Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection February 2015 – 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

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Old Bridge Surgery on 12 December 2017 as part of our planned 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 that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw two areas of outstanding practice:

Patients with learning disabilities were offered and provided a health check every year during which their long term care plans were discussed with the patient and their carer if appropriate. The practice had supported one of the nurses to become a learning disability specialist. This nurse ensured all patients with learning disabilities had regular check-ups and had also set up and led a group of volunteers to support patients with learning disabilities. This included organised field trips, activities and days out every three weeks. The practice had won a local award for outstanding contribution to supporting patients with learning disabilities. Positive benefits and impact upon this group of patients included opportunities to get out of their care setting and explore the wider world.

Patient under witness protection programmes, with significant health needs, were registered using the practice address by arrangement with the police. This procedure was used when patients were in fear of being traced. For example, following incidents of domestic violence. Positive benefits and impact upon this group of patients included peace of mind with reduced risk of being traced.

The areas where the provider should make improvements are:

The practice should ensure that all of its infection control protocols including hand washing techniques and laundering of uniforms were reviewed on an annual basis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Old Bridge Surgery was inspected on Tuesday 24 February 2015. This was a comprehensive inspection. Overall the practice is rated as good.

Old Bridge Surgery provides primary medical services to people living in East Looe and the surrounding areas. The practice provides services to a homogeneous population and is situated in a rural coastal location. The practice had a General Medical Services (GMS) NHS contract to supply health services to the local population.

At the time of our inspection there were approximately 9,500 patients registered at the service with a team of 6 GP partners. There were three male and three female GPs. GP partners held managerial and financial responsibility for running the business. There were four nurses and four health care assistants at the practice. 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:

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 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 an area of outstanding practice;

Patients with learning disabilities were offered and provided a health check every year during which their long term care plans were discussed with the patient and their carer if appropriate. The practice had supported one of the nurses to become a learning disability specialist. This nurse ensured all patients with learning disabilities had regular check ups. In addition, she had set up and led a group of volunteers to support patients with learning disabilities. This included organised field trips, activities and days out every three weeks. The practice had won a local award for outstanding contribution, as voted by patients in 2014.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Old Bridge Surgery provides primary medical services for approximately 9, 500 patients. The practice had two branch surgeries at Pelynt and Polperro. Patients who were unable to obtain appointments at the branch surgeries in Pelynt and Polperro were offered appointments at the main surgery.

As part of our inspection we spoke with the registered manager, practice manager, GP’s, nursing staff and reception staff.

We spoke with patients at Old Bridge Surgery to obtain their feedback regarding the services they received from the practice. Comments included, “I’ve always had a very good service”, “they’re [staff] lovely, and “very good can’t complain”. Overall patients were satisfied with the service they received at the practice.

Patients we spoke with at the Pelynt and Polperro were complementary of the staff and service they received, although some patients commented about the reduced opening times. However, patients confirmed that they were given alternative appointments at Old Bridge Surgery as an alternative.

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 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 receive. 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.