St James' Surgery

Updated 21 February 2017

St James Surgery is a GP practice located in the town of Dover, Kent. It provides care for approximately 8200 patients.

There are three GP partners and a salaried GP. All are male. There are four nurses and three healthcare assistant all female. There is a practice manager and administrative and reception staff.

The demographics of the population the practice serves is generally similar to the national average although there are fewer people aged between 20 and 49 years than nationally. The practice cares for the pupils at a local state boarding school and therefore has many more patients between the ages of 10 and 19 than the national average. The majority of the patients describe themselves as white British. Income deprivation is marginally below the national average though there are pockets of quite severe urban deprivation in the practice area. Unemployment is about half the national average.

The practice has a general medical services contract with NHS England for delivering primary care services to local communities. The practice offers a full range of primary medical services. The practice is a training practice (training practices have GP trainees and foundation year 2 doctors).

The practice is open between 7.30am and 6.30pm Monday to Friday. There are evening surgeries until 8pm on Wednesdays and Thursdays. GPs and nurses varied their appointment times so appointments might be at any time when the practice was open.

The surgery building has three stories with consulting, treatment rooms and administration rooms on the ground floor. It is accessible to patients in wheelchairs or those with pushchairs

Services are provided from

St James Surgery,

2 Harold St,

Dover

CT16 1SF

The practice has opted out of providing out-of-hours services to their own patients. This is provided by Primecare. There is information, on the practice building and website, for patients on how to access the out of hours service when the practice is closed.

Updated 21 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St James Surgery on 10 January 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 an effective system for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the experience, and had been trained to provide them with the skills and knowledge, 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 an area of outstanding practice:

• The practice had two mobile telephone apps to improve communication with patients, this had impacted positively, particularly on young people and working age patients. It had also helped to reduce the number of patients who failed to attend their appointments by approximately 50%.

The area where the provider should make improvement is:

• Continue to identify patients who are also carers to help ensure they are offered appropriate support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 February 2017

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.
• There are 11 indicators for the management of diabetes, these can be aggregated. The aggregated practice score for diabetes related indicators was 89% compared with the clinical commissioning group (CCG) average of 93% and the national average of 90%. The percentage of patients on the diabetes register, with a record of a foot examination and a risk classification within the proceeding twelve months was 85% compared to a national average of 89%.
• 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.
• The clinical pharmacist worked with these patients and the GP to help ensure a consistent supply of medicines and “rescue” medicines. (these are medicines used for quick relief of symptoms, such as wheezing in asthma

Updated 21 February 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. Immunisation rates were relatively high for all standard childhood immunisations.
• The practice cared for the pupils at a local state boarding school. We saw that services were tailored to help meet their needs. There was a branch of the patient participation group planned specifically for school. There was a GP surgery daily at the school.
• The practice had two mobile telephone apps to improve communication with patients, this had impacted positively, particularly on young people. It had also helped to reduce the number of patients who failed to attend their appointments by approximately 50%.
• The practice’s uptake for the cervical screening programme was 85%, compared with the CCG average of 82% and the national average of 81%.
• 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 21 February 2017

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.
• Information and correspondence was available in large print if requested
• There was close working with nearby care homes and a local charity, this included referring family members for respite care when necessary.

Updated 21 February 2017

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.
• The practice had two mobile telephone apps to improve communication with patients, this had impacted positively, particularly on working age patients. It had also helped to reduce the number of patients who failed to attend their appointments by approximately 50%.

Updated 21 February 2017

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

• Eighty seven per cent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, compared with to the national average of 84%.
• the percentage of patients with schizophrenia and other psychoses who had had a comprehensive care plan in the preceding 12 months, agreed between individuals, their family and/or carers was 98%. This was markedly better than the CCG and the national average at 88%
• 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 had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended A&E 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.

Updated 21 February 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 homeless people and those with a learning disability. There was cooperative working with the local learning disability nurse.
• The practice kept a record of patients on the palliative care register who were most likely to have immediate need of care. This was checked weekly to help ensure these patients had the right medicines in the right quantity for any eventuality. The patients and their carers had dedicated telephone numbers so that they could contact the practice in case of emergency.
• 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.