St Albans Medical Centre

Updated 22 May 2017

St Albans Medical Centre provides primary medical services in Kingston to approximately 6850 patients and is one of 23 practices in Kingston Clinical Commissioning Group (CCG).

The practice population is in the least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 9%, which is lower than the CCG average of 12%; and for older people the practice value is 11%, which is lower than the CCG average of 13%. The practice has a smaller proportion of patients aged 20 to 34 years than the CCG average, and a slightly larger proportion of patients aged 35 to 54 years. Of patients registered with the practice, the largest group by ethnicity are white (80%), followed by asian (11%), mixed (5%), black (2%) and other non-white ethnic groups (3%).

The practice operates from a three-storey converted residential premises. A small amount of car parking is available at the practice, and there is space to park in the surrounding streets. The reception desk, waiting area, and four consultation rooms are situated on the ground floor. The practice manager’s office and three consultation rooms are situated on the first floor; and the second floor consists of two locked storage areas. The practice has access to four doctors’ consultation rooms and three nurses’ consultation rooms.

The practice team at the surgery is made up of one part time female GP, one full time male GP and one part time male GP who are partners, in addition, one part time female salaried GP is employed by the practice, and they have one trainee GP (Registrar) on a year-long placement. In total 25 GP sessions are available per week; and in addition seven Registrar sessions are offered. The practice also employs three female nurses and one healthcare assistant. The clinical team are supported by a practice manager, deputy practice manager, five receptionists, two secretaries and two administrators.

The practice operates under a General Medical Services (GMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice is open between 8am and 6:30pm Monday to Friday. Appointments are from 7:30am to 11:20am every morning, from 1:30pm to 6:30pm on Monday, Wednesday and Thursday afternoons, from 3:00pm to 6:30pm on Tuesday afternoons and from 3:30pm to 6:30pm on Friday afternoons. Extended hours surgeries are offered daily between 7:30am and 8am.

When the practice is closed patients are directed to contact the local out of hours service.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease, disorder or injury; surgical procedures; and family planning.

Updated 22 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Albans Medical Centre on 11 October 2016. The overall rating for the practice was requires improvement, and the practice was rated as inadequate for safety. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for St Albans Medical Centre on our website at www.cqc.org.uk.

Following the October 2016 inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulations 12 (Safe care and treatment), 17 (Good governance) and 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this announced focussed inspection on 25 April 2017 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements.

Overall the practice is now rated as 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.

• 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 and to carry out their roles effectively. Processes were in place to ensure that staff undertook training updates at the recommended intervals.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• The partners were clear about the performance of the practice and we saw evidence of action they had taken to address areas of below-average performance. Data showed patient outcomes were comparable to the national average and the practice had improved their processes in order to address their previously high exception reporting rate.
• Clinical audits had been completed and we saw evidence of these being used to improve patient care.
• The practice had a number of policies and procedures to govern activity; these had been reviewed and amended following issues raised during the previous inspection.
• Information about services and how to complain was available and easy to understand; however, not all complaint responses included information about how the complaint could be escalated.

There were three areas of where the provider should make improvements.

The provider should:

• Continue to ensure that they are identifying carers so they can be signposted to appropriate support.
• Ensure that all complaint responses include details of how the complaint can be escalated.
• Continue to work to develop their Patient Participation Group.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 22 May 2017

The provider had resolved the concerns relating to the issues identified in the safe, effective and well-led domains identified at our inspection on 11 October 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

In particular:

• During the initial inspection we found that the practice did not have adequate processes and safety nets in place to ensure that patients with some long-term conditions were adequately monitored and the practice had higher than average exception reporting rates for care of some long-term conditions. When we re-inspected the practice on 25 April 2017 we found that the practice had changed their process for inviting patients with long-term conditions for annual reviews, and as a result, their exception reporting rate had improved.

Updated 22 May 2017

The provider had resolved the concerns relating to the issues identified in the safe, effective and well-led domains identified at our inspection on 11 October 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

In particular:

• During the initial inspection we found that the practice did not have a system in place to ensure that results were received for all samples sent for analysis as part of the cervical screening programme, and that there was no system to ensure that patients with an abnormal result were followed-up. When we re-inspected we found that the practice had introduced a system of monthly patient records searches to ensure that sample results were received and patients were followed-up where necessary.

Updated 22 May 2017

The provider had resolved the concerns relating to the issues identified in the safe, effective and well-led domains identified at our inspection on 11 October 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

In particular:

• During the initial inspection we found that the safety of care for older people was not a priority, and we saw examples where the practice had failed to contact patients to arrange care following the receipt of test results. When we re-inspected the practice on 25 April 2017 we found that the practice had introduced a new system to ensure that follow-up action required following the receipt of test results was carried-out and that an audit trail was available.

Updated 22 May 2017

The provider had resolved the concerns relating to the issues identified in the safe, effective and well-led domains identified at our inspection on 11 October 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Updated 22 May 2017

The provider had resolved the concerns relating to the issues identified in the safe, effective and well-led domains identified at our inspection on 11 October 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Updated 22 May 2017

The provider had resolved the concerns relating to the issues identified in the safe, effective and well-led domains identified at our inspection on 11 October 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

In particular:

• During the initial inspection we found that the practice had failed to ensure that all non-clinical staff had received regular safeguarding training. When we re-inspected we found that all staff had completed safeguarding training within the recommended timeframe.