Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at the Port Isaac, The Surgery on 6 July 2016. This was to review the actions taken by the provider as a result of CQC issuing one legal requirement. In September 2015, the practice did not operate effective audit and governance systems to evaluate, improve and mitigate risks relating to the health, safety and welfare of patients and others. The practice sent us a plan showing how these issues would be addressed and we have monitored this with the practice. At this inspection, we reviewed the actions taken since the last inspection.

Overall the practice has been rated as Good following our findings, with well led now rated as Good.

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

• The provider had introduced systems to regularly assess and monitor the quality of all services provided and identify, assess and manage all risks related to health, welfare and safety.

• The level of clinical audit had increased at the practice with an audit programme in place for the whole year.Prescribing data was now being used to drive audits to improve safety and patient health outcomes.

• The practice had implemented a system to review all policies and procedures in a rolling programme to ensure that these were in line with current legislation. For example, the child safeguarding policy and procedures had been reviewed with the Clinical Commissioning Group lead

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 Port Isaac, the Surgery on 29 September 2015. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• All 60 patients who gave feedback in the inspection told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They also said that GPs went above and beyond what was expected of them.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

• The practice governance frameworks were not always effective in supporting the delivery of the strategy and good quality care. Whilst staff assessed patients’ needs, the practice did not have a robust risk management system with which to identify and mitigate all potential risks in a timely way.

We saw an area of outstanding practice:

• Integrated health and social care is advocated by the practice and any potential barriers for patients to experience this are reduced .Early involvement in pilots to improve the experience of support and healthcare for people with mental health needs has resulted in improvements to the way this is co-ordinated.The practice has an integrated community nursing service, which through shared expertise and communication systems has meant that there is greater anticipatory care of vulnerable patients.

The areas where the provider must make improvement:

• Establish and operate effective audit and governance systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients.This is in respect of monitoring risks, proactive use of clinical audit to improve patient care, and reviewing and updating policies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive at Port Isaac The surgery, and the two branch surgeries at St Kew surgery and Bridge Medical Centre on 23 and 24 January 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. (Previous rating July 2016 – Good)

At this inspection we found:

• Feedback from patients about the staff, care and treatment was positive. National patient survey results regarding staff, care, treatment and the service were consistently higher than local and national averages.

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

• Leaders communicated well, were knowledgeable about issues and priorities relating to the quality and future of services and participated in external groups to ensure they understood the local changes and challenges. The practice strategy was in line with health and social care priorities nationally and across the local area.

• The leadership team were aware of and involved in the future of General practice nationally and within Cornwall.

• The practice worked effectively with other practices in the locality.

• The new practice manager had reviewed governance process at the practice and addressed where they were not fully established.

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice recognised where systems and processes had worked well and improved their processes where appropriate.

• The practice had established and embedded systems in place to assess, monitor and manage risks to patient safety.

• 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.

• The dispensaries, medicines, prescribing, high risk medicines were effectively managed.

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

• 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 many local pilots to test new methodology.

We found one area of outstanding practice:

The practice had recognised the geographical locations and isolation of the practice branches, the needs of the local population and associated restrictions for some patients accessing healthcare. The GPs and staff had reviewed this and offered additional support and services to reduce the need for long journeys, improved access to services. For example:

• Offering twice monthly rheumatology appointments for practice patients and those in the locality with a hospital consultant.

• Providing a home delivery service and phlebotomy service for housebound patients.

• Use of a community healthcare assistant (HCA) seconded to the practice who visited housebound patients to carry out blood tests, near patient testing and portable ECGs (electrocardiogram heart monitoring). The HCA visited elderly patients post hospital discharge.

• Providing same day interventions such as just in case bags and antibiotics to elderly patients in need who would otherwise require admission to hospital.

• Providing a women’s contraceptive and menopause service for patients by a GP with a special interest.

• Offering a physiotherapy service which enabled patients to access to physiotherapy services closer to home. The physiotherapy was offered within a purpose-built room with equipment provided by the practice. The practice also offered an equipment loan service and run regular Pilates classes.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice