Letter from the Chief Inspector of General Practice

Mevagissey Surgery was inspected on 3rd February 2015. This was a comprehensive inspection. Overall, we rated the practice as good.

Mevagissey Surgery provides primary medical services to people living in Mevagissey, Pentewan, Caerhayes, Gorran Haven, Sticker, Polgooth and St Austell. During the summer months the practice experiences a large influx of temporary residents. Mevagissey Surgery is situated in a rural coastal location. The practice also had a dispensary. A dispensing practice is where GPs are able to prescribe and dispense medicines directly to patients who live in a rural setting which is a set distance from a pharmacy.

At the time of our inspection there were approximately 4,953 patients registered at the service with a team of three GP partners and one GP registrar. GP partners held managerial and financial responsibility for running the business. In addition there was a practice manager, nurses, health care assistants, dispensary staff together with 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:

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 took into account the cultural needs of the local area. Patients could identify themselves as being Cornish on patient records and questionnaires. 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 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.

There were areas of practice where the provider needed to make improvements.

The provider should:

Consider arrangements for monitoring room temperatures in rooms where medicines are stored to ensure the integrity of those medicines. The minimum and maximum range of fridge temperatures should also be recorded in writing for the same reason.

We found examples of outstanding practice. These included

To address the significant care gap left by restrictions to the local community nurse team, the practice deployed their own practice nurses to patient’s own homes. Elderly and vulnerable patients received home visits from the practice nurses and from practice GPs. This went beyond the contractual obligations of the practice.

Nurses at the practice carried out combined chronic disease management appointments to include all conditions experienced by one patient. This facilitated fewer appointments and was very convenient for the patient. The practice nurses also visited families in their own homes if they had suffered bereavement to offer emotional support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection was on 3 Feb 2015 and was rated as Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at the Mevagissey Surgery on 26 April 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported they were able to access care when they needed it. Patient feedback about the care and treatment delivered by all staff was overwhelmingly positive.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw an area where the practice should improve services:

• Review the needs of patients with mental health problems to improve the support being offered to them.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice