We carried out an announced comprehensive inspection at Drs Bridger, Ball, Campbell, Purchas, Lin and Murthy known as ‘Probus Surgery’ on 5 February 2019 as part of our inspection programme.

At this inspection, we visited the main location at Probus Surgery and one of the four branch surgeries at Grampound both of which have dispensaries on site.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall. We rated safe and well led as requires improvement because w

e found that:

• We found some gaps in recording of actions taken to mitigate risks and overall governance was not effective.
• The practice provided care in a way that kept patients safe and protected them from avoidable harm. However, some safeguarding procedures and processes lacked consistency, access and appropriate risk levels being assigned when applied.
• The practice did not have reliable systems for appropriate and safe handling of medicines: the security and tracking of blank prescriptions within the practice was not in line with national guidance. Infrequent checks of emergency medicines led to some of these being out of date. Medicines refrigerator temperatures were not undertaken on all days that the practice, including branch surgeries were open affecting the reliability of assurance of cold chain.
• Appropriate standards of cleanliness and hygiene were partially met. Audit was not completed frequently so did not provide assurance of embedded procedures being followed.

We have rated this practice good for all population groups and effective, caring, responsive because:

• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way. Examples were: a five-days per week medicines delivery service to many drop off points, which was accessible for 95% patients receiving dispensed medicines.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care. The practice was a positive outlier in several parts of the national GP patient survey.
• All patients providing feedback during the inspection were strongly positive about the practice. Staff were said to be compassionate, friendly and went the extra mile to support patients and their carers’.
• Audit continued to be used to identify in-depth learning and implement changes to improve patient care and treatments.
• Succession planning and staff development was proactive and created a flexible and responsive workforce. In the context of national GP shortages, the practice had successfully recruited a salaried GP as a new partner from July 2019.

The area where the provider must make improvements are:

Establish effective systems to ensure the proper and safe management of medicines.

Establish effective systems and processes to prevent abuse of patients.

Established effective systems and processes to ensure good governance in accordance with the fundamental standards of care to manage and mitigate risk.

The areas where the provider should make improvements are:

• Ensure there are processes in place to evidence nurses and GPs are compliant with requirements to revalidate professional registration. Review safeguarding procedures and processes to make information about patient concerns clearly available and consistently applied by all authorised staff.
• Ensure that there is a robust system for checking the expiry dates of medicines within the service
• Ensure checks of fridge temperatures used to store medicines have been checked and appropriate actions taken where required
• Follow national guidance for the handling of controlled drugs and review security for the storage of controlled drugs in line with the Misuse of Drugs (Safe Custody) regulations
• Ensure that there is a complete medicines profile on the computer system that includes medicines prescribed for patients from other service providers.
• Ensure there is a system in place to follow up patients who failed to attend for follow up of long term conditions
• Ensure learning and actions following significant events is documented in line with national guidance on this.
• Review the infection prevention and control arrangements to increase the frequency of audit.

Letter from the Chief Inspector of General Practice

We undertook a planned, comprehensive inspection of Probus Practice on 4 February 2015. The practice provided primary medical services to approximately 8700 patients living in the village of Probus and surrounding villages in Cornwall. The practice also had a main branch surgery (Grampound) that was open four days a week and had a small dispensary attached. Additional to this, it used three other rural locations where patients were seen. Tregony branch, the Merlin Centre and Summercourt. A triage service was offered every day by the on call GP.

The practice comprised of a team of six GP partners (four male and two female) who held managerial and financial responsibility for running the business. In addition there were two salaried GPs, four registered nurses, eleven qualified dispensers and three health care assistants. There was also a comprehensive administrative team that consisted of a full time practice manager, a deputy practice manager, a finance manager, receptionists and administration staff.

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

The practice had a dispensary attached. A dispensing practice is where GPs are able to prescribe and dispense medicines directly to patients who live in a rural setting. Probus practice dispensed to patients who did not have a pharmacy within a mile radius of where they lived.

The practice is rated as good. A safe, caring, effective, responsive and well-led service was provided that met the needs of the population it served.

Our key findings were as follows:

• There were arrangements in place to respond to the protection of children and vulnerable adults and to respond to any significant events affecting patient’s well-being.

• The practice worked well with other health care service to enable a multi-disciplinary approach in meeting the health care needs of patients receiving a service from the practice.

• Patients told us they were treated with respect and kindness and staff maintained their confidentiality.

• Patients were able to have an appointment on the same day unless they wished to see a particular GP. Some patients said if they wanted to see a particular GP for continuity of care and treatment they had to wait. The practice took complaints seriously.

• There was a clear management structure with approachable leadership. Staff were supported and had opportunities for developing their skills. The provider responded to feedback from patients.

We saw several areas of outstanding practice including:

• Patients were able to access appointments when they needed them. Appointments were available at four different locations at varying times throughout the week in different rural locations. This included triage appointments by the on call GP when booked appointments were not necessary. Extended hours were offered four times a week for those people that were working.

• Patients were enabled to attend a memory clinic that operated in the village once a week. This was led by one of the GPs at the practice. This gave an opportunity to monitor and evaluate those people with dementia on a regular basis and plan their care accordingly.

• The practice has been EEFO approved. (The term EEFO does not stand for anything. EEFO is a word that has been designed by young people, to be owned by young people) EEFO works with community services to make sure they are young people friendly. Once a service has been EEFO approved it means that service has met the quality standards. For example, confidentiality and consent, easy to access services, welcoming environment and staff trained on issues young people face. Part of this scheme is the C-Card scheme. The C card is given so that a younger person can get free condoms at different places across Cornwall & the Isles of Scilly. This is in partnership with the local secondary school. One of the GPs at the practice has become a younger persons ‘champion’ and has plans to implement further improvements to the health of younger people.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice