This practice is rated as Outstanding overall. (The previous inspection was in September 2015 where we rated the practice as good overall- outstanding in providing responsive services)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

We carried out an announced comprehensive at Drs Hargadon, Atkinson, Thornton, Thinakararajan & Mr D Sheppard (known as Rosedean Surgery) on Wednesday 6 June 2018 as part of our 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.
• Medicines were managed well at the practice with prescribing rates and patterns kept under review to ensure patient safety, effective treatment and cost effectiveness.
• Improvements within the dispensary had taken place since the last inspection and included an extension and additional security measures.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients gave strongly positive feedback about the care and treatment they received. Results from the July 2017 national GP patient survey, friends and family test results, independent survey results, comment cards, feedback on NHS Choices and google were all positive. For example, an external survey used each year to benchmark achievements showed the practice exceeded the national average patient satisfaction score in 27 of the 29 criteria.
• 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. Staff said the practice was a good place to work and added that the leadership team were supportive and encouraged career development and learning to help improve patient safety.
• There was evidence of systems and processes for learning, continuous improvement and innovation. The practice had taken part in local pilots to test new methodology.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The leadership team and staff group were organised, efficient and had effective governance processes.
• The leadership team focused on the needs of patients and morale of staff and proactively and continuously sought feedback about care, treatment and access to services. This feedback and engagement was seen as a positive way to influence change and investigate how to make processes and patient care more streamlined, efficient and improved for patients.

We saw areas of outstanding practice:

There was a proactive approach to understanding the needs of different groups of patients and an awareness to deliver care in a way that meets these needs, promotes equality and ensure individual needs and preferences were central to the planning and delivery of tailored services. This included older patients, those with long term conditions and patients who are in vulnerable circumstances or who have complex needs. This approach continued to improve the healthcare, reduce emergency admissions and reduce the need for journeys to hospital. For example,

• The practice had responded to the needs of the high numbers of frail elderly and completed a restructure of the care pathway by increasing clinical commitment for patients in both nursing and residential homes in the area had contributed in a reduction of emergency admissions by 14% in the last three years.
• The practice shared the care of 101 patients with a local addiction service (Addaction Liskeard). This was a reduction of 13% in the number of patients compared to the previous 12 month period. However, the practice had experienced an increase of 18% in Addaction contacts and referrals, reflecting the general increasing complexity of such patients. The practice had also completed a specific piece of work last year where practice staff worked with Addaction to highlight patients on anti-depressive medicines who were also being prescribed Methadone. The exercise resulted in 20 patients having their anti-depressive medicines titrated down and ultimately stopped - in line with best practice.

The leadership team invested and focused on the needs of patients and morale of staff and proactively and continuously sought feedback about care, treatment and access to services. This feedback and engagement was seen as a positive way to influence change and investigate how to make processes and patient care more streamlined, efficient and improved for patients.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rosedean House Surgery on Wednesday 9 September 2015. Overall the practice is rated as good.

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

• There was a safe track record and staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed. Medicines were well managed and the practice had good facilities and was well equipped to treat patients and meet their needs
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• There were clear recruitment processes in place. Staff had received training appropriate to their roles and any further training needs had been identified and planned
• The practice was well organised and there was a clear leadership structure. The practice proactively sought feedback from staff and patients, which it acted on.

We identified areas of outstanding practice:

The practice were responsive to the needs of their patients. This can be demonstrated by:

• The proactive care of older patients. One GP had a particular interest in the health care of older patients and undertook weekly telephone calls to care homes in the local area and visited on a weekly basis. This provided continuity of care, palliative care and developed strong relationships with the residents, managers and staff. The service had resulted in a 16% reduction in emergency department attendances/admissions for the practice patients in these care homes. The GP was part of a team who were submitting this example as a case history to the National Institute for Health and Care Excellence (NICE).

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice