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Inspection carried out on 6 January 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Neetside Surgery on 6 January 2015. This was a comprehensive inspection. The practice is based at Neetside Surgery and provides primary medical services to people living in the town of Bude and surrounding villages in Cornwall. The practice GPs have sole responsibility for managing 11-16 inpatient beds at Stratton Community Hospital. The practice provides services to a diverse population, covering an area of approximately 50 square miles.

At the time of our inspection there were 4,300 patients registered at the service with a team of two GP partners and two salaried GPs. Neetside Surgery is a training practice. When we inspected there were no students on GP training placements at the practice.

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.

Overall the practice is rated as Outstanding.

Specifically, we found the practice to be good for providing safe, caring and well led services. We found the practice to be providing outstanding services in respect of being effective and responsive. It was outstanding for providing services to older people, people with long term conditions and people with mental health needs including dementia. The practice was good for families, babies children and young people and working age and vulnerable people.

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

  • There was a strong commitment to providing well co-ordinated, responsive and compassionate care for patients. A named GP and nurse monitored the health and well being of vulnerable patients with a learning disability and/or complex mental health needs. Patient reviews were routinely carried out in their own homes, some of the patients lived in care homes in the local area. This promoted a trusting rapport with patients and had increased patient involvement in the management their health and well being. Practice nurses also routinely visited vulnerable patients in their homes to review and deliver care to them because they were too frail to attend the practice
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were available the same day and staff were flexible and found same day gaps for patients needing routine appointments.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Audits were used by the practice to identify where improvements were required. Action plans were put into place, followed through and audits repeated to ensure that improvements had been made.
  • 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.

We saw areas of outstanding practice including:

  • The practice was responsive to patients needs in providing a flexible and extended service for the whole population. For example, equipment been had obtained to provide greater access to health monitoring. This included a centrifuge, which had increased the lifespan of blood samples so that patients did not have to travel for up to five hours on public transport to the local hospital. In the summer months the demand on the practice could increase by a third at the height of summer, with over a 500 temporary patients, as Bude is a popular holiday resort. The practice strived to ensure that the services provided to patients was not affected by the seasonal impact of the influx of patients.

  • The practice takes a truly holistic approach to assessing, planning and delivering care and treatment to people who use services. For example, the practice supported a high percentage of patients needing palliative care support due to the remote setting, overseen by a GP partner who holds qualifications and has extensive experience in the field.

  • All staff were actively engaged in activities to monitor and improve quality and health outcomes for people. For example, data showed the percentage of patients with diabetes who had reviews was better than the national average at 93.3% compared with 77.7%. The practice provided patients with an insulin passport, which contained comprehensive information about how to safely manage this condition and maintain good health. Retinal eye screening was being held at the practice each year to reduce the risk for patients in developing diabetic retinopathy.

  • Staff were consistent in supporting people to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill health. For example, during an audit of patients on anticlotting medicines the practice identified a number of factors influenced blood results.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

CQC Insight

These reports bring together existing national data from a range of indicators that allow us to identify and monitor changes in the quality of care outside of our inspections. The data within the reports do not constitute a judgement on performance, but inform our inspection teams. Our judgements on quality and safety continue to come only after inspection and we will not make judgements on data alone. The evidence tables published alongside our inspection reports from April 2018 onwards replace the information contained in these files.