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Pensilva - The Health Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 23 April 2015

Letter from the Chief Inspector of General Practice

Pensilva Health Centre was inspected on Tuesday 17 March 2015. This was a comprehensive inspection. Overall the practice is rated as good.

The practice provides general medical services to people living in Pensilva and the surrounding areas. The practice provides services to a predominantly Cornish population and is situated in a rural location.

At the time of our inspection there were approximately 4,700 patients registered at the service with a team of three GP partners. There were also two salaried GPs. In total the practice had five GPs. Three were male and two were female. GP partners held managerial and financial responsibility for running the business. There were two nurses and one health care assistant at the practice. One of these nurses was an assistant practitioner. In addition there was a practice manager, and additional administrative and reception staff.

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.

Our key findings were as follows:

Pensilva placed an emphasis being a caring practice in the face of increasing demands for its services. The patient population had risen by 100 a year for the past three years. This was one of the highest rates in Kernow.

The practice was engaged with local population and GPs and staff knew their patients personally. There was a very active Friends of the Health Centre group. There was also a good Patient Participation Group (PPG) with a walking group, carers group, and bereavement group.

We rated this practice as good. Patients reported having good access to appointments at the practice and liked having a named GP which improved their continuity of care. The practice was clean, well-organised, had good facilities and was well equipped to treat patients. There were effective infection control procedures in place.

The practice valued feedback from patients and acted upon this. Feedback from patients about their care and treatment was consistently positive. We observed a patient centred culture. Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. Views of external stakeholders were positive and were aligned with our findings.

The practice was well-led and had a clear leadership structure in place whilst retaining a sense of mutual respect and team work. There were systems in place to monitor and improve quality and identify risk and systems to manage emergencies.

Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessment of a patient’s mental capacity to make an informed decision about their care and treatment, and the promotion of good health.

Suitable staff recruitment, pre-employment checks, induction and appraisal processes were in place and had been carried out. Staff had received training appropriate to their roles and further training needs had been identified and planned.

Information received about the practice prior to and during the inspection demonstrated the practice performed comparatively well with all other practices within the clinical commissioning group (Kernow CCG) area.

Significant events had been recorded, discussed and acted upon in a systematic way. Shared learning had taken place.

We found examples of outstanding practice at Pensilva Health Centre. For example;

The practice had a level of commitment to safeguarding which went beyond its contractual obligations. Written evidence about individual incidents confirmed this. GPs at the practice liaised regularly with other health and social care professionals to ensure high standards of safeguarding were in place. All patients told us they felt safe in the hands of the staff and confident in clinical decisions made. There were effective safeguarding procedures in place. There was a highly trained lead GP for safeguarding.

The practice was rated the best in Kernow for diagnostic rates of dementia. The practice had achieved 84% of the expected rate of their practice population in dementia diagnosis.

There were also areas which the practice needed to improve. For example;

There was some uncertainty among the nursing team as to responsibility for lead nursing roles. One of the new nurses had not received a three monthly probation review which was due. The practice should ensure that the nursing team received appropriate management support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 April 2015

The practice is rated good for being safe. Patients we spoke with told us they felt safe, confident in the care they received and well cared for

The practice had systems to help ensure patient safety and staff had appropriately responded to emergencies.

Recruitment procedures and checks were completed as required to help ensure that staff were suitable and competent. Risk assessments had been undertaken to support the decision not to perform a criminal records check for administration staff.

Significant events and incidents were investigated both informally and formally. Staff were aware of the learning and actions taken. Meetings were held every three months or more frequently if required.

Staff were aware of their responsibilities in regard to safeguarding and the Mental Capacity Act (MCA) 2005. There were suitable safeguarding policies and procedures in place that helped identify and protect children and adults at risk of abuse. All staff had received training in the MCA in March 2015.

All patients told us they felt safe in the hands of the staff and confident in clinical decisions made. There were effective safeguarding procedures in place. There was a trained lead GP for safeguarding.

There were suitable arrangements for the efficient management of medicines within the practice.

Medicines management policies had been updated in February 2015.

The practice was very clean, tidy and hygienic. Suitable arrangements were in place to maintain the cleanliness of the practice. There were systems in place for the retention and disposal of clinical waste.

Effective

Good

Updated 23 April 2015

The practice is rated good for being effective. Supporting data obtained both prior to and during the inspection showed the practice had effective systems in place to make sure the practice was efficiently run.

The practice had a clinical audit system in place and regular audits had been completed on coil fitting, prescriptions and minor surgery procedures. These had been completed on an annual basis and a complete audit cycle was in place.

Care and treatment was delivered in line with national best practice guidance. The practice worked closely with other services to achieve the best outcome for patients who used the practice.

Information obtained both during and after the inspection showed staff employed at the practice had received appropriate support, training and appraisal. GP partner appraisals and revalidation had been completed.

The practice had extensive health promotion material available within the practice and on the practice website.

Caring

Good

Updated 23 April 2015

The practice is rated as good for being caring. Feedback from patients about their care and treatment was consistently positive.

We observed a patient centred culture and found evidence that staff were motivated to offer kind and compassionate care and worked to overcome obstacles to achieving this. We found many positive examples to demonstrate how patients’ choices and preferences were valued and acted on. Views of external stakeholders were very positive and aligned with our findings. We met up with members of the patient participation group and of the friends of the health centre group during the inspection who confirmed this.

Patients spoke positively about the care provided at the practice. Patients told us they were treated with kindness, dignity and respect. Patients told us how well the staff communicated with them about their physical, mental and emotional health and supported their health education.

The practice cared about patient’s comfort as they waited for appointments. The waiting room had bariatric chairs of different sizes to heights to suit patients of all shapes and sizes.

Patients told us they were included in the decision making process about their care and had sufficient time to speak with their GP or a nurse. They said they felt well supported both during and after consultations.

Responsive

Good

Updated 23 April 2015

The practice was rated good for being responsive. Patients commented on how well all the staff communicated with them and praised their caring, professional attitudes.

Patients told us that the practice responded promptly to their needs. This was confirmed by our meetings with patients in the waiting room. There was information provided on how patients could complain. Complaints were managed according to the practice policy and within timescales.

There was an accessible complaints system with evidence.

The practice recognised the importance of patient feedback and had encouraged the development of a patient participation group to gain patients’ views. The practice had worked with their PPG and had completed patient surveys in 2014 and in previous years. There was also a suggestions box available for patients to provide feedback on a day to day basis.

Practice staff had identified that not all patients found it easy to understand the care and treatment provided to them and made sure these patients were provided with relevant information in a way they understood.

Patients said it was easy to get an appointment at the practice and were able to see a GP on the same day if it was urgent.

Well-led

Good

Updated 23 April 2015

The practice is rated as good for being well led. The practice had a clear vision and strategy. The practice met up annually to refresh this strategy and it was discussed regularly at team meetings. Staff were clear about the vision and their responsibilities in relation to this. Nursing staff, GPs and administrative staff demonstrated they understood their responsibilities including how and to whom they should escalate any concerns.

Staff spoke positively about working at the practice. They told us they were actively supported in their employment and described the practice as having an open, supportive culture and being a good place to work.

The practice had a number of policies to govern the procedures carried out by staff and regular governance meetings had taken place. There was a programme of clinical audit in operation with clinical risk management tools used to minimise any risks to patients, staff and visitors.

Significant events, incidents and complaints were managed as they occurred and through a more formal process to identify, assess and manage risks to the health, welfare and safety of patients. There was a nominated GP lead for health and safety at the practice.

The practice sought feedback from patients, which included using new technology, and had an active patient participation group (PPG). There was also an active friends of the health centre group.

Checks on specific services

People with long term conditions

Good

Updated 23 April 2015

The practice is rated as good for providing care to people with long term conditions.

The practice offered chronic disease clinics for ongoing monitoring, support and care. The practice continually reviewed its recall system with the aim of providing a better patient experience to patients with multiple long term conditions. The practice had access to specialist nurses for complex care patients. This included asthma, COPD and diabetes.

The PPG helped to set up the local breathers group for patients with COPD. The PPG also run a Carers Group, with regular speakers, which provide advice and support for carers and families.

Palliative Care teams attend our monthly MDT meetings and Palliative care nurses have telephone and email access to the GPs, which enhances the management of these patients, particularly in the terminal phase of their care

The practice had a system which proactively invited patients in this population group for a health review every nine months. This met best practice.

Families, children and young people

Good

Updated 23 April 2015

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

All staff are trained within their level of responsibilities in safeguarding. The practice held monthly cause for concern meetings which ensured that vulnerable children were identified and actions discussed and agreed.

All new babies and pregnant mothers were discussed at these meetings and recorded on a register. The practice audited this register every six weeks and informed the local health visitor if the child had not been seen.

Pensilva Surgery was a rural location which meant patients with travel difficulties felt they were not being fully supported by centrally based services. Until recently the health visitor and midwife teams had been based centrally, now they were starting to provide in-house services at the practice. The practice was pleased to report they would be able to offer in-house health visitor and midwifery services again.

The practice patient participation group (PPG) offered a parent’s group service for new parents, which was beginning to generate interest and prove useful. There were 10 members of the PPG. The PPG was advertised on the website so that patients could join if they wished to do so. The PPG had members from the various different population groups mentioned in this report.

All staff were trained in confidentiality with particular reference to a young people presenting at reception requesting to see a GP or nurse. These patients were not asked the reason for their visit and were offered the opportunity to wait in a private area should they wish to do so.

The practice stressed the importance of providing appropriate services for young people. The practice had attained an EEFO kite mark level 1 for engaging with young people and planned to improve this to level 2. EEFO kite marks services that meet young person friendly quality standards across Cornwall and the Isles of Scilly. The term EEFO is not an abbreviation. EEFO is a word that has been designed by young people, to be owned by young people.

Older people

Good

Updated 23 April 2015

The practice is rated as good for providing care to older people.

11% of the total practice population was aged over 75. Each of these patients have their own accountable GP, however they are able to see any GP of their choice.

Over 75 year old health checks are available on request; 97% of this population group had been seen in the last 12 months.

The practice participated in the Avoiding Unplanned Admissions enhanced service. The practice also referred appropriate patients to the Living well scheme which used vetted local voluntary services.

The practice participated in the East Cornwall local enhanced service which includes polypharmacy reviews and frailty assessments. GPs proactively visited four local care homes on a monthly basis to see all residents registered, offering patients unable to come to the practice a health check. The practice also offered rapid access appointments to these patients.

The practice dispensary offered monitored medicine dose packs following a needs assessment. The practice also provided a repeat prescription pre-ordering system so patients were not required to contact or visit the practice until collection. The practice was currently in discussion to provide a regulated delivery service. The practice currently offered patients the choice to have their prescriptions sent to a local chemist who already provided a delivery service.

Staff told us that they assist whenever they can, for example, helping patients by taking medication to patients in the car park if they are unable to leave their vehicle easily.

The practice’s flu vaccination clinics had been successful with a high take up. The practice had consistently been within the top five in Kernow for this. The practice received positive feedback from patients who attended these vaccination clinics, where large numbers of patients had been successfully vaccinated. The practice ensured that all disabled or wheel-chair user patients had priority parking and full access to services.

Working age people (including those recently retired and students)

Good

Updated 23 April 2015

The practice is rated as good for providing care to working age people.

The practice booking system allowed for pre-bookable and same day appointments. Staff worked to maintain a high level of access so that working people were able to be seen promptly and at a convenient time during the working week.

If the appointments were fully booked and a patient requested to be seen that day, they were seen at the end of practice or by the triaging GP creating an additional slot. The practice now offered a number of bookable telephone consultations. Once these were full, a patient could still obtain a ring back appointment if required.

The practice website had access to the online booking system known as “The Waiting Room” which enabled patients to order repeat prescriptions and book appointments online.

The practice was open between Monday and Friday: 08.30am – 6.00pm. The practice would remain open for late appointments if a patient expressed the need for it.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 April 2015

The practice is rated as outstanding for people experiencing poor mental health (including people with dementia). All patients with mental health issues had been invited in for an annual health check. 92% of these patients had attended the practice for these checks. The remainder had been sent reminders by the practice and were being followed up.

Patients at the practice had ease of access to the local mental health trust’s support services and to local support agencies.

The practice offered patients who wished to discuss complex mental health issues an appointment at the end of the session so if they needed more time, this was easily possible without disrupting other patient’s care. Patients experiencing poor mental health were also discussed at multi-disciplinary meetings with mental health professionals to provide joined up care and appropriate support for patients and families.

The practice utilised the early intervention team and the central point of access for any patients experiencing or at risk of an acute mental health crisis.

The practice was able to provide data to demonstrate support of patients in this population group. For example, of the total of 24 patients recently diagnosed with depression, 92% had been seen within 10-56 days. The practice was on target to see all of these patients within the 56 day target. This met best practice.

GPs had high awareness of dementia care. The practice had links with four local care residential homes. GPs visited these on a monthly basis and updated patient’s care plans each time. GPs also liaised with dementia specialists which ensured that comprehensive care plans were in place.

The practice had achieved the highest rate for diagnosis of dementia in Kernow compared to other practices in Kernow CCG. The practice had identified 84% of the expected rate of their practice population with dementia.

People whose circumstances may make them vulnerable

Good

Updated 23 April 2015

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

All of the patients with a learning disability had been offered an annual health check, with two of the practice nurses fully trained in this. These patients all had a pop up alert on the practice computer system. This enabled reception staff when booking a routine appointment, to see that these patients may need a longer appointment.

Any vulnerable adults were discussed at monthly multi-disciplinary team meetings with other health care professionals to provide a collaborative working relationship.

The practice did not have any patients who had registered as homeless. However, in the past the practice had been able to provide all the required elements of care for these patients.

The practice had patients with health needs that were in fear of being traced. For example, following domestic violence incidents. The practice had undertaken steps which ensured these patients identity was securely protected.