Wadebridge and Camel Estuary Practice

Updated 27 July 2017

Wadebridge and Camel Estuary Practice was inspected on Thursday 13 July 2017. This was a focused inspection.

The main practice is situated in the Cornish town of Wadebridge, with a smaller branch surgery located in the village of Rock. Together, the practice provides a primary medical service to approximately 7,500 patients of a diverse age group. Each branch has a dispensary. A dispensing practice is where GPs are able to prescribe and dispense medicines to patients who live in a rural setting which is a set distance from a pharmacy. The practice is a training practice for doctors who are training to become GPs.

There is a team of five GP partners and one salaried GP within the organisation. Partners hold managerial and financial responsibility for running the business. There are five male and one female GP. The team are supported by a practice manager, a deputy manager, two nurse practitioners, three practice nurses, two health care assistants and three phlebotomists (staff who take blood). The practice also employs four dispensing staff.

Patients using the practice also have access to community staff including community matron, district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

The practice is open between 8am and 6:30pm and offers appointments Monday to Friday, between the hours of 8.30am and 1pm and 2pm to 6.00pm. Between the hours of 1pm and 2pm a duty GP was available for emergencies and details on how to contact them is on the practice telephone messaging service. Pre booked appointments are also available one evening a week from 6.30pm to 8.30pm.

The practice has opted out of providing out-of-hours services to their own patients and referred them to another out of hour’s service.

The Wadebridge and Camel Estuary Centre provides regulated activities from Brooklyn Wadebridge Cornwall PL27 7BS. We visited this location during our inspection.

There is also a branch practice at Rock Surgery, Rock, St Minver, PL27 6PW. We did not visit this branch practice.

Updated 27 July 2017

Letter from the Chief Inspector of General Practice

This announced focused inspection was carried out on 13 July 2017 to confirm that the practice had made improvements to meet the actions falling below a regulatory breach in our previous comprehensive inspection on 25 March 2015. In March 2015 the overall rating for the practice was Good. The full comprehensive report for the March 2015 inspection can be found by selecting the ‘all reports’ link for The Wadebridge and Camel Estuary Practice on our website at www.cqc.org.uk.

Overall the practice is  rated as Good

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. The practice had introduced new systems and processes to ensure that lessons were shared and action was taken to improve safety in the practice.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• The practice had an induction programme for all newly appointed staff and locum staff. This covered such topics as safeguarding, infection prevention and control, fire safety, health and safety and confidentiality.

• 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 suitable arrangements were in place which ensured the cleanliness of the practice was maintained to a high standard.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 June 2015

The practice identified patients who might be vulnerable, have multiple or specific complex or long term needs and ensured they were offered consultations or reviews where needed.

The staff at the practice maintained links with external healthcare professionals for advice and guidance. Particular clinics operated for patients with diabetes, cardiovascular disease, asthma and chronic respiratory conditions. The nurses attended educational updates to keep sure their lead role knowledge and skills up to date.

The asthma and chronic lung disorders clinics used spirometry to assess the evolving needs of this patient group. The practice promoted independence and encouraged self-care for these patients. There was a blood pressure machine in the waiting area so patients could monitor their own blood pressure. Scales in the waiting room allow patients to monitor their own weight. Patient information leaflets were available in the waiting areas and corridors of the practice.

There were regular diabetic clinics, with GP input, to treat and support patients with diabetes. These clinics included education for patients to learn how to manage their diabetes through the use of insulin. Patients were able to start insulin at the practice which was supervised by the practice nurse and saved the patients going to hospital for this. Health education was provided on healthy diet and lifestyle and access to weight management programmes facilitated by the GPs and practice nurses.

The practice referred carers to a carer support worker for support and guidance on social care issues.

Patients receiving certain medicines were able to access monitoring services at the practice to ensure the medication they receive was effective and not damaging.

Updated 4 June 2015

GPs performed 24 hour post natal baby checks following discharge from hospital or home delivery and carried out six week checks on all babies registered.

There were well organised baby and child immunisation programmes available to ensure babies and children could access a full range of vaccinations and health screening. Regular immunisation clinics were held at the practice.

Ante-natal care was provided at the practice by a midwife who had access to the practice computer system and could speak with a GP should the need arise. The practice had effective relationships with health visitors and school nursing team. Systems were in place to alert health visitors when children had not attended routine appointments and screening.

The practice held regular meetings with the health visitor to discuss any vulnerable babies, children or families.

Patients had access to a full range of contraception services (including coils and implants) and sexual health screening including chlamydia testing and cervical screening. There were quiet private areas in the practice for women to use when breastfeeding.

The practice had an arrangement with the local comprehensive school to allow same day access for pupils who require contraceptive advice.

Appropriate systems were in place to help safeguard children or young people who may be vulnerable or at risk of abuse.

Updated 4 June 2015

The practice had an open list. Patients aged 75 and over had their own allocated GP but had the choice of seeing whichever GP they prefer. Treatment was organised around the individual patient and any specific condition they have.

A programme of pneumococcal, shingles and influenza vaccinations were provided at the practice for older people. Vaccines, for older people who have problems getting to the practice or those in local care homes are administered in the community by the community nurses. GPs undertook home visits for older people and patients who require a visit following discharge from hospital.

The practice had a system to identify older patients and coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care for people approaching the end of life. This included the community matron, district nurses and a palliative care specialist nurse. Patients on the palliative care register were discussed at monthly MDT meetings.

The practice worked to avoid unnecessary admissions to hospital and collaborated with other health care professionals to provide joint working. This included providing personal care plans for those at high risk. Vulnerable patients were discussed at the monthly MDT meetings.

The practice had in house physiotherapy clinics for those unable to attend the hospital.

The dispensary provided medicines in blister packs for older people with memory problems.

Both premises were all one level for easy access. Chairs in the waiting room included some with arm rests to assist patients to stand.

Updated 4 June 2015

Advance appointments (up to two weeks in advance) and evening appointments were available once a week to assist patients not able to access appointments due to work commitments. There was an online appointment booking system. Patients were able to opt in to a text message reminder service for appointments.

Travel advice was available from the GPs and nursing staff. The practice website allowed patients to submit information on line for a personal vaccination plan.

The staff offered opportunistic health checks on patients as they attend the practice. This included offering referrals for smoking cessation, providing health information, routine health checks and reminders to have medication reviews. The practice also offered age appropriate screening tests such as cholesterol testing. Smoking cessation clinics were held in-house on a weekly basis.

Patients could order repeat medication online, by post or in person and said this system worked well. Dispensing patients could collect from either surgery. Non-dispensing patients could collect from a chemist of their choice.

Updated 4 June 2015

The practice had a register which identified patients who had mental health problems.

There was a practice attached community dementia care practitioner who attended regular MDT meetings. There were nationally recognised examination tools used for people who were displaying signs of dementia.

Patients had access to an in house counsellor for depression, alcohol issues or more general issues. Patients who had depression were seen regularly and were followed up if they did not attend appointments.

In house mental health medicine reviews were conducted to ensure patients received appropriate doses of their medicines. Blood tests were regularly performed on patients receiving certain mental health medications.

There was communication, referral and liaison with the psychiatry specialist. Monthly meetings were held at the practice with the consultant psychiatrist, community psychiatric nurse, counsellor and third sector mental health charity representatives. Patients were able to be assessed at home or in Bodmin.

Staff were aware of the Mental Capacity Act (2005) but had not received training on this.

Updated 4 June 2015

The practice had a learning disabilities register. These patients were offered a health check each year, during which their long term care plans were discussed with the patient and their carer if appropriate. Practice staff liaised with the community disabilities nurse who saw those patients who had difficulty attending clinic.

Practice staff were able to refer patients with alcohol addictions to an alcohol service for support and treatment. The support service visits the practice on a fortnightly basis.

The practice worked with and referred patients to a community matron who visited vulnerable patients to assess and facilitate any equipment, mobility or medication needs they may have. These patients were discussed at regular multidisciplinary meetings.

There were a small number of patients whose first language is not English. A translation service was available.