Marazion Surgery

Updated 8 May 2015

The Marazion Surgery provides primary medical services to people living in Marazion and the surrounding areas. This was a comprehensive inspection.

At the time of our inspection there were approximately 7,000 patients registered at the service. The practice had a team of 5 GP partners, two female and three male GPs which equates to four fulltime GPs, and one part time female salaried GP. The partners held managerial and financial responsibility for running the business. There were three nurses and two assistant practitioners at the practice. 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 and midwives.

The practice is open between Monday and Friday 8am – 6pm. Early morning appointments were available from 7.40am one day a week and 6.30pm - 8pm one evening a week. These are pre-bookable appointments with a GP or the assistant practitioner and are designed to be used by patients going to work.

The practice also has a dispensary that is open Monday to Friday between 8:30 am to 6pm closing between 1:30pm to 2pm for lunch each day except Wednesdays when it is closed between 1pm and 2pm to allow for staff training.

Outside of these hours patients dial the practice telephone number and obtain instruction on how to contact the GP on call for emergencies. Advice can also be obtained by another health care provider by patients dialling the national 111 service.

Routine appointments are available daily and are bookable up to two weeks in advance. Urgent appointments are made available on the day and telephone consultations also take place. Patients could obtain these appointments either by telephoning the practice or on line using the system The Waiting Room.

Updated 8 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Marazion Surgery on 3 March 2015. Overall the practice is rated as good.

We found the practice to be good for providing safe, responsive and effective and well led services. It was also good for providing services for older people, people with long term conditions, families, children and young people, working age people including those recently retired and students, people who were vulnerable and those experiencing poor mental health and those with dementia.

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 addressed at team meetings.

• 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 planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• 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. For patients unable to visit the practice nursing staff from the practice delivered care to housebound patients in their homes.

• 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 areas of outstanding practice:

The practice had reviewed patients taking medicines that were affected by the new law on driving after taking certain medicines. The Drug Driving Specified Limits Amendment Regulations 2015 came into force on 2 March 2015. This new offence covers driving with certain controlled drugs, including some prescription drugs and a number of over the counter medicines, above specified limits. They had written to the patients making sure that they were aware of the new ruling and invited patients to arrange for a telephone consultation if they had any concerns

The practice was accredited with Level 3 EEFO status. 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 were young people friendly. Once a service had been EEFO approved it meant that service had met the quality standards. For example, confidentiality and consent, easy to access services, welcoming environment and staff trained on the issues young people face to face. Part of this scheme was the use of a green card. This allowed for a young person to be seen on the same day by a GP.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 May 2015

The practice is rated as good for providing care to people with long term conditions. The practice managed the care and treatment for patients with long term conditions in line with best practice and national guidance. Health promotion and health checks were offered in line with national guidelines for specific conditions such as diabetes and asthma. Letters were sent to patients to remind them to book appointments for their routine checks. Longer appointments were available for patients if required, such as those with long term conditions. The practice had a carers' register and all carers were offered an appointment for a carers' check with nursing staff. The practice worked with the district nurses to keep patients within their own homes by visiting them and carrying out routine checks.

Updated 8 May 2015

The practice is rated as good for families, children and young people. Families had a named GP. Staff worked well with the midwife to provide antenatal and postnatal care. Postnatal health checks were provided by a GP. The practice provided baby and child immunisation programmes to ensure babies and children could access a full range of vaccinations and health screening. The practice is a member of the EEFO system for young people. Information relevant to young patients was displayed and health checks and advice on sexual health for men, women and young people included a full range of contraception services and sexual health screening including chlamydia testing and cervical screening. The GPs training in safeguarding children from abuse was at the required level. Young carers were identified and supported to contact support services.

Updated 8 May 2015

The practice is rated as good for providing care to older people. All patients over 75 years had a named GP. Health checks and promotion were offered to this group of patients. The practice worked with the community matron to keep patients within their own homes. Staff from the practice visited the housebound to ensure tests and routine examinations were carried out. Medicines were delivered to the patient’s home or to a nearby shop for ease of access. There were safeguards in place to identify adults in vulnerable circumstances. The practice worked well with external professionals in delivering care to older patients, including end of life care. Pneumococcal vaccination and shingles vaccinations were provided at the practice for older people on set days as well as during routine appointments. Staff recognised that some patients required additional help when being referred to other agencies and assisted them with this.

Updated 8 May 2015

The practice is rated as good for providing care to working age people. The practice provided appointments on the same day. The practice operated extended opening hours one morning and two evenings a week with the GP and healthcare assistant. Appointments could be booked on line and nurses appointments up to six weeks in advance to allow for flexibility. Smoking cessation appointments were available. The practice website invited all patients aged between 40 years to 75 years to arrange to have a health check with a nurse if they wanted. A cervical screening service was available.

Updated 8 May 2015

The practice is rated as good for people experiencing poor mental health, including people with dementia. The practice was aware of their ageing population group. Staff were aware of the safeguarding principles and GPs and nurses had access to safeguarding policies. All staff had received training in the Mental Capacity Act (MCA) 2005 and were aware of the principles and used them when gaining consent. The practice worked closely with the community matron and district nurses to keep patients at home. There was signposting and information available to patients. The practice referred patients who needed mental health services to the community psychiatric nurses and GPs kept in regular contact with the patient during a crisis or illness to ensure that they were managing. Support services for patients with depression were provided at the practice, such as counselling. Patients suffering poor mental health were offered annual health checks as recommended by national guidelines.

Updated 8 May 2015

The practice is rated as good for people whose circumstances may make them vulnerable. The practice had a vulnerable patient register to identify these patients. Vulnerable patients were reviewed at team meetings. Referral to a counselling service was available. The practice did not provide primary care services for patients who are homeless within the village as none were known, however, the practice looked after patients in a homeless hostel in Penzance. Staff said they would not turn away a patient if they needed primary care and could not access it. Patients with interpretation requirements were known to the practice and staff knew how to access these services. Patients with learning disabilities were offered a health check every year during which their long term care plans were discussed with the patient and their carer if appropriate. Reception staff were able to identify vulnerable patients and offer longer appointment times where needed.