Letter from the Chief Inspector of General Practice

Fowey River Practice was inspected on Tuesday 3 February 2015. This was a comprehensive inspection, which focussed on the Fowey practice and Polruan branch practice, which had a dispensary.

Overall the practice is rated as good.

Specifically we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for all the population groups with exception of people with mental health which is rated as outstanding.

Our key findings 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.
• There was a strong commitment to providing well co-ordinated, responsive and compassionate care for patients.
• 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.
• 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 and planned.
• 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 staff 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.
• Audits were used by the practice to identify where improvements were required. Action plans were put into place, followed through and audits repeated to ensure that improvements had been made.

We saw several areas of outstanding practice including:

• The practice is contributing to nurse education in the region with the aim of promoting primary medical services as a career option when general practice is facing significant challenges in recruiting nurses. Fowey River practice is one of few practices in the peninsula providing placements for trainee practice nurses. Placements for pre-registration nursing students were due to start shortly after the inspection.
• The practice takes a truly holistic approach to assessing, planning and delivering care and treatment to people who use services. GPs at the practice had been recognised for leading research on advanced care planning for people with advanced dementia. GPs had disseminated this information across the primary care sector and in particular with practices in the Kernow Clinical Commissioning group. Since carrying out the research, the implementation of advanced care plans at the practice had reduced unplanned admission to hospital for people with dementia by 40% over the course of two years.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection February 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 Fowey River Practice on 25 and 26 July 2018. The inspection was a routine inspection as part of our inspection schedule.

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 processes.
• Audit was embedded, with the practice routinely reviewing the effectiveness and appropriateness of the care it provided. Care and treatment was always delivered according to evidence-based guidelines.
• All 30 patients gave strongly positive verbal and written feedback at the inspection about staff treating them with compassion, kindness, dignity and respect.
• Staff were caring and raised funds for local charities every year.
• People’s individual needs and preferences were central to the planning and delivery of flexible tailored services.
• All patient feedback highlighted ease of access to the appointment system. Extended hours were available enabling working patients and school children to access a range of services from the multi-disciplinary team.
• As a training practice, 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.
• The practice was one of only 12 research practices in the Southwest, supporting and recruiting patients for research studies to improve outcomes for patients.
• Fowey River Practice had successfully registered a further 1500 additional patients in 2017/18, increasing the list size by 25%. Patient feedback indicated existing patients reported no adverse impact for them.

We saw an area of outstanding practice including:

The practice provides truly holistic patient centred care. Many examples were seen demonstrating that patients were treated with dignity and received compassionate care. Carers and patients verified that GPs went above and beyond what was expected of them, for example providing 24 hour/7 day telephone access and visits to support for vulnerable patients receiving end of life care.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice