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Wheal Northey Good Also known as Wheal Northey Site

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 10 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wheal Northey, which is run by St Austell Healthcare on 25, 26 and 27 April 2017. 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 a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety, which included an organisational risk register that was monitored and acted upon.
  • The practice held six weekly educational sessions which were used as opportunities for local hospital consultants to share latest evidence based practice and answer questions on referring and prescribing practice.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. Staff were encouraged and actively supported to develop their roles.
  • There were GPs with a special interest (GPwSI) employed at the practice. These included dermatology GPwSI and ophthalmology GPwSI.
  • The practice employed two pharmacists five days week who performed roles to assist the GPs across the practice group. These roles included medicine reviews and audits.
  • Results from the in house patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Vulnerable patients, their carers and staff at local care homes where some of these patients lived were given a direct access phone number; the number gave faster access to staff in the practice so urgent appointments could be accessed. All of the patients had a named GP and there was continuity of care. For example, the named GPs visited their designated care home twice a week to see patients there.
  • Patients were able to access urgent appointments on the same day at the Carlyon Road Health Hub from 8am to 8pm Monday to Friday. Patients were able to see either a GP or minor illness nurse for appointments.
  • Patients we spoke with said they found it difficult to get through to the Hub to make a routine appointment. The practice had audited the appointment system twice and made changes, but we found further improvements were needed to improve patient flow in the Hub and on the telephone.
  • The practice had good facilities at Wheal Northey and its other three sites and was well equipped to treat patients and meet their needs.
  • There were age appropriate toys and books in all the waiting rooms of the main site and other three sites.
  • Recruitment was well managed and detailed systems were efficiently used to monitor staff recruitment and employment issues.
  • The prescriptions team at the practice worked closely with the local pharmacies to ensure blister packs were provided for older people with memory problems.
  • 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 provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw several areas of outstanding practice including:

The diabetic patient care pathway was proactive in supporting patient needs and improving health outcomes for patients through a social prescribing approach. Patients in the first social prescribing group of 180 patients reported that their diabetes was in remission or had significantly improved by 25% through a combination of closely monitored prescribing, exercise, diet and regular monitoring.

Basecamp, a dedicated internet space with a secure mobile phone application was developed at the practice for staff. This provided real time information about current best practice guidelines and shared learning which all clinical staff were able to access, particularly when visiting patients in their own homes.

A monthly outreach clinic was run by a GP partner and practice nurse from the practice for vulnerably housed patients staying at a hostel. The practice had equipped the clinic so that patients were able to be seen at the hostel. Patients access shared care and support to recover from drug addiction, sexual health screening, family planning and mental well being support there.

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

Importantly, the provider must:

  • Ensure care and treatment is provided in a safe way to patients through effective access to appointments.

The areas where the provider should make improvement are:

  • Review how management of elderly frail patients should be implemented in the same way other patient registers are managed at the practice.
  • Review the system for safety netting two week wait referrals to set out clear roles and responsibilities to reduce any potential risks.
  • Continue to review security in some consulting rooms to ensure prescription paper remains secure at all times.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 July 2017

The practice is rated as good for providing safe services.

  • From the sample of documented examples we reviewed, we found there was an effective system for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had defined and embedded systems, processes and practices to minimise risks to patient safety.
  • Detailed systems were efficiently used to monitor staff recruitment and employment issues.
  • Medicines were well managed at the practice by a dedicated prescriptions team and managed by a pharmacist. Further improvements were needed in some consulting rooms to ensure prescription stationery remained secure.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • The practice had adequate arrangements, covering all four sites, to respond to emergencies and major incidents.

Effective

Good

Updated 10 July 2017

The practice is rated as good for providing effective services.

  • Unpublished data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average. The data showed a two year trajectory of improvement which had been achieved by setting up a data team, which had prioritised coding for all 31,000 patients when St Austell Healthcare took over the practice group.
  • Other systems introduced included a closely monitored birth date recall system for patients on specific registers for conditions such as diabetes and respiratory disorders. All 52 patients who we spoke with or received written comments from said they had confidence in their care and treatment. Some of these patients had long term conditions and remarked that the system was working well for them.
  • Holistic patient centred health promotion was strongly advocated at the practice. There were activities improving physical and mental wellbeing of patients which had been mapped and were accessible to patients. The practice worked in partnership with local providers such as the Eden Project and Active for Health to deliver these activities. Patients reported positive outcomes from their participation in these activities.
  • Staff were aware of current evidence based guidance and had a bespoke systems, such as a secure mobile phone application, in place to update the team in real-time when changes occurred. This included a medicines formulary embedded within the patient record system guiding clinical staff on the latest guidance and cost effective treatments to use.
  • The practice employed a pharmacist five days a week, and had recently appointed another pharmacist. Their role and responsibilities included providing advice to patients, conducting medicines reviews, management of medicine safety and performing audits of medicines to ensure the correct processes and checks were being followed. Data from the practice showed positive improvements in the ways medicines were prescribed since the pharmacists had been employed.
  • Clinical audits demonstrated quality improvement across a range of activities.
  • Staff had the skills and knowledge to deliver effective care and treatment. Staff were encouraged and actively supported to develop their roles.
  • There were GPs with a special interest (GPwSI) employed at the practice. These included specialisms such as dermatology and ophthalmology.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 10 July 2017

The practice is rated as good for providing caring services.

  • Data from the in house patient survey showed patients rated the practice highly for several aspects of care.
  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • Carers at the practice were provided with written and verbal information and were invited to a carer’s assessment.
  • 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.

Responsive

Requires improvement

Updated 10 July 2017

The practice is rated as requires improvement for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia. The practice took a multidisciplinary approach to delivery of appointments for patients. For example, nurse practitioners and nurse specialists led the monitoring of patients with long term conditions. An emergency care practitioner supported GPs with home visits to vulnerable people.
  • All telephone calls into the practice were handled by receptionists and escalated, where necessary, for triage by a duty GP to determine what type of support or appointment the patient needed. However, the majority of verbal and written feedback from patients highlighted their frustration with the journey of access to make appointments. Patients reported issues with the telephone system with long waits in getting through to the practice. Patients highlighted concerns regarding telephone access to routine appointments released every day at 10am, which they said were quickly filled. GP partners highlighted this as the main priority for improvement, which was on the organisations risk register. They demonstrated changes to systems were communicated to the public through various avenues but recognised further improvements were necessary. The practice had audited the appointment system twice in the previous six months, making changes to the telephone system with a menu of options diverting patient calls direct to specific teams.
  • All 55 patients in written or verbal feedback reported satisfaction with accessing same day appointments for urgent concerns at Carlyon Road Health Hub. Urgent appointments could be accessed from 8am by phone or in person and were available up to 8pm every working day at the Hub.
  • The practice at the main site of Wheal Northey and the three branch surgeries had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was easily available. Examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
  • All vulnerable patients including the over 75s, their carers and care homes had a named GP for continuity. They had access to a direct line telephone number so that they could contact the practice without delay when an urgent response was needed.
  • The practice brought some services closer to home for patients through sub-contracting with secondary providers. Examples included: A consultant led secondary care ophthalmic clinic for patients across the locality with macular degeneration and glaucoma (degenerative eye conditions),

Well-led

Good

Updated 10 July 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it. The team had won awards in recognition of their work in the area, which included: Primary Care Innovation – turn around award averting a service failure. Patience of a Saint Award from people using a homeless charity hotel for services to them.
  • There was a clear leadership structure and the majority of staff felt supported by an enthusiastic and energised management. Two culture surveys had taken place in the previous nine months with an action plan in progress to address issues highlighted for improvement by the staff involved.
  • The practice had policies and procedures, accessible online for staff, to govern activity and held regular governance meetings and there was an overarching system to ensure these were kept under review.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk held for example through an organisational risk register.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the active patient participation group. For example, action taken regarding dissatisfaction regarding ease of access to appointments and recognition of this as a continuing issue for improvement.
  • As a training practice, there was a strong focus on continuous learning and improvement at all levels. Staff training was a priority and evidence seen demonstrated that safe delivery of care to patients was competency based.
  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.

Checks on specific services

Older people

Good

Updated 10 July 2017

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population. Each patient had a named GP and were also able to see other GPs at the practice. Unlike other patient health groups, the practice did not have a cohesive system such as a register or lead GP specialising in and having responsibility for oversight of frail elderly patients. We highlighted this was an area for improvement and saw the practice noted the need for a lead GP.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. The practice employed an emergency care practitioner who supported the GPs in carrying out home visits. A duty GP was accessible for triaging the support and care vulnerable elderly patients might need.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. They involved older patients in planning and making decisions about their care, including their end of life care. A direct line telephone number was provided to these patients and their carers to ensure they could access care or advice when needed.
  • The practice followed up on older patients discharged from hospital, where they were aware about the admission and discharge, and ensured that their care plans were updated to reflect any extra needs and changes of treatment.
  • Care plans were in place for patients at high risk of unplanned admission to hospital and these were shared with local out-of-hours providers, the ambulance services and emergency department. Regular hospital avoidance of admission meetings were held.
  • Patients had access to a direct line for requesting support and rapid home visits were available and carried out by GPs, a nurse consultant and an emergency care practitioner.
  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • Older patients and carers were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible
  • The practice had responsive systems in place for the care of 244 patients living in care homes. All care homes supported by the practice had a named GP, who visited twice a week to discuss and review the care provided to their patients. The care homes were given a direct line telephone number so that they could contact the practice without delay when urgent access to treatment was needed.

People with long term conditions

Good

Updated 10 July 2017

The practice is rated as good for the care of people with long-term conditions.

  • Person centred health promotion was provided via an onsite social prescribing team. Patients with long term conditions were assessed and prescribed bespoke programmes of activities to improve their overall health. Patients reported significant improvements in their health; for example, a patient with diabetes improved their blood results moving from diabetic to ‘normal’ range following a programme of exercise, diet, medicines review and regular monitoring.
  • The practice had an educational programme with housebound patients at risk of developing diabetes and worked with the community matrons to ensure practice patients with diabetes received the care and screening needed.
  • Nursing staff had lead roles in long-term disease management. Patients at risk of hospital admission were identified as a priority and able to access rapid home visits which were carried out by GPs, a nurse consultant and an emergency care practitioner.
  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
  • St Austell Healthcare at Wheal Northey practice had signed up for the local ‘shared care record project’ in 2016. This enabled health and care professionals such as Cornwall Health Ltd running the out of hours service, the ambulance service and Royal Cornwall hospital to view relevant information about the patients to support a better understanding of patients needs in unplanned or emergency situations.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 10 July 2017

The practice is rated as good for the care of families, children and young people.

  • From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.
  • Immunisation rates were around the national standard of 95% achievement for all standard childhood immunisations. Data provided by the practice showed year on year improvement in immunisation rates particularly for children ages two years and over.
  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • The practice provided support for premature babies and their families following discharge from hospital. For example, new mothers were able to access a check of themselves and their baby at 8 weeks.
  • Appointments were available outside of school hours and up to 8pm at night at Carlyon Road Health Hub (Monday to Friday). All four of the practices premises were suitable for children and babies.
  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
  • There were age appropriate toys and books at all sites in the waiting rooms.
  • Young people were able to access drop in appointments for advice about sexual health matters, contraception and their wellbeing.

Working age people (including those recently retired and students)

Good

Updated 10 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of these populations had been identified and the practice was making adjustments to the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, telephone consultations and online access to appointments were available for working people. The practice recognised further improvements were needed and had been carrying out audits about patient flow and access, as well as reviewing patient comments.

  • Online services were available to request repeat prescriptions, appointments and to view blood test results. Information about managing health conditions could be found on the practice website pages.
  • Extended opening hours and appointments were available at the Carlyon Road Health Hub from 8am to 8pm Monday to Friday.
  • The practice was proactive in promoting health checks for patients. These included offering referrals for smoking cessation, providing health information, routine health checks, carers assessments and reminders to have medicine reviews. This gave the practice the opportunity to assess the risk of serious conditions on patients which attend. The Practice also offered age appropriate screening tests including cholesterol testing.

People whose circumstances may make them vulnerable

Good

Updated 10 July 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice provided care and treatment to patients living in vulnerable circumstances including homeless people, refugee families and those with a learning disability. The practice held registers of patients and used these in a proactive way to recall patients for appointments to assess their general health.
  • A monthly outreach clinic was run by a GP partner and practice nurse from the practice for vulnerably housed patients staying at a local hostel. Patients were able to access shared care and support to recover from drug addiction, sexual health screening, family planning and mental well being support there.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • The practice offered longer appointments for patients who needed them. For example, patients identified at risk of developing diabetes were offered a one hour appointment to discuss their lifestyle and receive support through the social prescribing scheme to help improve their health.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice had information available for vulnerable patients and their carers about how to access various support groups and voluntary organisations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 July 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • The practice carried out advance care planning for patients living with dementia.
  • In 2016/17 84.5% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average (30-75%). The practice had increased the percentage of patients reviewed from the previous year 2015/16 by 4.2% and had plans to further improve patient diagnosis.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. A clinical pharmacist had been employed by the practice to assist with this role.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. For example, monthly multidisciplinary meetings were held with a consultant psychiatrist and mental health workers to review patients under their care experiencing complex mental illnesses. Risks were identified and proactive management plans agreed.
  • Patients at risk of dementia were identified and offered an assessment.
  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • The prescriptions team at the practice worked closely with the local pharmacies to ensure blister packs of medicines were provided for older people with memory problems to help indicate when they should take their medicines.