We carried out an announced focused inspection at The Medical Centre on 4 December 2018. We undertook a focused follow up inspection of The Medical Centre under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions, in order to ensure the practice had continued to embed the improvements made since previous inspections. The overall rating for the practice was good.

The full comprehensive report on this location can be found by selecting the ‘all reports’ link for The Medical Centre on our website at www.cqc.org.uk.

The key question at this inspection are rated as:

Are services safe? – Good

Overall the practice is rated as Good.

Our key findings were as follows:

• 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.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice had continued to embed improvements made in the safe domain, for example, in physical security measures such as door keypad locks, prescription security and clear audit trails.
• The practice had also continued to embed improvements in providing a safe and clean environment, for example, in its arrangements for checking on infection prevention control.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 26 April 2016 – 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/focused inspection at The Medical Centre (Padstow) on 28 November 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:

The practice GPs trained local Royal National Lifeboat Institute (RNLI) staff in emergency first aid and life support. The practice had also provided post incident counselling to RNLI staff following traumatic accidents at sea. Positive benefits included reduced risk for the local and transient seagoing population, the RNLI being supported in their role, maintaining their ability to respond to emergencies. This work reinforced the practice’s place in the local community.

The practice had considered the needs of its working fishing communities, which comprised approximately 6% of the patient list. The practice offered flexible appointments to support this population group due to their time at sea. Fishermen and women who had long term conditions were provided with sufficient medicines for their time at sea and offered a health check on return. The practice also offered a ‘see and treat’ walk in service for injured fishing industry workers.

The areas where the provider should make improvements are:

• The practice should ensure that the number of patients who found their last appointment was convenient, or who described their experience of making an appointment as good or who could get through easily by phone was increased, in order to become comparable with the national averages in the GP Patient national survey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Our previous inspection visit on 2 September 2015 found a breach of regulation 12(2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the proper and safe management of medicines.

On 2 September 2015 we found the practice required improvement for the proper and safe management of medicines and was rated as requires improvement for providing safe services. The practice was rated good overall and we rated all patient population groups as good.

This inspection on 26 April 2016 was undertaken to check the practice was meeting regulations. For this reason we have only rated the location for the key questions to which these relate. This report should be read in conjunction with the full inspection report published on 17 December 2015.

We found the practice had made improvements since our last inspection and was meeting the regulation that had previously been breached.

Specifically we found:

• The practice had introduced a new standard operating procedure which ensured that all staff had clear procedures to follow to ensure the security of prescription forms.
• Prescription pads and prescription forms were being stored securely at all times.
• Treatment room doors had new keypad entry locks in order to protect unattended rooms.
• An audit trail was now in place to track all prescription forms and pads through the practice.
• There were formal governance arrangements in place including systems for assessing and monitoring risks to the safe management of medicines.

In addition to making improvements to the regulation breaches the practice had also acted upon suggestions for good practice as detailed in the previous inspection report.

• The practice had introduced the use of the NHS Protect prescription form security risk assessment tool. NHS Protect is part of the NHS Business Services Authority and leads on work to safeguard NHS staff and resources from crime.
• Staff had received training and understood how to use the new systems in place.

We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well-led services.

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 The Medical Centre – Padstow on Wednesday 2nd September 2015.

Overall the practice is rated as good.

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

• Staff fulfilled their responsibilities to raise concerns and report incidents. All opportunities for learning from incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• Patients said they were treated with compassion, dignity and respect and were involved in decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice worked closely with other organisations in planning how services were provided to ensure that they meet people’s needs.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• The practice was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand

• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We identified areas of outstanding practice. For example;

Following serious incidents involving loss of life at sea in this coastal community, the practice had responded by providing post incident counselling to lifeboat crews and their families, in addition to responding with on the spot first aid care.

The practice employed an emergency care practitioner who had led the practice response to a number of serious incidents, which had resulted in the saving of lives. In addition, one of the practice GPs was a qualified trainer for emergency care accredited by the UK Resuscitation Council. The practice provided time and resource for this GP to train other health professionals across Cornwall in this important area.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

Ensure that there is proper and safe management of medicines so that blank prescription forms and prescription pads are handled in accordance with national guidance, providing an audit trail through the practice to demonstrate that they are kept secure at all times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice