This practice is rated as Good overall. (Previous inspection January 2015 – Requires Improvement. Follow up inspection October 2015 - Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Bottreaux Surgery, including the dispensary on 1 November 2018. We visited the branch surgery at Tintagel and inspected the dispensary there. The inspection was a routine inspection as part of our inspection schedule.

At this inspection we found:

• Despite national recruitment challenges for the primary medical services sector, the practice had successfully attracted a new GP partner to join Bottreaux Surgery practice.
• The practice was focussed on safety and had clear systems to manage risk across the practice so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved processes.
• Audit was an area for improvement for practice to routinely review the effectiveness and appropriateness of the care it provided.
• Care and treatment was always delivered according to evidence-based guidelines.
• All the feedback from 10 patients at the inspection was positive about staff treating them with compassion, kindness, dignity and respect.
• Patient feedback about the appointment system had been listened to. The practice had increased patient access to appointments employing a varied skill mix of staff and increasing the number of appointments available with the GP and nursing team.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. Proactive succession planning based on staff development and training of future GPs, doctors and practice nurses was evident at this training practice.
• There was a proactive approach to preventing development of long term health conditions. For example, 226 patients within the pre-diabetic range received support and advice and were reviewed annually.

Areas where the provider should make improvements are:

• Review the security of blank prescriptions within the dispensaries so that it is in line with national guidance.

• Review infection prevention and control arrangements to promote patient and staff safety.

• Develop an overall quality improvement programme with regular audits carried out across all staff groups and services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Bottreaux Surgery on 20 October 2015. This was to review the actions taken by the provider as a result of our issuing two legal requirements.

Overall the practice has been rated as GOOD following our findings.

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

• The provider had established and is operating effective recruitment procedures to ensure that information regarding pre-employment checks are kept regarding persons employed.

• Effective systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients and others had been implemented. These included the regular review and updating of policies to meet current guidance, monitoring the training needs of the whole team (including temporary staff), identification of any trends and risks in relation to complaints, significant events, incidents and accidents that could impact patient care and business continuity.

• Communication systems had improved so that important learning messages were shared across the whole team.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bottreaux Practice on 20 January 2015. This was a comprehensive inspection covering the main practice at Bottreaux Surgery, and Tintagel Surgery. Both practices provide primary medical services to people living in the coastal village of Boscastle and surrounding villages in Cornwall covering approximately 100 square miles. Transport links within the area are limited. Bottreaux Surgery covers coastal villages, which are rural, with high percentage of agriculture and mid-range deprivation. The practice provides primary medical services to a diverse population and supports patients living in two adult social care homes in the area. Both surgeries have dispensaries, which we inspected on the same day.

At the time of our inspection there were approximately 5000 patients registered at the service with a team of three GP partners. GP partners held managerial and financial responsibility for running the business. The practice also had one salaried GP. In addition there were two registered nurses who are both independent prescribers. Bottreaux Surgery is a training practice, with two GP partners approved to provide vocational training for GPs, second year post qualification doctors and medical students.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

Overall the practice is rated as REQUIRES IMPROVEMENT.

Specifically, we found the practice to be outstanding for providing responsive services. We found the practice to be good for providing effective and caring services. It was also good for providing services for older people, people with long term conditions, families, children and young people and people experiencing poor mental health (including people with dementia), working age people (including those recently retired and students) and people whose circumstances may make them vulnerable. It required improvement for providing safe and well led services.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Patients’ needs were assessed and care was planned and delivered following current practice guidance. The practice had a very good skill mix which included two advanced nurse practitioners (ANPs) and was able to see a broader range of patients than the practice nurses.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified with individuals.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were available the same day and staffs were flexible and found same day gaps for patients needing routine appointments.
• 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.
• There was a strong commitment to providing well-co-ordinated, responsive and compassionate care for patients nearing the end of their lives. This included proactive management of emergency and short term pain relief medicine to counteract access to very limited out of hours pharmacist services in the practice area. This enabled carers to avoid having to travel long distances for these medicines.

We saw areas of outstanding practice:

• The practice understood the needs of the patient list and the challenges of the coastal location and had developed a responsive service accordingly. There were many examples of this seen at the inspection. Patients were experiencing advanced care and treatment from staff that were skilled in delivering a flexible and integrated service with other providers. This was significant for patients living in an isolated coastal area and promoting access to services normally run at the main hospital some 37 miles away

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

Importantly the provider must:

• Establish and operate effective recruitment procedures to ensure that information regarding pre-employment checks are kept regarding persons employed. This must include recording when checks of the performers list are carried out for all GPs, including locum GPs.

• Establish and operate effective systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients and others. This must include regular review and updating of policies to meet current guidance, monitoring the training needs of the whole team (including temporary staff), identification of any trends and risks in relation to complaints, significant events, incidents and accidents that could impact patient care and business continuity.

In addition the provider should:

• Review communication systems so these are audited and ensure all staff including temporary staff such as locum GPs are included.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice