Wheal Northey Also known as Wheal Northey Site

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wheal Northey, which is run by St Austell Healthcare on 25, 26 and 27 April 2017. Overall the practice is rated as good.

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.
• The practice had clearly defined and embedded systems to minimise risks to patient safety, which included an organisational risk register that was monitored and acted upon.
• The practice held six weekly educational sessions which were used as opportunities for local hospital consultants to share latest evidence based practice and answer questions on referring and prescribing practice.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. Staff were encouraged and actively supported to develop their roles.
• There were GPs with a special interest (GPwSI) employed at the practice. These included dermatology GPwSI and ophthalmology GPwSI.
• The practice employed two pharmacists five days week who performed roles to assist the GPs across the practice group. These roles included medicine reviews and audits.
• Results from the in house patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Vulnerable patients, their carers and staff at local care homes where some of these patients lived were given a direct access phone number; the number gave faster access to staff in the practice so urgent appointments could be accessed. All of the patients had a named GP and there was continuity of care. For example, the named GPs visited their designated care home twice a week to see patients there.
• Patients were able to access urgent appointments on the same day at the Carlyon Road Health Hub from 8am to 8pm Monday to Friday. Patients were able to see either a GP or minor illness nurse for appointments.
• Patients we spoke with said they found it difficult to get through to the Hub to make a routine appointment. The practice had audited the appointment system twice and made changes, but we found further improvements were needed to improve patient flow in the Hub and on the telephone.
• The practice had good facilities at Wheal Northey and its other three sites and was well equipped to treat patients and meet their needs.
• There were age appropriate toys and books in all the waiting rooms of the main site and other three sites.
• Recruitment was well managed and detailed systems were efficiently used to monitor staff recruitment and employment issues.
• The prescriptions team at the practice worked closely with the local pharmacies to ensure blister packs were provided for older people with memory problems.
• 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.

We saw several areas of outstanding practice including:

The diabetic patient care pathway was proactive in supporting patient needs and improving health outcomes for patients through a social prescribing approach. Patients in the first social prescribing group of 180 patients reported that their diabetes was in remission or had significantly improved by 25% through a combination of closely monitored prescribing, exercise, diet and regular monitoring.

Basecamp, a dedicated internet space with a secure mobile phone application was developed at the practice for staff. This provided real time information about current best practice guidelines and shared learning which all clinical staff were able to access, particularly when visiting patients in their own homes.

A monthly outreach clinic was run by a GP partner and practice nurse from the practice for vulnerably housed patients staying at a hostel. The practice had equipped the clinic so that patients were able to be seen at the hostel. Patients access shared care and support to recover from drug addiction, sexual health screening, family planning and mental well being support there.

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

Importantly, the provider must:

• Ensure care and treatment is provided in a safe way to patients through effective access to appointments.

The areas where the provider should make improvement are:

• Review how management of elderly frail patients should be implemented in the same way other patient registers are managed at the practice.
• Review the system for safety netting two week wait referrals to set out clear roles and responsibilities to reduce any potential risks.
• Continue to review security in some consulting rooms to ensure prescription paper remains secure at all times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice