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Inspection Summary


Overall summary & rating

Good

Updated 8 May 2015

Letter from the Chief Inspector of General Practice

St Blazey Surgery was inspected on Tuesday 3 March 2015. This was a comprehensive inspection. Overall the practice is rated as good.

St Blazey Surgery provides primary medical services to people living in St Blazey and the surrounding areas. Of the 6,350 patients registered at the service, 99% had described their ethnicity as White British. The practice provides services to a predominantly Cornish population and is situated in a semi-rural location. The practice provided health services under a General Medical Services contract (GMS) from the NHS.

The service had a team of four GP partners. Two were male and two were female. GP partners held managerial and financial responsibility for running the business. There were two nurses and two health care assistants at the practice. In addition there was a practice manager, a deputy manager and additional administrative and reception staff.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

Our key findings were as follows:

We rated this practice as good. Patients reported having good access to appointments at the practice and liked having a named GP which improved their continuity of care. The practice was clean, well-organised, had good facilities and was well equipped to treat patients. There were effective infection control procedures in place.

The practice valued feedback from patients and acted upon this. Feedback from patients about their care and treatment was consistently positive. We observed a patient centred culture. Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. Views of external stakeholders were positive and were aligned with our findings.

The practice was well-led and had a clear leadership structure in place whilst retaining a sense of mutual respect and team work. There were systems in place to monitor and improve quality and identify risk and systems to manage emergencies.

Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessment of a patient’s mental capacity to make an informed decision about their care and treatment, and the promotion of good health.

Suitable staff recruitment, pre-employment checks, induction and appraisal processes were in place and had been carried out. Staff had received training appropriate to their roles and further training needs had been identified and planned.

Information received about the practice prior to and during the inspection demonstrated the practice performed comparatively with all other practices within the clinical commissioning group (CCG) area.

Patients told us they felt safe in the hands of the staff and felt confident in clinical decisions made. There were effective safeguarding procedures in place.

Significant events, complaints and incidents were investigated and discussed. Learning from these events was communicated and acted upon.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 May 2015

The practice is rated good for being safe. Patients we spoke with told us they felt safe, confident in the care they received and well cared for

The practice had systems to help ensure patient safety and staff had appropriately responded to emergencies.

Recruitment procedures and checks were completed as required to help ensure that staff were suitable and competent. Risk assessments had been undertaken to support the decision not to perform a criminal records check for administration staff.

Significant events and incidents were investigated both informally and formally. Staff were aware of the learning and actions taken. There were monthly significant event meetings.

Staff were aware of their responsibilities in regard to safeguarding and the Mental Capacity Act 2005. There were suitable safeguarding policies and procedures in place that helped identify and protect children and adults from the risk of abuse. GPs had been trained to level three in safeguarding which was the highest level. All staff had completed safeguarding training in February 2015.

Medicine management policies had been reviewed in May 2014. There were suitable arrangements for the efficient management of medicines within the practice.

The practice was clean, tidy and hygienic. Suitable arrangements were in place to maintain the cleanliness of the practice. There were systems in place for the retention and disposal of clinical waste.

Effective

Good

Updated 8 May 2015

The practice is rated good for being effective. Supporting data obtained both prior to and during the inspection showed the practice had effective systems in place to make sure the practice was efficiently run.

The practice had a clinical audit system in place and seven audits had been completed in the last 12 months. These included audits on prescribing, cervical smears, coil fitting and minor surgery.

Care and treatment was delivered in line with national best practice guidance. The practice worked closely with other services to achieve the best outcome for patients who used the practice.

Information obtained both during and after the inspection showed staff employed at the practice had received appropriate support, training and appraisal. GP partner appraisals and revalidation had been completed.

The practice had extensive health promotion material available within the practice and on the practice website.

Caring

Good

Updated 8 May 2015

The practice is rated as good for being caring. Data showed patients rated the practice higher than others for many aspects of care. Feedback from patients about their care and treatment was consistently positive.

We observed a patient centred culture and found evidence that staff were motivated to offer kind and compassionate care and worked to overcome obstacles to achieving this. We found many positive examples to demonstrate how patients’ choices and preferences were valued and acted on. Views of external stakeholders were very positive and aligned with our findings.

Patients spoke positively about the care provided at the practice. Patients told us they were treated with kindness, dignity and respect. Patients told us how well the staff communicated with them about their physical, mental and emotional health and supported their health education.

The practice had conducted surveys with their patient participation group (PPG) to gather patient feedback. These surveys included questions about how caring the service was. The most recent survey in March 2014 showed patient satisfaction with the service.

Patients told us they were included in the decision making process about their care and had sufficient time to speak with their GP or a nurse. They said they felt well supported both during and after consultations

Responsive

Good

Updated 8 May 2015

The practice was rated good for being responsive. Patients commented on how well all the staff communicated with them and praised their caring, professional attitudes.

The practice carried out regular surveys in co-operation with its patient participation group (PPG). Results from these and from national GP Patient surveys showed that the practice listened to and responded to patient’s needs.

There was information provided on how patients could complain. Complaints were managed according to the practice policy and within timescales. There was an accessible complaints system with evidence that complaints were taken seriously and acted upon. There had been six complaints in the last 12 months.

The practice recognised the importance of patient feedback and had encouraged the development of a patient participation group to gain patients’ views.

Practice staff had identified that not all patients found it easy to understand the care and treatment provided to them and made sure these patients were provided with relevant information in a way they understood.

Patients said it was usually straightforward to get an appointment at the practice and that they were able to see a GP on the same day if it was urgent.

Well-led

Good

Updated 8 May 2015

The practice is rated as good for being well led. The practice had a clear vision which had quality and patient safety as its priority. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management. Nursing staff, GPs and administrative staff demonstrated they understood their responsibilities including how and to whom they should escalate any concerns.

Staff spoke positively about working at the practice. They told us they were actively supported in their employment and described the practice as having an open, supportive culture and being a good place to work.

The practice had a number of policies to govern the procedures carried out by staff and regular governance meetings had taken place. There was a programme of clinical audit in operation with clinical risk management tools used to minimise any risks to patients, staff and visitors.

Significant events, incidents and complaints were managed as they occurred and through a formal process to identify, assess and manage risks to the health, welfare and safety of patients.

The practice sought feedback from patients, which included using new technology, and had an active patient participation group (PPG).

Checks on specific services

Older people

Good

Updated 8 May 2015

The practice is rated as good for providing care to older people.

This population group formed a significant percentage of the total number of patients at the practice. 45% of the 6,350 patient population were over 65 years of age. There were four residential care homes in the area, including a nursing home. GPs at the practice worked closely with these services.

The practice GPs provided regular visits to patients in the nursing and residential care homes. Every patient was reviewed annually as part of the practice policy on nursing home reviews.

The practice had regular liaison with a community matron who was responsible for looking after some of the older and most vulnerable patients, providing extra support where needed. The practice and the community matron met up regularly to discuss cases and ensure continuity of care.

The practice held monthly multi-disciplinary meetings to discuss patients at risk of unplanned hospital admissions. This enabled patient’s care plans to be reviewed to ensure that safe and appropriate care was being provided.

The practice also discussed any patients that were classed as vulnerable and any adult safeguarding concerns. In order to fully support patients, there was a a system in place which ensured that any carer’s details were recorded on the patient’s records.

People with long term conditions

Good

Updated 8 May 2015

The practice is rated as good for providing care to people with long term conditions.

The practice had a significant number of patients who were suffering from long term conditions. The two practice Nurses carried out regular reviews of all patients in this population group. Patients received a letter of invitation when their annual health check was due, or more frequently if appropriate

The practice ensured that each patient was sent at least three reminders to attend the health check. GPs were made aware of any patients who have not responded after these reminders so that appropriate follow up action could be taken. This included phone calls by the GP.

Patients with long term conditions were able to request their repeat medications via email as well as more traditional methods. The practice offered electronic transfer of prescriptions so that patients did not have to attend the practice in order to collect their prescriptions.

The practice held regular clinics for patients in this population group. For example, warfarin clinics at the practice provided “in-house” testing so that patients were provided with instant results. In this way, the practice was able to provide patients with a new prescription or update their treatment the same day.

Families, children and young people

Good

Updated 8 May 2015

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

Practice nurses carried out regular immunisation and vaccination programmes. Practice GPs provided 24 hour baby checks. They also carried out baby checks when new babies reached the eight week old stage. The practice acted on feedback to not hold specific baby clinics as it was suggested that families should be able to attend at a time to suit them.

The practice had a child friendly waiting room with toys which were easy to keep clean. There was also a wide range of educational health leaflets for parents. All staff we spoke with were aware of child safeguarding procedures and the practice held regular safeguarding meetings with the health visitor and midwife.

Details of children’s attendance at A&E were routinely copied to the health visitor for review and if necessary discussed at GP meetings.

The practice had effective liaison with the local midwife. The midwife held their clinics at the practice following feedback that this was more convenient for expectant mothers, rather than attending the local hospital.

Information relevant to young patients was displayed and health checks and advice on sexual health for men, women and young people included a range of contraception services and sexual health screening. This included chlamydia testing and cervical screening.

Working age people (including those recently retired and students)

Good

Updated 8 May 2015

The practice is rated as good for providing care to working age people.

The practice had taken on board feedback from patients which recognised that patients who worked or were in education found it difficult to access the practice in the traditional ways. As a result the practice offered patients the ability to book their appointments via the internet, request prescriptions electronically and the ability to book telephone consultations at a pre-arranged time.

The practice also held appointments later in the evening three days a week which enabled patients to attend outside of normal working hours.

The practice had considered this population group when they arranged for the “Stop Smoking” advisor to hold clinics at the practice itself rather than locations elsewhere. Patients had responded positively to this and stated that it made access easier.

The practice used its website to inform patients how to make the best use of the health services available. For example, patients could book appointments online. Patients were able to request their prescriptions electronically and have them sent to the pharmacist of their choice via an automated system.

The practice had regular liaison with an independent pharmacy attached to the practice which was open seven days a week until 10pm. This enabled patients in this population group to collect their prescriptions at a time convenient to them.

Late appointments were available on Tuesdays, Wednesdays and Fridays until 7.15pm. This enabled working people to make appointments at a time convenient to them.

People whose circumstances may make them vulnerable

Good

Updated 8 May 2015

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

The practice considered that vulnerable patients could be of any age. For example, patients may be classed as vulnerable due to homelessness, learning disability, social circumstances, elderly and frail or unable to speak English.

The practice held weekly GP meetings in which they discussed any vulnerable patients that there were concerns about. This included safeguarding concerns. These meetings were minuted and recorded in writing.

The practice monitored all of its patients with learning disabilities. These patients were invited annually in for a yearly health check. The practice had also devised an easy to read practice information leaflet and other easy read materials which helped to ensure that patients understood how to access the services available. The practice also had scale models of body parts which were used to explain care and treatment to patients.

The practice had a plan in place to obtain easy to read versions of all health information leaflets in its waiting room.

Staff told us that they understood how to arrange language interpretation for any patients who were unable to communicate in English.

The practice had a portable hearing induction loop for patients who used a hearing aid.

The practice held regular palliative care meetings to discuss end of life care. All recent patient deaths were reviewed at these meetings regardless of circumstances in case there was any learning to be shared.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 May 2015

The practice is rated as good for providing care to people experiencing poor mental health.

The practice maintained registers which showed that they currently had 66 patients who suffered from dementia. There were 48 patients on the practice mental health register. Practice staff kept these registers up to date.

All patients in this population group were invited to have an annual review, including a review of their physical health. The practice invited the local community psychiatric nurse and dementia liaison nurse to its regular multi-disciplinary team meetings so that they could discuss any concerns with the wider team as appropriate. This facilitated a joined up approach to fully support patients in this population group.

The practice liaised with two mental health support groups and provided facilities for them to run clinics from the practice on a regular basis. In addition the practice worked closely with a local consultant psychiatrist. The mental health single point of access team also worked closely with the practice and saw patients on the premises.

The practice supported patients experiencing alcohol and substance misuse by helping support groups to hold clinics at the practice. The practice had acted on feedback which demonstrated having these organisations hold their clinics at the practice made access much easier for patients.