Letter from the Chief Inspector of General Practice

This inspection was an announced focused inspection carried out on 27 September 2017 to follow up on information we received and to confirm the practice had continued to meet legal requirements and to identify additional improvements made since our last inspection.

We carried out an announced comprehensive inspection at The Health Centre on 28 April 2015. At that inspection the overall rating for the practice was Outstanding. The four domains of responsive, caring, effective and well led were rated as outstanding and the safe domain was rated as good. All inspection reports for The Health Centre can be found by selecting the ‘all reports’ link for The Health Centre on our website at www.cqc.org.uk.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Weekly meetings took place the agenda of which included significant events and incidents. These prioritised risks at the practice and showed agreed actions. For example, following a serious accident on a lifeboat one of the GPs had joined the RNLI and had become the lifeboat doctor.
• The needs of vulnerable patients had been identified and since our last inspection additional measures had been put in place. For example, additional nurse clinics were held on the small islands.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• 97% of the patients surveyed said they found it easy to make an appointment with a named GP and added 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.
• Procedures for emergencies were in place. We were told that each of the inhabited islands had a defibrillator and trained ‘first responders’ (people who had completed first aid and emergency response training), who lived on the islands.
• There was a strong focus on continuous learning and improvement at all levels.
• The Health Centre provided placements for GP registrars (qualified doctors training to be GPs) and medical students. Feedback from trainees and students demonstrated this was a popular placement.
• 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.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Mary’s Health Centre on 28 April 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be good for providing safe services, and outstanding for providing effective, caring, responsive and well-led services. It was also outstanding for providing services for all the population groups of older people; people with long term conditions; families, children and young people; people experiencing poor mental health; people who are vulnerable; people of working age and those recently retired.

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 improvements made.

• Risks to patients were assessed and well managed, including those relating to recruitment checks. 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.

• 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 carried out to enhance the service for patients.

• 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 several areas of outstanding practice including:

• The leadership, governance and culture at the practice were used to drive and improve the delivery of high quality person-centred care. The GPs had visited Sweden and looked into the Esther Project which focussed on ensuring patients received care in or close to home and knew where and who to turn to for care; it helped patients see the healthcare system as an entity working together to provide good quality care. Staff discovered that most patients wanted to receive as much care in their home or as nearby as possible. If they had to go to hospital, the patient preferred to leave as soon as feasible and have their continuing care needs met at home. To fulfil these principles the GPs at the practice had developed services and obtained additional skills to provide optometry, blood testing, x-rays, ultra-sound scans, and had integrated patient care between all caring agencies on the islands. This had significantly reduced the need for patients to travel by sea or air to hospitals on the mainland, for example we were shown evidence that demonstrated at least 80 patients had received and ultra sound tests, 94 patients had received blood tests and approximately 130 patients had optometry testing.
• Being a close-knit community, to ensure patient confidentiality and encourage younger patients to care for their health, a separate telephone line direct to the GP was available to help protect confidentiality and encourage young people to access services. The practice is an accredited member of a scheme specifically for young people given the name and known as EEFO. The scheme is aimed at young people aged 13 to 19 living in Cornwall and the Isles of Scilly and addresses the barriers identified by national and local research which prohibit young people from accessing the services they need.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice