Wheal Northey Also known as Wheal Northey Site

Updated 16 April 2018

There have been significant changes for the practice group in recent years including the takeover of an inadequate GP practice. Changes are still underway and improvements are in the process of being implemented. In 2014, the three GP practices in St Austell formed a consortium called St Austell Healthcare (SAHC) to assist with the management and care delivery of a failing practice. At the time, 8,300 patients re-registered with SAHC increasing the total overall register to approximately 31,200 patients. SAHC put systems in place immediately to manage any potential risks, including reviewing all patient records of the failing practice.

Since 2015 the consortium had streamlined its registration with CQC twice. The latest was in March 2017 when St Austell Healthcare was registered as one practice at Wheal Northey. The practice is located on the outskirts of St Austell at Wheal Northey, with about 3% of the people coming from minority ethnic groups. At the last census the practice area population identified themselves as predominantly White British. There are three branch surgeries two of which are located in St Austell and one at Foxhole:

• Wheal Northey, 1 Wheal Northey,St Austell,Cornwall,PL25 3EF (registered location)

• Carlyon Road Health Hub 14 Carlyon Road,St Austell,Cornwall,PL25 4EG (branch)

• Foxhole Surgery Carpalla Road,Foxhole,St Austell,Cornwall,PL26 7TZ (branch)

• Park 19 Bridge Road,St Austell,Cornwall,PL25 5HE (branch)

There were 31,200 patients registered with the practice when we inspected in February 2018. The following regulated activities are carried out at the practice; Treatment of disease, disorder or injury; Surgical procedures; Family planning; Diagnostic and screening procedures.

The practice population area is in the fifth decile for deprivation. In a score of one to ten the lower the decile the more deprived an area is. There is a practice age distribution of male and female patient’s equivalent to national average figures. Average life expectancy for the area is higher than national figures with males living to an average age of 83 years and females to 86 years. The population of St Austell and Cornwall has a high incidence of chronic disease, economically inactive and unemployment.

The practice has reviewed the skill mix of staff and provides a multidisciplinary approach to care for patients. SAHC employs 94 staff working across four sites, including the main practice at Wheal Northey. There are 11 partners comprising of 10 GPs and a managing partner /executive manager who sit on the partnership board. There are three salaried GPs and two GP retainers. The GP retainer scheme enables GPs to maintain their skills and development with a view to returning to NHS GP practice in the future. The gender mix of GPs is nine males and five females. Together they provide 87 patients sessions per week (10.88 WTE staff).

The GPs are supported by a large team, including an executive manager, a finance and estates manager, operations manager, business support managers, administrative and reception staff. There is a large team of nurses led by a nurse consultant and two matrons. The team is organised into urgent and planned care with highly qualified and skilled nurses able to deliver all aspects of care and support for patients. In total, there are 14 qualified nurses and eight healthcare assistants. Six nurses and a clinical pharmacist hold the non-medical independent prescribers qualification and are able to treat patients with minor illnesses. The practice has recruited an emergency care practitioner who works alongside GPs in seeing patients at the practice and carrying out home visits each day to vulnerable patients with complex health needs. A dedicated prescribing team managed by a clinical pharmacist deals with all medicines queries, prescriptions and reviews for patients. This team has recently increased with the addition of a second clinical pharmacist.

Wheal Northey is a teaching and training practice with four approved GP trainers. The practice provides placements for GP registrars training to become GPs. GPs work with the university of Exeter Medical School providing placements for 3rd, 4th and 5th year medical students on the undergraduate programme. Placements are also provided for foundation doctors (FY1 or FY2 is a grade of medical practitioner in the United Kingdom undertaking the two year post graduate Foundation Programme). Wheal Northey is one of a small number of practices in Cornwall able to provide placements for student nurses on the undergraduate programme at Plymouth University.

Patients using the practice have access to community staff including district nurses, health visitors, midwives and mental health workers. The practice has contracts to run several clinics enabling patients to be seen on site. These include an ophthalmology service, where patients with macular degeneration and glaucoma are able to see a consultant ophthalmologist from the Royal Cornwall

Hospital Trust. Shared care arrangements for patients in recovery from substance misuse. The practice has a social prescribing team comprising of onsite Cornwall County Council health promotion officers working collaboratively with the practice own social prescribing co-ordinator to assess and signpost patients to activities and events to promote better health. All activities and events available have been mapped and work is on-going with third party providers to expand these for people living in the St Austell area.

Opening hours at Wheal Northey are currently under review as part of a pilot to improve access for patients. There is one telephone number for patients to phone into, with options to choose from so that their call is diverted to the appropriate team. The appointment system has been completely overhauled since the last inspection in April 2017. Staff and appointments have been increased and access improved. Patients are able to telephone and request routine appointments any time between 8am and 7.30pm every weekday. Patients are placed on a waiting list for routine appointments and their named GP reviews this information throughout the day assessing and responding to patient needs and clinical risk. The practice is currently running a pilot until 31 March 2018, providing Saturday appointments for patients. Patients can book routine, blood test and cervical smear appointments up to eight weeks in advance via the website.

The branch surgeries are open as follows:

Carlyon Road Health Hub 14 Carlyon Road, St Austell,PL25 4EG (branch) open from 8am to 8pm Monday to Friday. At Carlyon Road Health Hub, patients are able to access urgent care by appointment .There is a duty GP and nursing staff to see patients who need same day appointments.

Park 19 Bridge Road, St Austell, PL25 5HE (branch) open from 8.30 am to 5.30 pm Monday to Friday

Foxhole Surgery Carpalla Road, Foxhole,St Austell, PL26 7TZ (branch) 8.30 to 1pm (Mon, Tue, Thur and Fri) and 8.30 am to 4.30 pm (Wed). There is a Nurse Led Clinic held each Wednesday with a Phlebotomy (blood tests) clinic on alternate Tuesday mornings.

During evenings and weekends, when the practice is closed, patients are directed to dial NHS 111 to talk to the Out of Hours service.

We inspected Wheal Northey and Carlyon Road Health Hub at this inspection.

Updated 16 April 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wheal Northey on 25, 26 and 27 April 2017. The overall rating for the practice was good. The full comprehensive report published in July 2017 can be found by selecting the ‘all reports’ link for Wheal Northey on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 20 February 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection in April 2017. This report covers our findings in relation to the requirement and also additional improvements made since our last inspection.

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Overall the practice is now rated as good for responsive.

Our key findings were as follows:

• Patient feedback was taken seriously and there were systems in place to ensure continuous engagement with people using the services. Several surveys had taken place to obtain patient feedback about the telephone system, satisfaction with nurses and Saturday extended hours opening. The surveys showed a trajectory of improvement in patient satisfaction in all of these areas.

• The appointment system was completely overhauled. Barriers highlighted by patients had been significantly reduced and appointments, numbers of available staff and improved pathways for patients to obtain help for routine matters had increased.

• All requests for routine appointments were now reviewed by the patient’s named GP, providing continuity of care that was appropriate, timely and met their needs.

• The practice now had a register of elderly frail patients, which was closely monitored by the clinical team in collaboration with community health and social care workers supporting patients.

• GPs now had a much clearer overview of workflow and were effective in managing the needs of patients based on risk and clinical needs. The skill base of the team had extended with the creation of new roles and recruitment of staff with advanced qualifications to support patients. For example, a newly appointed integrated nurse specialist worked jointly with practice pharmacists reviewing all newly discharged patients to ensure they had appropriate medicines and support in place.

• The system for safety netting two week wait referrals had been reviewed with clear roles and responsibilities for staff in place to reduce any potential risks.

• Security measures had been reviewed so that prescription paper remained secure at all times.

• Audit was embedded in practice, with many examples seen of completed audits being used proactively to make the necessary changes to improve patient access to appointments through continuous monitoring of capacity and patient demand.

• Succession planning and implementation of GP recruitment and retention was effective, within the context of the severe national shortage of GPs.

• Since the last inspection, new services were made available for patients reducing the need for them to attend secondary health services. For example, the practice now had a bladder scanner as a result of fundraising by the patient participation group, enabling patients to be screened and diagnosed on site.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 July 2017

The practice is rated as good for the care of people with long-term conditions.

• Person centred health promotion was provided via an onsite social prescribing team. Patients with long term conditions were assessed and prescribed bespoke programmes of activities to improve their overall health. Patients reported significant improvements in their health; for example, a patient with diabetes improved their blood results moving from diabetic to ‘normal’ range following a programme of exercise, diet, medicines review and regular monitoring.
• The practice had an educational programme with housebound patients at risk of developing diabetes and worked with the community matrons to ensure practice patients with diabetes received the care and screening needed.
• Nursing staff had lead roles in long-term disease management. Patients at risk of hospital admission were identified as a priority and able to access rapid home visits which were carried out by GPs, a nurse consultant and an emergency care practitioner.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• St Austell Healthcare at Wheal Northey practice had signed up for the local ‘shared care record project’ in 2016. This enabled health and care professionals such as Cornwall Health Ltd running the out of hours service, the ambulance service and Royal Cornwall hospital to view relevant information about the patients to support a better understanding of patients needs in unplanned or emergency situations.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 10 July 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.
• Immunisation rates were around the national standard of 95% achievement for all standard childhood immunisations. Data provided by the practice showed year on year improvement in immunisation rates particularly for children ages two years and over.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice provided support for premature babies and their families following discharge from hospital. For example, new mothers were able to access a check of themselves and their baby at 8 weeks.
• Appointments were available outside of school hours and up to 8pm at night at Carlyon Road Health Hub (Monday to Friday). All four of the practices premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• There were age appropriate toys and books at all sites in the waiting rooms.
• Young people were able to access drop in appointments for advice about sexual health matters, contraception and their wellbeing.

Updated 10 July 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. Each patient had a named GP and were also able to see other GPs at the practice. Unlike other patient health groups, the practice did not have a cohesive system such as a register or lead GP specialising in and having responsibility for oversight of frail elderly patients. We highlighted this was an area for improvement and saw the practice noted the need for a lead GP.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. The practice employed an emergency care practitioner who supported the GPs in carrying out home visits. A duty GP was accessible for triaging the support and care vulnerable elderly patients might need.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. They involved older patients in planning and making decisions about their care, including their end of life care. A direct line telephone number was provided to these patients and their carers to ensure they could access care or advice when needed.
• The practice followed up on older patients discharged from hospital, where they were aware about the admission and discharge, and ensured that their care plans were updated to reflect any extra needs and changes of treatment.
• Care plans were in place for patients at high risk of unplanned admission to hospital and these were shared with local out-of-hours providers, the ambulance services and emergency department. Regular hospital avoidance of admission meetings were held.
• Patients had access to a direct line for requesting support and rapid home visits were available and carried out by GPs, a nurse consultant and an emergency care practitioner.
• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• Older patients and carers were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible
• The practice had responsive systems in place for the care of 244 patients living in care homes. All care homes supported by the practice had a named GP, who visited twice a week to discuss and review the care provided to their patients. The care homes were given a direct line telephone number so that they could contact the practice without delay when urgent access to treatment was needed.

Updated 10 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice was making adjustments to the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, telephone consultations and online access to appointments were available for working people. The practice recognised further improvements were needed and had been carrying out audits about patient flow and access, as well as reviewing patient comments.

• Online services were available to request repeat prescriptions, appointments and to view blood test results. Information about managing health conditions could be found on the practice website pages.
• Extended opening hours and appointments were available at the Carlyon Road Health Hub from 8am to 8pm Monday to Friday.
• The practice was proactive in promoting health checks for patients. These included offering referrals for smoking cessation, providing health information, routine health checks, carers assessments and reminders to have medicine reviews. This gave the practice the opportunity to assess the risk of serious conditions on patients which attend. The Practice also offered age appropriate screening tests including cholesterol testing.

Updated 10 July 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients living with dementia.
• In 2016/17 84.5% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average (30-75%). The practice had increased the percentage of patients reviewed from the previous year 2015/16 by 4.2% and had plans to further improve patient diagnosis.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. A clinical pharmacist had been employed by the practice to assist with this role.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. For example, monthly multidisciplinary meetings were held with a consultant psychiatrist and mental health workers to review patients under their care experiencing complex mental illnesses. Risks were identified and proactive management plans agreed.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• The prescriptions team at the practice worked closely with the local pharmacies to ensure blister packs of medicines were provided for older people with memory problems to help indicate when they should take their medicines.

Updated 10 July 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice provided care and treatment to patients living in vulnerable circumstances including homeless people, refugee families and those with a learning disability. The practice held registers of patients and used these in a proactive way to recall patients for appointments to assess their general health.
• A monthly outreach clinic was run by a GP partner and practice nurse from the practice for vulnerably housed patients staying at a local hostel. Patients were able to access shared care and support to recover from drug addiction, sexual health screening, family planning and mental well being support there.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients who needed them. For example, patients identified at risk of developing diabetes were offered a one hour appointment to discuss their lifestyle and receive support through the social prescribing scheme to help improve their health.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients and their carers about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.