Letter from the Chief Inspector of General Practice

Saltash Health Centre was inspected on 3rd March 2015. This was a comprehensive inspection.

Overall the practice is rated as good for the five domains of safe, effective, caring, responsive and well led. It was also rated as good for providing services for five of the six population groups; with a rating of outstanding for the population group families, children and young people.

Our key findings were as follows:

Patients reported having good access to appointments at the practice and liked having a named GP which improved their continuity of care. Same day appointments were available. 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 overwhelmingly 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 (CCG) area.

Patients told us they felt safe in the hands of the staff and felt confident in clinical decisions made. There were effective safeguarding procedures in place.

Significant events, complaints and incidents were investigated and discussed. Learning from these events was communicated and acted upon.

We found examples of outstanding practice:

The practice had been recognised as being young people friendly and had been EEFO approved. EEFO is a word that has been designed by young people, to be owned by young people. Part of this scheme is the use of a green card. This is a local collaboration between the practice and the local secondary school whereby a young person can request a green card from the school office allowing them to access medical services without the need to be asked lots of questions by teaching staff. The young person is then seen without the requirement to be given an appointment and is able to see a GP/nurse or associated health professional during the school lunch hour on the school premises. The scheme was set up to improve young peoples’ accessibility to health services.

The practice produced a business plan to NHS Kernow CCG and successfully set up a school outreach clinic called TicTac which holds daily lunchtime drop in sessions at the local secondary school. GPs and practice nurses attended the school on a rota basis with the other local practices to staff these clinics.

The practice was engaged in a programme called “Living Well,” which utilises Age Concern to visit and assess an older persons needs and put in place volunteers/helpers to improve their quality of life. This could be practical help with cleaning, shopping, transport or aimed at addressing their social needs by providing companions, clubs to attend, someone to visit and read them the paper once a week. This system ensures that social needs are being addressed along with the medical needs of the patient.

Practice nurses and health care assistance carried out complex leg ulcer dressings in the practice, which included complex layer bandaging. The practice took over this service as the provision in the community was reduced and it meant that by attending the practice it was more convenient for patients, rather than having to travel to the hospital. The practice received no additional funding for this; the patient participation group (PPG) provided the funds for a Doppler machine and other equipment to facilitate this service.

Action the provider SHOULD take to improve:

The provider should introduce a system to record and identify learning of GP appraisal and re-validation outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice