18 January 2019
Oak Tree Surgery is situated in the town of Liskeard. The practice is comprised of two sites. The address of the main practice is Clemo Road, Liskeard, Cornwall, PL14 3XD. The address of the branch is Pensilva, School road, Pensilva, Cornwall PL14 5RP.
We visited both sites during our inspection. The practice provides a service to approximately 16,000 patients of a diverse age group and offers the following regulated activities:
Treatment of disease, disorder or injury
Diagnostic and screening procedures
Maternity and midwifery services and
The practice is located in a deprived area of Cornwall; the deprivation decile rating for this area is four (with one being the most deprived and 10 being the least deprived). The 2011 census data showed that majority of the local population identified themselves as being White British. The mix of male and female patients were equal. The average life expectancy for females was 83 years and 79 years for males (equal to national averages. The practice has about 39% of its practice population over the age of 65 years compared to the national average of 27%.
There are seven GP partners, five Salaried GPs, six specialist nurse practitioners, three practice nurses, six health care assistants and two phlebotomists. The clinical team are supported by a strategic business manager, two deputy practice managers and additional administration staff.
Patients using the practice also have access to health visitors, counsellors, carer support workers, district nurses and midwives who are co-located at the practice. Other health care professionals visited the practice regularly.
The premises are open between 7.30am and 1pm and 2pm and 6pm on Mondays, between 8am-1pm and 2pm-6pm on Tuesdays, Thursdays and Fridays and 7.30-1pm and 2pm-9pm on Wednesdays. The dispensaries are open Monday to Friday between 8am and 6pm. Outside of these times patients are directed to contact the out of hour’s service and the NHS 111 number. This is in line with local contract arrangements.
The practice offers a range of appointment types including face to face same day appointments, telephone consultations and advance appointments (three months in advance) as well as online services such as access to records, online appointments and repeat prescription requests.
The practice have a special interest in training, research, family planning and working at scale.
The practice train medical students, foundation doctors, GP registrars and many other clinical staff in reproductive medicine.
18 January 2019
We carried out an announced comprehensive at Oak Tree Surgery and Pensilva branch surgery on 19 December 2018 as part of our inspection programme.
This practice is rated as Good overall. (Previous rating September 2015 – Good)
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
At this inspection we found:
- The practice had recently undergone a merger with another local practice. This was completed in a short time frame and feedback was that the process and merger had been managed well.
- Leaders were knowledgeable about issues and priorities relating to the quality and future of services and participated in external groups to ensure they understood the local changes and challenges.
- The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice recognised where systems and processes had worked well and improved their processes where appropriate.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
- Medicines, high risk medicines and the dispensaries were managed well.
- The practice were research active, acting as a research site for several international studies into a variety of chronic disease areas over the last few years. The practice employed a full-time research nurse and have been active in many trials.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
- There was a strong focus on continuous learning, improvement and involvement at all levels of the organisation.
- Despite a recent merger with another practice, staff morale remained high. Staff said the practice and branch were good places to work.
- The GPs led the creation of a more locally orientated provider CIC (Kernow Health East) which had been successful in driving integrated working across silos in community care. For example, an integrated physiotherapy service at the practice, a social hub providing wound care in a social setting, social prescribing training and a consultant led dermatology service.
The areas where the provider should make improvements are:
- Review and standardise governance systems across the organisation to ensure accurate records are kept in respect of recruitment checks, training records and meetings held.
- Review and standardise processes across the organisation to further improve prescription stationary security.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
Please refer to the detailed report and the evidence tables for further information.