We carried out an announced comprehensive inspection at Petroc Group Practice on 12 March 2019 as part of our inspection programme.

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 good overall and good for all population groups apart from patients with long term conditions which we rated as requires improvements.

We found that:

• 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.
• 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.
• Improvements since our previous inspection included a patient’s orchard.
• The practice offered extended hours which included early morning and evening opening. Appointments were also available on Saturdays from 10am until 1pm at various locations in the area, through joint working with the local GP practice federation.
• The practice identified military veterans in line with the Armed Forces Covenant 2014. This enabled priority access to secondary care to be provided to those patients with conditions arising from their service to their country.

Whilst we found no breaches of regulations, the provider should:

• Review systems in relation to high risk medicines.
• Continue to implement actions to improve uptake on the cervical screening.

• Consider the display of more information about its services offered for young people, both at the practice and online.
• Improve the rates of exception reporting for patients with long term conditions.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out a desktop review of Petroc Group Practice, St Columb Major on 26 November 2015. This was to review the actions taken by the provider as a result of our issuing a legal requirement.

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 made improvements so that there was proper and safe management of medicines. Nurses were working from the most up-to-date guidelines about vaccinations. Blank prescription forms and prescription pads were being handled in accordance with national guidance, providing an audit trail through the practice to demonstrate that they are kept secure at all times.

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 St Columb Major practice on 17 February 2015. Overall the practice is rated as good.

Specifically, we found the practice was good for providing effective, caring, responsive and well-led services. It requires improvement for safe services. The practice was good for providing services to older people, and people with mental health needs including dementia, vulnerable people, people with long term conditions, families, babies children and young people and working age people.

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.
• There was a 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 current practice guidance.
• 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.
• Audits were used by the practice to identify where improvements were required. Action plans were put into place and audits repeated to ensure that improvements had been made.
• 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.
• The practice had a vision and a strategy. However, there was a lack of governance cohesiveness which we highlighted at the inspection. We found specific gaps in communication and systems, which would if improved enhance governance arrangements at the practice.

We saw areas of outstanding practice including:

• The continuing development of practice staff and those of other agencies are recognised as integral to ensuring high quality, responsive emergency care. With no land based ambulance station in an area of 200 square miles, the practice has a highly qualified and skilled team who provide rapid emergency assessment and treatment for patients en-route to the main hospital from all areas of North Cornwall. One of the GP partners is an Advanced Life Support instructor working with the Resuscitation Council UK and is also a Royal College of Surgeons Pre Hospital Life Support Instructor. This GP provides training for all paramedics in Cornwall as well staff at the practice and other organisations including the Lifeboat service. The practice is well equipped with the same level of emergency equipment seen at the local Accident & Emergency Unit.

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

Importantly the provider must:

Ensure that there is proper and safe management of medicines by:

• Ensuring that nurses always work from the most up-to-date guidelines about vaccinations.
• Blank prescription forms and prescription pads are handled in accordance with national guidance, providing an audit trail through the practice to demonstrate that they are kept secure at all times.

The provider should:

• Ensure that records are kept of recruitment checks carried out for locum staff, including checks of the performers list.
• Have a mechanism which provides oversight of skills and training needs across the whole team utilising information from the appraisal system.  This should ensure that there is proactive management of training to provide triggers for when updates are due and identifies if staff have any gaps in training or skills.
• Staff responsible for managing Health & Safety should have the appropriate skills and training to manage COSHH risks associated with identified hazards and carry out actions to reduce these.
• Create greater cross communication across staff groups to ensure that audit and governance systems remain effective. For example, there was limited collaboration and involvement of nurses in clinical and strategy at the practice. Practice nurses should be actively invited to attend multidisciplinary meetings about vulnerable patients, and involved at strategic level in analysis of all significant events and complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice