Archived: Cudmore House

Updated 4 May 2017

Cudmore House is the registered location for the out-of-hours GP service provided for Cornwall by Cornwall Health Limited.

Cornwall Health Limited is owned by two organisations in partnership; Devon Doctors which is a social enterprise and Kernow Health a community interest company. Cornwall Health Limited provides urgent medical care and advice out-of-hours for patients in Cornwall. The service is contracted by the NHS Kernow clinical commissioning group. The service provides primary medical services outside of usual working hours (out-of-hours or OOH) when GP practices are closed. This includes overnight and during weekends, when practices are closed. The service covers a population of approximately 550,000 people. During the summer months this population increases significantly.

Cornwall Health Limited is part of the Devon Doctors group which provides shared services, such as finance and human resources services, across the South West.

Most patients access the out-of-hours service via the NHS 111 telephone service. This service is undertaken by a different service provider and calls arrive electronically at Cudmore House after being triaged by that provider. Patients may be seen by a clinician at a local primary care treatment centre, at home or by telephone consultation depending on their needs. Some patients are able to access the primary care centres by walking in or are referred from the hospital accident and emergency departments or other urgent care centres.

Cornwall is a predominantly rural and semi-rural area in which over 40% of the population live in settlements of less than 3,000 population. The Indices of Multiple Deprivation 2015 datashow Cornwall is now ranked 143 out of 326 local authority areas for deprivation (where 1 is having the highest proportion of the population living in the most deprived neighborhoods). The datashows that 5% of neighborhoods in Cornwall are among the most deprived in England. Approximately 17% (15,200) of children in Cornwall live in poverty. Life expectancy for both men and women is in line with the national average.

Cudmore House (Cornwall Health Ltd) has ten active locations registered with CQC and is registered to provide the following regulated activities: transport services, triage and medical advice provided remotely, treatment of disease, disorder or injury.

Clinicians, Advanced Nurse Practitioners and Advanced Paramedics work from Cudmore House to offer telephone consultations to patients. There is a treatment centre to see patients at Cudmore House. We visited Cudmore House during our inspection. The additional treatment centres which are used to provide care to patients are:

West Cornwall Hospital, St Clare Street, Penzance, Cornwall, TR18 2PF (visited during inspection)

Newquay Hospital St Thomas Road TR7 1RQ

Falmouth Hospital, Trescobeas Road TR11 2JA

St Austell Hospital Porthpean Road PL26 6AD (visited during inspection)

Bodmin Hospital Boundary Road PL31 2QT

Launceston Hospital Link Road PL15 9JD

Liskeard Hospital Clemo Road PL14 3XD

Helston Hospital, Meneage Road, TR13 8DR (visited during inspection)

Stratton Community Hospital Lane EX23 9BR

Updated 4 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cudmore House (Cornwall Health Ltd) on 24 and 25 January 2017. Overall the service 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 recording, reporting and learning from significant events.
• Risks to patients were assessed and well managed.
• Patients’ care needs were assessed and delivered in a timely way according to need. The service met the National Quality Requirements.
• 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.
• There was a system in place which enabled staff access to patient records, and the out of hours staff provided other services; for example, the local GP and hospital, with information following contact with patients as was appropriate.
• The service managed patients’ care and treatment in a timely way.
• 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.
• The service worked proactively with other organisations and providers to develop services that supported alternatives to hospital admission where appropriate and improved the patient experience.
• The service had good facilities and was well equipped to treat patients and meet their needs. The vehicles used for home visits were clean and well equipped.
• There was a clear leadership structure and staff felt supported by management. The service 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.
• Prescription security was highly developed and ensured all prescriptions were accounted for in each location.
• Medicines storage in vehicles had been developed to support security, integrity of packaging and maintaining medicines effectiveness in fluctuating temperatures.
• A children’s review service was being developed following local provider research showing more effective patient treatment could be provided by the out of hours service.

We saw one area of outstanding service:

The urgent care car (UCC) was an innovation to meet the needs of patients in a county without an out of hours district nursing service. The UCC car was staffed by an experienced driver and an urgent care practitioner (UCP) who supported a range of patients who met specific criteria (blocked catheters, deaths, urinary tract infections and end of life care). This enabled other clinicians to focus on the more complex, unwell patients. In a two month period the UCC had responded to 61 urgent non-complex cases, and enabled the service to meet its national quality requirements such as response times in 99% of its cases.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice