am to 11.30am on Saturdays.

When the practice is closed patients are advised to call 111 if they require medical assistance and are unable to wait until the surgery reopens. The out of hours service is provided by IC24.

The practice has lower than national average numbers of 0 to 49 year olds, and higher than the national average numbers of 65 to 85+ year olds.

Updated 28 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St James Surgery on 18 October 2016. Overall the practice is rated as good.

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

• Staff were aware of their responsibilities regarding safety, and reporting and recording of significant events. There were policies and procedures in place to support this.
• The practice assessed risks to patients and staff. There were systems in place to manage these risks.
• Processes and systems around medicines management kept patients safe. 
• Staff used current guidelines and best practice to inform the care and treatment they provided to patients.
• All patients said that they were treated with dignity and respect and involved in decisions about their care and treatment.
• There was a clear and effective complaints system in place. Any comments regarding suggestions for improvements using this system were also responded to by the practice.
• Patients told us that access to appointments was good. The practice had a system in place to try to provide continuity of care.
• The practice was equipped to meet the needs of its patient population.
• There was a strong leadership structure in place and staff were invested in and supported to increase their knowledge and skills.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• Where staff showed an interest in a particular clinical area, the practice supported that member of staff to gain knowledge and skill in that area. If they were unable to drive to the location the practice financially supported them to physically access the training and paid staff overtime if training took place outside of their working hours.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 November 2016

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

• Both GPs and nursing staff took the lead in reviews and management of patients with long term conditions.
• The practice performance for diabetes indicators was in line with or higher than the CCG and national averages. For example, the number of patients who had received a foot examination and risk classification was higher than the CCG and national average.
• All patients had a named GP.
• Those patients unable to come to the practice, for example, due to being housebound, were able to access home visits, vaccination and health checks from the GP and nursing staff.
• The practice worked with other health and social care professionals to provide coordinated care and treatment.

Updated 28 November 2016

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

• There were systems and processes in place to enable staff to identify and take appropriate action to monitor and safeguard children and young people living in disadvantaged situations. For example, where a child did not attend a booked appointment this was followed up.
• The GP practice completed the pre-school checks.
• Urgent same day appointments were available for babies and children.
• Immunisation rates were above CCG and national averages for all standard childhood immunisations.
• Appointments were available outside of school hours.
• The premises were suitable for children and babies.

Updated 28 November 2016

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

• If patients required a longer appointment due to complex needs or multiple medical conditions this was available. 
• All older patients had a named GP.
• Those patients unable to come to the practice, for example, due to being housebound, were able to access home visits, vaccination and health checks from the GP and nursing staff.

Updated 28 November 2016

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

• The practice offered Saturday morning pre booked appointments. These appointments could be used for a variety of reasons including travel vaccines and chronic disease management.
• Prescriptions were sent electronically to the patients preferred chemist.
• The practice offered online appointment booking and prescription requests.
• The percentage of women aged 25-64 who have had a cervical screening test in the past 5 years was above the CCG and national average.
• The practice operated a virtual patient population group (PPG) which was popular with this group.

Updated 28 November 2016

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

• The practice performance for mental health indicators was higher than the CCG and national average. For example, the percentage of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, was higher than the CCG and national average.
• The practice worked closely with mental health professionals to deliver coordinated care in the community.
• Longer appointments were available for patients experiencing poor mental health.
• The practice sign-posted patients to local voluntary support services.

Updated 28 November 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice was aware of those patients on their register who lived in vulnerable circumstances.
• The practice computer system provided an alert to staff if patients had any sensory deficit and therefore may require extra support to access their appointment.
• If patients required a longer appointment due to complex needs or multiple medical conditions this was available.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• All patients had a named GP.
• The practice sign-posted vulnerable patients to various support groups and voluntary organisations.
• There were established systems and processes in place to ensure patient safety and enable staff to identify and take appropriate action to safeguard patients from abuse. Staff knew how to recognise signs of abuse in vulnerable adults and children.
• The practice had identified and supported carers on their register.