Pendeen Surgery

Updated 15 August 2016

Pendeen Surgery is located just to the south of the market town of Ross-on-Wye. The practice is registered with the Care Quality Commission (CQC) as a partnership provider and delivers a full range of family medical services. Pendeen Surgery holds a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. At the time of the inspection, Pendeen Surgery was providing medical care to approximately 8,300 patients.

The practice is suitable for wheelchair users and patients with poor mobility. The automatic front doors are also convenient for wheelchair users. All consultation rooms are situated on the ground floor, which means that there is easy access for patients. Car parking for patients is available at the practice and on the road outside.

The practice has a children’s area set off the main reception. This area is visible to staff in reception. Toys and books are provided for the children. There is ample room for pushchairs or prams to be left in the foyer and baby changing facilities are provided.

There are two partners (one male, one female) and four salaried GPs (all female). The GPs are supported by a practice manager, four practice nurses, one health care assistant, one phlebotomists (plus one trainee phlebotomist) and administrative and reception staff.

Pendeen Surgery is also a teaching practice and there is currently one trainee GP working at the practice. A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice.

There is a pharmacy on site, which is run independently of the practice.

The practice is open from 8am to 6.30pm. Appointments are offered from 9am to 6pm every week day. There is provision for ‘urgent extras’ to be seen at 12 mid-day and at 5pm. The practice hosts the GP Access Service at weekends, when patients can see a GP or nurse between 10am and 2pm on Saturdays and Sundays. At all other times when the practice is closed, cover is provided by the NHS 111 service.

Updated 15 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pendeen Surgery on 7 June 2016. Overall the practice is rated as good.

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

• There were robust systems in place to monitor and maintain safety in the practice.
• Staff understood their responsibilities to raise concerns and to report incidents and near misses. Incidents were viewed as opportunities for learning and improving patient care.
• The practice was visibly clean and hygienic. There were arrangements for assessing and mitigating the risks from healthcare associated infections.

• Patients’ needs were assessed and their care was delivered in line with best practice guidance.
• The practice team was well trained and had skills and experience in a range of health conditions.
• Feedback from patients about their care was consistently positive. Patients said that GPs listened to them and that they were treated with compassion, dignity and respect. Patients felt that they were involved in their care and decisions about their treatment.
• The system for recording and learning from significant events was well embedded and robust.
• The system for undertaking regular audits was robust. The practice routinely presented the findings at the educational meetings to drive improvement in patient care.
• Information about services and how to complain was available and easy to understand. The practice responded to complaints in an appropriate and timely manner. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients told us that it was easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had an area set aside for use by children, which contained books and toys.
• There was a clear leadership structure and staff felt supported by management.
• The practice proactively sought feedback from staff and patients and used the feedback to improve services to patients.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw two areas of outstanding practice:

• The practice had proactively engaged with a manager and the welfare officer of a local farm where many seasonal workers from overseas were employed in order to facilitate access to the practice services. This was a practice led initiative which resulted in the seasonal workers being accompanied at appointments by a person who could translate for them.
• The system in place for managing and monitoring significant events was extremely robust. The summary details were logged on a spreadsheet, which contained hyperlinks to the full discussion and decision process. This system originated in 2005 and had been adopted by other practices.

The area where the provider should make improvement is:

• Review the arrangements for checking on any uncollected prescriptions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 August 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Achievement data from the Quality and Outcome Framework 2014/15 showed that 95% of patients with diabetes had a foot examination in the last 12 months. This was above the Clinical Commissioning Group (CCG) average of 90% and above the national average of 88%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP. Systematic medicines reviews were offered at least annually.
• Chronic disease management was co-ordinated by a GP, a nurse and an administrator, which ensured a consistent organisational approach.
• The practice had identified 3% of the patient population as being at high risk of hospital admission. Advance care planning was offered to all these patients. Monthly meetings took place with a multidisciplinary team to review at-risk patients.
• Clinical staff were leads for asthma, chronic obstructive pulmonary disease (COPD) and diabetes.
• Diabetic patients were started on insulin treatment in conjunction with the community diabetic team.
• NHS health checks and healthy lifestyle advice (smoking cessation, exercise) were provided by the nursing team.

Updated 15 August 2016

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

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. For example, children who did not attend hospital appointments were reviewed by the safeguarding lead every three months. The safeguarding lead met regularly with the health visitor to discuss children and young people who were considered to be at risk.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• There was a specially decorated area, adjacent to the main reception area, which was set aside for children with books and toys. There was a baby change facility and plenty of room for pushchairs or prams to be parked in the foyer.
• Clinical rooms were all situated on the ground floor with easy access.
• Appointments were offered after school hours on every working day. Urgent sit-and-wait appointments were also available.
• The health visitor held a drop-in clinic every Tuesday afternoon, which coincided with the baby vaccination clinics.
• The midwife ran an ante-natal clinic on Wednesday afternoons.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 15 August 2016

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 people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Longer appointments were available if needed.
• Although patients were able to sign up to online services, older, frail patients were still able to request repeat prescriptions by phone.
• Consulting rooms were all situated on the ground floor, which meant that there were no stairs to negotiate.
• The practice had responsibility for seven local care homes. The managers of 2 homes said that the GPs were thoughtful, understanding and very efficient.
• The practice had developed close links with Hereford Carers Support, who were due to attend the forthcoming flu clinics.
• A receptionist acted as lead for carers’ support.

Updated 15 August 2016

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

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• Patients could book routine GP appointments online as well as request repeat prescriptions. Five telephone appointments were available to pre-book before each surgery.
• In addition to the choice of pre-booked or on-the-day appointments, patients could attend the urgent sit-and-wait appointments, which were available from Monday to Friday.
• The practice hosted the extended hours hub at weekends, which was appreciated by patients.
• Cervical screening uptake was 80%, which was in line with CCG and national averages.
• The practice offered a range of contraceptive services, including coils and implants.
• NHS health checks were offered to patients aged between 40 and 75.
• Saturday morning flu clinics were held every autumn, which provided extra flexibility for those patients who could not attend during the working week.

Updated 15 August 2016

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

• 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average and 4% above the national average.
• 91% of patients with poor mental health had a care plan documented in the last 12 months, which was in line with the CCG average of 92% and 3% above the national average.
• A dementia outreach nurse held clinics once a month and could signpost to local support services.
• A primary care mental health nurse came to the practice on a weekly basis The nurse provided short term intervention, as well as signposting to other agencies.
• The practice held monthly meetings with the community multi-disciplinary teams to discuss the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia: 96% of patients with dementia had been sent advance care planning paperwork.
• Information about how to access various support groups and voluntary organisations was available in reception and on the practice website.
• All accident and emergency reports for patients who may have been experiencing poor mental health were promptly reviewed by a GP and followed up as appropriate.
• There was a GP lead for mental health and staff showed that they understood how to support patients with mental health needs and dementia. The GP lead for safeguarding presented a mental capacity update to all staff in January 2016.

Updated 15 August 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice was very flexible with regards to registering homeless patients and travellers. For example, we saw that the practice had recorded an address as the local swimming pool car park.
• The practice offered longer appointments for patients with a learning disability.
• The practice held regular meetings with the multi-disciplinary community team to discuss the management of vulnerable patients.
• Vulnerable patients and their families were advised how to access various support agencies and voluntary organisations.
• Staff had been trained to recognise signs of abuse in vulnerable adults and children. All staff had safeguarding training as part of their induction and regular training sessions were held. Staff were aware of their responsibilities with regard to information sharing and documentation of safeguarding concerns. The most recent safeguarding training session was held in January 2016. Contact details were readily available for the relevant agencies in normal working hours and out of hours.
• There were a number of seasonal farm workers from overseas registered with the practice, particularly during the summer months. The practice had met with the manager and welfare officer in order to discuss the services offered by the practice. The practice had agreed an interpreter policy with the farm employers.