The Care Quality Commission
  • Doctor
  • GP practice

Drs. Howe and Hendriksz Also known as Lostwithiel Medical Practice

Overall: Outstanding read more about inspection ratings

North Street, Lostwithiel, Cornwall, PL22 0EF (01208) 872589

Provided and run by:
Dr J Hendriksz

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Drs. Howe and Hendriksz on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Drs. Howe and Hendriksz, you can give feedback on this service.

20 February 2020

During an annual regulatory review

We reviewed the information available to us about Drs. Howe and Hendriksz on 20 February 2020. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

23 January 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous inspection January 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

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 – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

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

People whose circumstances may make them vulnerable – Outstanding

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

We carried out an announced comprehensive inspection at Lostwithiel Medical Practice on 23 January 2018 as part of our planned inspection programme.

At this inspection we found:

  • The practice had proven its safeguarding processes were effective and had been commended by the local authority on its use of these processes.
  • Outcomes for patients who used services were consistently better than expected when compared with other similar services.
  • We saw examples of where practice GPs had provided compassionate care following unexpected bereavements or when a simple act of kindness made a difference. For example, one GP took the elderly husband of a patient fishing at a weekend having arranged care for the patient’s wife. GPs considered patient’s emotional and social needs as important as their physical needs.
  • All staff were actively engaged in activities to monitor and improve quality and outcomes. Opportunities to participate in benchmarking, peer review and accreditation were proactively pursued. High performance was recognised by credible external bodies.
  • A systematic approach was taken in working to improve care outcomes, tackle health inequalities and obtain best value for money. The practice performed better for antibiotic prescribing compared to the 11 other practices in the mid Cornwall locality, which meant reduced costs for the NHS and reduced risks of antibiotic resistance to patients.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it, in a way and at a time that suited them.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.
  • The practice had a very low emergency admission to hospital rate compared to other practices in the locality. The practice unplanned admission to hospital rate (mid Cornwall locality) was the best rate in the locality of 12 practices. Lostwithiel Med Practice was 26% better than the locality rate and 25% better than the average rate for Cornwall.

  • The practice had very low accident and emergency (A&E) attendances, having achieved the second lowest of 12 practices in the locality. NHSE IRIS reporting data showed that in 2016-17 period 1,245 practice patients had attended A&E, and in the 2017-18 period 1,264 attended, which was the second lowest rise in the locality. The practice was 31% lower than the locality and 33% lower than Cornwall averages. The practice told us they were proactive in attending to patients with minor injuries at the practice, in order to achieve this low rate.

We found several examples of outstanding practice. These included:

  • The practice employed two specialist consultant orthopaedic surgeons. The practice had developed this service due to the particular difficulties these patient groups had in travelling long distances from this rural area to hospital-based services. The practice also provided secretarial services which ensured patient records were updated in a timely and accurate manner. Kernow CCG paid the practice for providing the service and the practice paid and employed the consultants directly, thereby saving the NHS money. The practice was in the process of extending this successful service to include a rheumatologist, a psychiatrist and ENT (Ear, nose and throat) specialists. Data provided demonstrated an extremely low DNA (did not attend) rate and a very positive patient experience.  
  • Three key areas of outstanding practice included dementia research, having a cancer champion nurse and an elder care co-ordinator nurse. Practice dementia research had been endorsed by the National Clinical Director for dementia in England. The practice developed specialist dementia nurse services who had provided care as a fully-integrated service by the practice to both the patient and the carers. They had provided home visits and ensured continuity of care for those diagnosed with dementia or mild cognitive impairment. A cancer champion nurse raised awareness across the clinical team in order for cancer to be taken into account when patients attended for other reasons. An elder care co-ordinator nurse specifically supported local care homes. This increased the amount of time practice GPs spent providing a holistic approach to a significant patient population with complex needs. Positive outcomes for patients included reductions in referral rates, low emergency admission rates and patients with deaths at home rather than in hospital, a low referral to consultant rates, thorough care planning and more accurate diagnosis, and increased awareness of the difficulties vulnerable groups of patients faced on a daily basis.
  • The practice had gained SAVVY level two, (a county-wide initiative by the council supporting improved access to GP services for young people) approval. This indicated a focus on the emotional health and well-being of young people. Staff encouraged young people to visit the practice and engage with their GP and reassure them that their appointments were entirely confidential. The practice used their SAVVY level two accreditation to maintain the full confidence of its young patients. This was not only about teenage pregnancy rates(total terminations since April 2017 to date numbered three) but about sexual health (participating in chlamydia screening was part of SAVVY level two requirements), providing free condoms, encouraginghealthy living, staying well andbeing safe.Extended opening times with pre-bookable appointments ensured that the target age range of 13 to 19 years could find the practice accessible at all times). The differing levels for SAVVY recognition was an assessment of approachability, accessibility, a variety of services provided in-house, publicising services for young people and included an inspection visit.
  • GPs and nurses had created and regularly updated patient information leaflets (PILS) and public health leaflets (PHILS) which were available on a shared computer drive throughout the building for access by all staff and clinicians. These covered a variety of topics and were given to patients as an adjunct to consultations and explanations for specific medical conditions. The leaflets were based on National Institute for Health and Care Excellence (NICE) guidance and examples include spirometry, blood tests and vaccinations. There was also a handout available giving links to health information sites. Additional information and links were provided on the practice website.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

21 January 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

Lostwithiel Medical Practice was inspected on 21 January 2015. This was a comprehensive inspection. Overall, we rated this practice as good.

Lostwithiel Medical Practice provides primary medical services to people living in Lostwithiel and the surrounding areas. The practice provides services to a local population the vast majority of whom are Cornish and is situated in a semi rural location.

At the time of our inspection there were approximately 4,850 patients registered at the service with a team of two male GP partners, together with one female salaried GP and one trainee male GP. GP partners held managerial and financial responsibility for running the business. 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, visiting orthopaedic and gastroenterological services, acute care at home team, early intervention team and a community matron.

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 several examples of outstanding practice. These included:

  • The practice delivered outstanding dementia care. There was a GP with an interest in dementia and a dementia nurse at the practice. A GP at the practice had created dementia care guidelines which had been adapted by the local Clinical Commissioning Group (CCG). The practice had been nominated for an award because of their dementia care by the British Medical Journal. The practice had been a finalist for this award.
  • The practice had been EEFO approved. (The term EEFO does not stand for anything. EEFO is a word that has been designed by young people, to be owned by young people) EEFO works with other community services to make sure they are young people friendly. The practice had a nominated EEGO GP and an EEFO nurse. Once a service has been EEFO approved it means that service has met the quality standards. For example, confidentiality and consent, easy to access services, welcoming environment and staff trained on issues young people face. Part of this scheme is the C-Card scheme. The C card is given so that a younger person can get free condoms at different places across Cornwall & the Isles of Scilly.
  • The practice had proven its safeguarding processes were robust and had been commended by the local independent safeguarding chair on its effective use of these processes.
  • The practice had a very low emergency admission to hospital rate compared to other practices in the locality. This was due to the long standing approach by the practice to personal care and continuity of care.
  • GPs at the practice had been instrumental in bringing ultrasound services to Bodmin hospital. This enabled many patients to receive an early diagnosis of their medical conditions at a convenient local site.
  • GPs and nurses had created a library of leaflets which could be provided to patients to explain specific medical conditions or procedures. These guides were based on National Institute for Health and Care Excellence (NICE) guidance. For example, leaflets were available on spirometry and blood tests.

There were also areas of practice where the provider needed to make improvements.

  • The provider should consider arrangements for recording the storage temperature of medicines and the checks made on expiry dates of products.
  • The provider should ensure an infection control audit is completed at least every 12 months.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice