This practice is rated as Good overall. (Previous rating October 2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at The Falmouth Health Centre Practice on 30 October 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.
• Information sharing and co-ordinated care was effective. The practice held daily meetings which were attended by clinical staff at the practice and other health professionals such as community nurses, health visitors and midwives co-located in the same building.
• Risks to patients were assessed and well managed. For example, legionella checks were in place.
• 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 clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on. All staff we spoke with felt supported by the practice leadership team.
• The practice embraced technology to continuously improve its service to patients. For example, in the use of social media, a website, online appointments and repeat prescriptions.
• The practice sought continuous improvement and shared this with other practices. This included community prescription templates for community nurses (adopted by all the practices in the county) as part of an ongoing improvement programme. Diabetic referral templates and protocols that were shared with all practices in the county. The practice provided technical support to practices to help them integrate these templates into their systems. The benefits to patients included better co-ordinated care and effective, consistent treatment.
• The practice provided a social media page and a website to keep its patients up to date with the latest health guidance and useful healthy lifestyle events taking place at the practice and in the local area.
• On Bank Holidays the practice provided a second duty GP to provide a faster response to patient needs. The practice had a “never say no” policy to providing appointments.

We saw areas of outstanding practice:

• Following a successful pilot, the practice had been amongst the first in the country (and the first in Cornwall) to successfully introduce e-Consult, an innovative online system for patients to access services. E-Consult took the patient through a pathway that altered depending on their enquiry. E-Consult offered a range of self-help solutions for minor illnesses such as consulting with a pharmacist to reduce the need for a visit to the practice. Positive patient feedback about the scheme had been obtained from Healthwatch Kernow. 35 percent of 3,000 users at the practice were able to resolve their health issues without the inconvenience of attending an appointment. E-Consult continued to grow in popularity as more patients adopted new technology.

• GPs at the practice had created a comprehensive range of computer based prompt templates which brought effective care and consistency across the practice. These templates had been created using the latest guidance and enabled accurate and consistent care and treatment to be provided across a range of different areas. Clinical staff used these templates for safeguarding, sepsis, resuscitation, referrals, and bowel screening. The benefits to patients included safer, prompter and more consistent care. The templates had been shared with local practices across Cornwall and adopted as best practice. Thereby improving the health outcomes for the wider population.

• The practice had innovatively reviewed its new patient questionnaire to include new questions which proactively identified military veterans. This was a new development arising from renewed emphasis upon the Armed Forces Covenant enabling priority access to secondary care to be provided to those patients with conditions arising from their service to their country. In an area with strong links to the Royal Navy, there were facilities at the practice to proactively offer health checks including hearing tests in a specialist audio booth to military veterans.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Falmouth Health Centre Practice on 4 October 2016. 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.
• Information sharing and co-ordinated care was effective. The practice held daily meetings at 2pm which were attended by clinical staff at the practice and other health professionals such as community nurses, health visitors and midwives co-located in the same building.
• Risks to patients were assessed and well managed. For example, legionella checks were in place.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. The practice provided time and resource opportunities for staff development.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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. A recent refurbishment had taken place providing three new treatment rooms at the practice following charity funding from the practice’s league of friends.
• 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. All staff we spoke with felt supported by the practice leadership team.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had identified 3% of the practice list as being carers.

We saw one area of outstanding practice:

• The practice was amongst the first in the country to become a pilot site for e-Consult, an innovative online system for patients to access primary medical services with a 24 hour response time. E-Consult took the patient through a pathway that altered depending on their enquiry, enabling the patient to enter details of their health condition, alcohol and smoking consumption and other key health information. E-Consult offered a range of self-help solutions for minor illnesses such as consulting with a pharmacist to reduce the need for a visit to the practice. Positive patient feedback about the pilot had been obtained from Healthwatch Kernow, who were conducting an e-consult survey in October 2016. 35% of users were able to resolve their health issues without the inconvenience of attending an appointment at the practice. Patients had a new way to contact their GP which was popular both for younger people using new technology and for the working population who could use it at any time of the day or night.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice