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.

Oak Tree Surgery provided primary medical services for approximately 11,200 patients.

As part of our inspection we spoke with the registered manager, practice manager, GP’s, nursing staff, pharmaceutical dispensary staff, medical and clerical staff, reception staff and representatives from the patient participation group (PPG).

We spoke with patients of Oak Tree Surgery to obtain their feedback regarding the services they received from the practice. Patients told us all staff spoke to them in a polite, respectful and helpful manner. We were told patients felt involved in decisions regarding their care and treatment. Comments included, “just fantastic practice”, “very happy” and “I think it is a very good practice, and I’m quite happy with the service personally, I think they do their best”.

The practice had introduced a new appointment system which meant patients sometimes had to speak with a GP prior to coming into the practice. Some patients we spoke with told us they did not have a problem with this, comments included “systems change, sometimes it saves you coming in, it’s a good thing” and “I like the idea of a phone call, and if he [GP] did need to see me I’d be in, in the afternoon”. One patient we spoke was not so complementary, they told us “different admin staff can be confusing to know who to speak to” and “I found it very confusing, you like to think you are able to see a GP”.

We found, people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People’s privacy, dignity and independence were respected.

People experienced care, treatment and support which met their needs and protected their rights.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people received. The provider also had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at 15 September 2015. Overall the practice is rated as good. Specifically we found the practice to be good for providing responsive, safe, effective, caring and well led services. It was also found to be good across all patient population groups (people with long-term conditions, working age people, people experiencing poor mental health (including people living with dementia), and families, children and young people.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw one areas of outstanding practice :

• The practice site was RCGP (Royal College of General Practitioners) accredited as ‘Research Ready’. The practice were members of the CCRG - Cornwall Clinical Research Group, formed 20 years ago and involved with all aspects of clinical research including global research studies and improving the quality of medical care. The practice undertook between eight and twelve research projects each year across a wide range of areas. Two experienced specialist research nurses, employed by the practice, together with some of the GPs at the practice created the research team. The practice felt strongly that primary care was an ideal place to conduct clinical research and believed that this drove quality in healthcare provision and that patients would benefit from the opportunities that involvement that research provided. At the time of the inspection the practice were actively working on six projects.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice