The Care Quality Commission
  • Doctor
  • GP practice

Probus Surgery

Overall: Good read more about inspection ratings

The Surgery, Tregony Road, Probus, Truro, Cornwall, TR2 4JZ (01726) 882745

Provided and run by:
Probus Surgery

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Probus Surgery 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 Probus Surgery, you can give feedback on this service.

21 April 2022

During an inspection looking at part of the service

We carried out an announced inspection at Probus Surgery on 21st April 2022. Overall, the practice is rated as Good

Safe - Good

Effective - Good

Well-led – Good

The ratings from the previous inspection for caring and responsive pulled through and were not inspected as part of this inspection.

Following our previous inspection on 26 August 2021 the practice was rated Good overall for all key questions but requires improvement for providing safe services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Probus surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a focused inspection to follow up on the previous inspection in August 2021 when the key question of safe was reported as requires improvement. A breach of Regulation 12 HSCA (RA) Regulations 2014 Safe care and Treatment was recorded.

Outline focus of this inspection included:

  • The key questions of safe, effective and well led
  • Follow up of breaches of regulation 12 and ‘shoulds’ identified in previous inspection
  • The ratings for caring and responsive were carried forward from the previous inspection

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, considering the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing facilities
  • Speaking with staff during the visit to the practice
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A staff questionnaire.
  • A short site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • What we found when we inspected
  • Information from our ongoing monitoring of data about services and
  • Information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall

We found that:

  • The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse. Staff had the information they needed to deliver safe care and treatment and the practice learned and made improvements when things went wrong.
  • There were adequate systems to assess, monitor and manage risks to patient safety and appropriate standards of cleanliness and hygiene were met.
  • The practice had systems for the appropriate and safe use of medicines, including medicines optimisation. Ongoing monitoring was being maintained with actions taken to follow up late reviews.
  • Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools. The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.
  • The practice was able to demonstrate that staff had the skills, knowledge and experience to carry out their roles. Staff worked together and with other organisations to deliver effective care and treatment.
  • The practice always obtained consent to care and treatment in line with legislation and guidance.
  • There was compassionate, inclusive and effective leadership at all levels. Leaders demonstrated that they had the capacity and skills to deliver high quality sustainable care. The practice had a clear vision and credible strategy to provide high quality sustainable care and had a culture which drove high quality sustainable care
  • There were clear responsibilities, roles and systems of accountability to support good governance and management and clear and effective processes for managing risks, issues and performance.
  • The practice involved the public, staff and external partners to sustain high quality and sustainable care. There were systems and processes for learning, continuous improvement and innovation.

Whilst we found no breaches of regulations, the provider should:

  • Continue to review, audit and organise the recruitment process to ensure a management overview of all records.
  • Include within all audits, including infection prevention and control audits, a timescale for completed actions.
  • Review the management of medical test results and letters to ensure that all results are seen by the appropriate staff in a timely way.
  • Ensure systems for managing patients with long term conditions continue to be monitored to maintain an effective overview of patient care and treatment.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

26 August 2021

During an inspection looking at part of the service

We carried out an announced inspection at Probus Surgery on 26 August 2021. Overall, the practice is rated as Good.

Set out the ratings for each key question

Safe - Requires Improvement

Effective - Good

Caring - Good

Responsive - Good

Well-led - Good

Following our previous inspection on 5 February 2019, the practice was rated Requires Improvement overall and for the safe and well led key questions. We issued requirement notices for regulation 12 (safe) and regulation 17 (good governance) of the Health and Social Care Act 2014. The effective, caring and responsive key questions were each rated as good.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Probus Surgery on our website at www.cqc.org.uk

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing and telephone
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • Reviewing documentation, policies and procedures
  • A short site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall and good for all population groups.

We found that:

  • There had been improvements to the areas identified as in need of action at our previous inspection. However, we identified new areas of concern which the practice were prompt to address.
  • The practice had not consistently provided care in a way that kept patients safe and protected them from avoidable harm due to patients on high risk medicines not always being monitored appropriately.
  • Not all staff were aware of the indicator on the electronic system to highlight them to patients who were included in the safeguarding processes or where concerns had been previously raised.
  • Systems and processes did not consistently ensure that learning was shared throughout the practice.
  • Staff were trained and competent to carry out their roles. Infection control procedures ensured safety and reduced the risk of cross infection.
  • There were appropriate referral pathways to make sure that patients’ needs were addressed.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • Prompt action was taken by the management team to address identified risks and systems and processes implemented to reduce the risk reoccurring. For example, the summarisation of patient records had been delayed during the pandemic and action was taken by the practice to address this and reduce the risk of this reoccurring.

We found one breach of regulation. The provider must:

  • Ensure care and treatment is provided in a safe way to patients

The provider should:

  • Continue to provide updates and guidance to staff so all staff are aware of updated information and where information is stored and highlighted. Ensure information is available to appropriate members of staff at all times, such as staff vaccination status.
  • Continue to follow the identified actions to improve the environment so that infection control and prevention is promoted in all areas.
  • Continue to update fire drill training and associated records to demonstrate that all staff had attended a recent fire drill.
  • Continue with the planned system to summarise patient records in a timely way and monitor the progress made.
  • Consistently be able to identify an overview of the action taken to address significant events.
  • Consistently identify and provide follow up care and treatment appropriately for patients at risk of diabetes.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

5 February 2019

During a routine inspection

We carried out an announced comprehensive inspection at Drs Bridger, Ball, Campbell, Purchas, Lin and Murthy known as ‘Probus Surgery’ on 5 February 2019 as part of our inspection programme.

At this inspection, we visited the main location at Probus Surgery and one of the four branch surgeries at Grampound both of which have dispensaries on site.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall. We rated safe and well led as requires improvement because w e found that:

  • We found some gaps in recording of actions taken to mitigate risks and overall governance was not effective.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm. However, some safeguarding procedures and processes lacked consistency, access and appropriate risk levels being assigned when applied.
  • The practice did not have reliable systems for appropriate and safe handling of medicines: the security and tracking of blank prescriptions within the practice was not in line with national guidance. Infrequent checks of emergency medicines led to some of these being out of date. Medicines refrigerator temperatures were not undertaken on all days that the practice, including branch surgeries were open affecting the reliability of assurance of cold chain.
  • Appropriate standards of cleanliness and hygiene were partially met. Audit was not completed frequently so did not provide assurance of embedded procedures being followed.

We have rated this practice good for all population groups and effective, caring, responsive because:

  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way. Examples were: a five-days per week medicines delivery service to many drop off points, which was accessible for 95% patients receiving dispensed medicines.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care. The practice was a positive outlier in several parts of the national GP patient survey.
  • All patients providing feedback during the inspection were strongly positive about the practice. Staff were said to be compassionate, friendly and went the extra mile to support patients and their carers’.
  • Audit continued to be used to identify in-depth learning and implement changes to improve patient care and treatments.
  • Succession planning and staff development was proactive and created a flexible and responsive workforce. In the context of national GP shortages, the practice had successfully recruited a salaried GP as a new partner from July 2019.

The area where the provider must make improvements are:

Establish effective systems to ensure the proper and safe management of medicines.

Establish effective systems and processes to prevent abuse of patients.

Established effective systems and processes to ensure good governance in accordance with the fundamental standards of care to manage and mitigate risk.

The areas where the provider should make improvements are:

  • Ensure there are processes in place to evidence nurses and GPs are compliant with requirements to revalidate professional registration. Review safeguarding procedures and processes to make information about patient concerns clearly available and consistently applied by all authorised staff.
  • Ensure that there is a robust system for checking the expiry dates of medicines within the service
  • Ensure checks of fridge temperatures used to store medicines have been checked and appropriate actions taken where required
  • Follow national guidance for the handling of controlled drugs and review security for the storage of controlled drugs in line with the Misuse of Drugs (Safe Custody) regulations
  • Ensure that there is a complete medicines profile on the computer system that includes medicines prescribed for patients from other service providers.
  • Ensure there is a system in place to follow up patients who failed to attend for follow up of long term conditions
  • Ensure learning and actions following significant events is documented in line with national guidance on this.
  • Review the infection prevention and control arrangements to increase the frequency of audit.

04/02/2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We undertook a planned, comprehensive inspection of Probus Practice on 4 February 2015. The practice provided primary medical services to approximately 8700 patients living in the village of Probus and surrounding villages in Cornwall. The practice also had a main branch surgery (Grampound) that was open four days a week and had a small dispensary attached. Additional to this, it used three other rural locations where patients were seen. Tregony branch, the Merlin Centre and Summercourt. A triage service was offered every day by the on call GP.

The practice comprised of a team of six GP partners (four male and two female) who held managerial and financial responsibility for running the business. In addition there were two salaried GPs, four registered nurses, eleven qualified dispensers and three health care assistants. There was also a comprehensive administrative team that consisted of a full time practice manager, a deputy practice manager, a finance manager, receptionists and administration staff.

Patients who used the practice had access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

The practice had a dispensary attached. A dispensing practice is where GPs are able to prescribe and dispense medicines directly to patients who live in a rural setting. Probus practice dispensed to patients who did not have a pharmacy within a mile radius of where they lived.

The practice is rated as good. A safe, caring, effective, responsive and well-led service was provided that met the needs of the population it served.

Our key findings were as follows:

  • There were arrangements in place to respond to the protection of children and vulnerable adults and to respond to any significant events affecting patient’s well-being.
  • The practice worked well with other health care service to enable a multi-disciplinary approach in meeting the health care needs of patients receiving a service from the practice.
  • Patients told us they were treated with respect and kindness and staff maintained their confidentiality.
  • Patients were able to have an appointment on the same day unless they wished to see a particular GP. Some patients said if they wanted to see a particular GP for continuity of care and treatment they had to wait. The practice took complaints seriously.
  • There was a clear management structure with approachable leadership. Staff were supported and had opportunities for developing their skills. The provider responded to feedback from patients.

We saw several areas of outstanding practice including:

  • Patients were able to access appointments when they needed them. Appointments were available at four different locations at varying times throughout the week in different rural locations. This included triage appointments by the on call GP when booked appointments were not necessary. Extended hours were offered four times a week for those people that were working.
  • Patients were enabled to attend a memory clinic that operated in the village once a week. This was led by one of the GPs at the practice. This gave an opportunity to monitor and evaluate those people with dementia on a regular basis and plan their care accordingly.
  • The practice has 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 community services to make sure they are young people friendly. 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. This is in partnership with the local secondary school. One of the GPs at the practice has become a younger persons ‘champion’ and has plans to implement further improvements to the health of younger people.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice