Archived: Dr S J Williams and Partners Also known as Rosmellyn Surgery

Updated 3 March 2016

The Rosmellyn Surgery provides primary medical services to people living within the West Penwith area which covers the area from St Ives to Praa Sands and Penzance.

The Rosmellyn Surgery in collaboration with The Alverton Practice and The Sunnyside Surgery - collectively known as Mounts Bay Surgery, share a branch surgery within a supermarket store in Penzance.

At the time of our inspection there were approximately 7,000 patients registered at the practice. There are five GP partners, two male and three female and two ST3 GP trainees.The GPs are supported by a lead nurse, two nurses and three healthcare assistants. Two of the nurses were independent prescribers. There is also a management team consisting of a strategic manager, assistant manager, nurse manager, clinical systems manager, and a reception manager with additional administrative and reception staff.

The practice is both a training and teaching practice for GP registrars, third year medical students and nurse mentoring.

Patients using the practice also have access to community staff including district nurses, health visitors, midwives, physiotherapists and counsellors.

The practice is open from Monday to Friday, between the hours of 8am and 6pm. Appointments are available between 8:30am to 6pm with extended hours on a Tuesday evening between 6:30pm and 7:40pm and a Saturday morning between 9am and 11:45am once a month at the Mounts Bay surgery. GPs also offered patients telephone consultations, and performed home visits where appropriate. During evenings and weekends, when the practice is closed, patients are directed to an Out of Hours service delivered by another provider.

The practice has a Primary Medical Services (PMS) contract. With this contract the NHS specifies what the GPs, as independent providers, are expected to do and provides the funding for this

Updated 3 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr S J Williams and Partners (also known as Rosmellyn Surgery) on 17 November 2015. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• 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.
• 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The nurse lead for diabetes was able to initiate insulin therapy for patients with diabetes

• Longer appointments and home visits were available when needed.

All these patients had a named GP and 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 3 March 2016

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

• There were systems in place 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 80.95% which was comparable to the national average of 81.88%

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The lead nurse worked with a local charity (which provided free and confidential sexual health and wellbeing services for young people) visiting colleges and local schools.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 3 March 2016

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 people in its population.

• The Healthcare Assistant made home visits to frail housebound patients to carry out routine checks.

• The practice is part of the Penwith Pioneer Project / Living Well project. Frail patients had been offered support from an Age UK worker, the practice worked collaboratively with this agency and the patient to agree their care plan for integrated care.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 3 March 2016

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

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice was EEFO (EFFO is a name of a scheme in Cornwall which helps young people access health services easily) accredited to level two. A drop in clinic was available two afternoons a week.

• The practice had links with the disability employment advisor at the local job centre to encourage patients back to work with the use of fit notes

Updated 3 March 2016

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

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  93.75% of people diagnosed with mental illness had been reviewed in a face to face meeting in the last 12 months compared to the national average of 86.4%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• There was a counselling service available to patients and a self-referral service for those patients suffering with anxiety and depression.

• The practice offered shared care prescribing for patients with substance misuse problems and a home and dry alcohol detox service. The counselling happened in the surgery, enabling easy links between the practice and the counsellor.

Updated 3 March 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.

• A healthcare assistant carried out home visits to vulnerable patients to assess their needs