Archived: Penalverne Surgery

Updated 1 February 2017

Updated 1 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Penalverne Surgery on 26 September 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.
• Risks to patients were assessed and well managed.
• 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.
• 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. The practice was clean, tidy and hygienic. We found arrangements were in place which ensured the cleanliness of the practice was maintained to a high standard.
• The patient participation group (PPG) were engaged and well represented across a diverse range of ages and professional backgrounds. The PPG suggestions for changes to the practice management team had been acted upon
• The practice also had a dispensary at their branch practice which dispensed medicines to about 500 patients. The practice had arranged a delivery service for some patients to have their dispensed medicines delivered to their homes
• 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 and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

The practice has created an innovative new role for a practice matron to provide further care to their high risk patients. Their role included carrying out health and medicine reviews for patients with long term conditions within their own homes. Updating care plans, including plans for end of life care and carry out home visits on a daily basis was part of their role. They were part of the multi-disciplinary team and could signpost patients to the right services. Since being in post the practice matron had reduced the number of home visits required by the GPs by 76% which equated to 17.5 hours more time in the practice for GPs.

The area where the provider should make improvement are:

• Review the processes for identifying carers in the practice to increase those being identified and to offer carers support and guidance about available services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 February 2017

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.

• Nationally reported data from the Quality and Outcomes Framework showed that outcomes for patients were good for patients with long term conditions. For example, 91% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received an annual health check review within the past 12 months.

• The practice had links with the Palliative Care team and held regular GSF (Gold Standard Framework) meetings to plan patient care and kept an end of life register.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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.

Updated 1 February 2017

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 and young people who had a high number of A&E attendances. 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.

• The practice promoted ‘SAVVY’ Kernow, a local scheme which encourages young people to become savvy and seek help and advice about their sexual, mental and physical health, wellbeing or everyday life.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 87%, which was above the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 1 February 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 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.

• Older patients with complex care needs or those at risk of hospital admission had personalised care plans. These were shared with local organisations to facilitate continuity and proactive care.

• The practice the practice has created an innovative new role for a practice matron to oversee patient care in the community which resulted in enhanced care for those patients.

• The practice was part of the Penwith Pioneer Project / Living Well project; frail patients were offered support from an Age UK worker to develop a care plan to allow them to be cared for and supported in their home. Age UK/Living Well/Carers UK representatives attended the multidisciplinary team meetings in support of, and to provide extra care to many vulnerable patients.

Updated 1 February 2017

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.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice offered extended hours appointments with a GP on one evening a week and on alternate Saturday mornings.

• Patients were able to order repeat prescriptions on-line.

• The practice offered text reminders for appointments.

• Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations, to help improve access to healthcare particularly for working patients and students.

• The practice held well woman clinics which included contraception advice and the administering of long acting reversible contraception.

• Patients were able to receive minor operations and cryotherapy clinics,

Updated 1 February 2017

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

• 80% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was below both the clinical commissioning group (CCG) average of 84% and national average of 84%.

• The practice supported and released a member of the practice team to join with Penwith Dementia Action Alliance forming a new group called “Dementia Friendly St Just and Pendeen”. The purpose of this initiative was to raise dementia awareness to non-clinical staff; this was in addition to dementia awareness on-line training which all staff took part in. This had been of benefit to the practice team by increasing their learning and also enhancing the patient experience through recognition of early dementia and flagging up any concerns to the clinical team.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 93%, which was better than the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 1 February 2017

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 used the food voucher scheme, used the ‘Breadline charity’ and referred homeless patients to the YMCA, a charitable organisation that provides accommodation.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.