We  carried out an announced comprehensive inspection at Callington Health Centre on 8 December 2017. The overall rating for the practice was good, with well led rated as requires improvement. The full comprehensive report on the Month Year inspection can be found by selecting the ‘all reports’ link for Callington Health Centre on our website at .

This inspection was an announced focused inspection carried out on 11 July 2018 to confirm that the practice had carried out their plan to meet the legal requirement in relation to the breach in regulations that we identified in our previous inspection on 8 December 2017. This report covers our findings in relation to that requirement and also additional improvements made since our last inspection.

The overall rating for the practice remains unchanged as good. As a result of the improvements made the well led domain is now rated as good.

Our key findings were as follows:

• The practice had established effective systems and processes to ensure good governance in accordance with the fundamental standards of care, particularly in regard of monitoring staff training and development, assurance of oversight of the complaints process and increased patient engagement.
• The recruitment process had been reviewed setting out how different responsibilities and activities of all staff are assessed to determine if they are eligible for a DBS check and to what level.
• Processes for obtaining and acting on patient feedback, including verbal and written complaints had been reviewed.
• The whistleblowing policy had been reviewed and included the name and contact details of the local Freedom to Speak Up Guardian to act as an independent and impartial source of advice to staff, with access to anyone in the organisation, or if necessary outside the organisation. Staff were aware of who the Freedom to Speak Up Guardian was and when to contact them.
• The process for registering new patients, including the checking of identity was reviewed with staff and spots checks undertaken to ensure the Data Protection Act 1998 and General Data Regulations 2018 were met.

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection report published

April 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? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Callington Health Centre on 8 December 2017. This was part of our scheduled inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines and to meet the needs of the patient population registered at the practice.

• The practice reviewed the team skill mix in response to increasing needs of an older population in the area. Two emergency care practitioners (ECPs) had joined the team and provided a rapid response for vulnerable older people and patients with long term conditions by making home visits within their scope of practice. The ECPs supported the duty GP seeing patients who needed same day appointments. This had released GP time so that they were able to focus on patients with complex and urgent needs.

• Childhood immunisation uptake rates for the vaccines given were above standard. For children up to 2 years of age the practice rates were 93-96% which was above the national target percentage of 90%.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw two areas of outstanding practice:

• The practice successfully secured additional funding to extend the confidential advice and healthcare service (Tic Tac) for young people at a local college. Young people were not required to be registered with the practice and able to access sexual health screening, contraception advice, smoking cessation and support for mental health issues five days a week. Staff were consistent in supporting young people live healthier lives through a targeted and proactive approach. For example, the practice was focused on working with young people to reduce the number of unplanned pregnancies. Statistics showed between 2014 – 2017, 643 consultations had been provided and the number of unplanned pregnancies for under 18s had fallen to zero.
• Specialist equipment was purchased through fundraising by the Friends of the Practice, which provided near patient testing. For example, the practice had a portable bladder ultrasound used for early diagnosis of conditions that could lead to urinary retention. This meant patients were spared having to wait for an appointment and travel to the secondary care service.

The areas where the provider must make improvements are:

• Ensure effective systems and processes are established to ensure good governance in accordance with the fundamental standards of care, particularly in regard of; The processes used for monitoring staff training and development were not effective. The complaints process did not provide sufficient assurance of oversight or input from GP partners into complaints. There were some gaps in patient engagement.

The areas where the provider should make improvements are:

• Review the recruitment process to assess the different responsibilities and activities of all staff to determine if they were eligible for a DBS check and to what level.
• Review the process for responding to patient feedback, including verbal and written complaints.
• Review the whistleblowing policy to include the name and contact details of the local Freedom to Speak Up Guardian to act as an independent and impartial source of advice to staff, with access to anyone in the organisation, or if necessary outside the organisation. Raise staff awareness about the Freedom to Speak Up Guardian role and responsibilities.

• Review staff understanding of the process for registering new patients, including the checking of identity, to provide assurance that the Data Protection Act 1998 is met.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Callington Health Centre was inspected on Wednesday 7 January 2015. This was a comprehensive inspection.

The practice is one of two health centres under the management of Tamar Valley Health. Both practices provided primary medical services to approximately 16,230 patients of which 10,040 attend the health centre at Callington. The practice was located in a rural area of Cornwall. The practice provided a service to a diverse age group.

There was a team of nine GP partners, six associate GPs and a strategic management partner within the organisation. Partners hold managerial and financial responsibility for running the business. There were six GP partners based at Callington health centre and four associate GPs. There were seven female and three male GPs. The team were supported by a nurse prescriber, five practice nurses and five health care assistants who worked across both sites. The practice employed two pharmacists who were both able to prescribe and review medicines. There were also additional administrative, reception staff and dispensing staff.

The practice was a dispensing practice. A dispensing practice is where GPs are able to prescribe and dispense medicines to patients who live in a rural setting which is a set distance from a pharmacy. Approximately 5,500 patients at the practice were able to use the dispensary at the health centre.

Patients using the practice also had access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

We rated this practice as good.

Our key findings were as follows:

There were systems in place to address incidents, deal with complaints and protect adults, children and other vulnerable people who use the service. There was a proven track record and a culture of promptly responding to incidents and near misses and using these events to learn and change systems changed so that patient care could be improved. Significant events were recorded and shared with multi professional agencies.

There were systems in place to support the GPs and other clinical staff to improve clinical outcomes for patients. The practice used the national Quality Outcome Framework (QOF- a national performance measurement tool) scheme. Patient care and treatment was considered in line with best practice national guidelines and staff are proactive in promoting good health. There were sufficiently skilled and trained staff working at the practice.

The practice was pro-active in obtaining as much information as possible about their patients which does or could affect their health and wellbeing. Staff knew the practice patients well, are able to identify people in crisis and are professional and respectful when providing care and treatment.

The practice planned its services to meet the diversity of its patients. There were good facilities available, adjustments were made to meet the needs of the patients and there was an effective appointment system in place which enabled a good access to the service.

The practice had a vision and informal set of values which were understood by staff. There were clear clinical governance systems. There was a clear leadership structure in place.

We saw two areas of outstanding practice including:

• The practice employed two pharmacists who were able to treat and prescribe minor illnesses, perform medicine reviews, answer medicine queries and perform basic health reviews. The pharmacists were independent prescribers and were involved with clinical activities in the practice as well as overseeing the dispensary procedures. They had systems in place to ensure any medicines alerts and recalls were assessed and actioned.

  The role had led to improvements in meeting patient needs during ‘on the day’ appointments and ensured GPs followed the most up to date guidance.

• The practice provided a service called TIC TAC to the local community college. This TIC TAC service provided a drop-in confidential advice and healthcare service to students during their college day. Although this was a funded enhanced service the practice had worked over and beyond the contract and reviewed the service changing it where necessary. For example initially the main services were for sexual health screening and contraception advice but more mental health issues have arisen resulting in the introduction of a counsellor and increased referrals of patients to the community mental health teams. The practice provided full time coordinator, daily GP and/or practice nurse and counsellor and had access to a school nurse. The service mainly provided health education, sexual health advice, contraception, smoking cessation advice and emotional support.

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

The provider should:

• Improve arrangements for recording the storage temperature of medicines kept in the dispensary, and the checks made on expiry dates of products.

• Introduce a system for the monitoring and recording of FP10 (prescription) pads in the dispensary to maintain a full audit trail.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice