Archived: The Alverton Practice

Updated 22 July 2016

The Alverton Practice provides primary medical services to people living in Penzance, Newlyn and wider Penwith. There is a branch practice in Newlyn and a branch located in a local supermarket. We did not visit these branches during this inspection.

The Alverton practice, in collaboration with The Sunnyside Surgery and Rosmellyn Surgery - collectively share a branch surgery known as Mounts Bay Surgery within the Sainsbury’s Store in Penzance.

At the time of our inspection there were approximately 6,150 patients registered at the practice. There are three GP partners and one Nurse Practitioner partner. There are also two salaried GPs employed. In addition to this there is one nurse prescriber, two practice nurses, five healthcare assistants, a practice manager, and additional administrative and reception staff.

The practice is a training practice for doctors training to become GPs as well as being a teaching practice for medical students from the Peninsular Medical School.

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

The practice is open from Monday to Friday, between the hours of 8am and 6:30pm. Appointments with the GP or nurse are available between these times and could be booked up to eight weeks in advance. There are evening appointments on Tuesdays until 8pm and on alternate Saturdays between 9am and 12pm for people unable to access appointments during normal opening times. GPs also offer patients telephone consultations, and provided 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.

Updated 22 July 2016

We carried out an announced comprehensive inspection at The Alverton Practice on 6 January 2016. Overall the practice is rated as outstanding

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.

We saw areas of outstanding practice, including;

• Multi-disciplinary team (MDT) meetings took place monthly and involved a range of other professionals we noted the uniqueness of this approach to MDT meetings and heard how their approach had been singled out locally and nationally as a model of best practice.

• The practice organised children’s “flu parties” as part of their childhood vaccination programme and had achieved the highest uptake for childhood flu vaccinations in the Clinical Commissioning Group area.

• In response to feedback about improving access to appointments the practice provided a branch surgery in a local supermarket. This was highlighted by NHS England as pioneering.

• The branch practice in Newlyn catered for a significant proportion of the local fishing community and offered tide and weather dependent flexibility with appointments for these patients. Two of the GPs worked with the Life Boat crew.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 22 July 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.

• Patients with multiple chronic diseases were offered a single appointment review.

• Housebound patients with chronic diseases were seen at home by the practice nurse.

• 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 22 July 2016

The practice is rated as outstanding 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.

• 72.48% of patients diagnosed with asthma, on the register, had an asthma review in the preceding 12 months compared to the national average of 75.35%

• 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 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 service was available whenever the practice was open.

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

• The practice organised children’s “flu parties” as part of their childhood vaccination programme and we were told they had achieved the highest uptake for childhood flu vaccinations in the Clinical Commissioning Group area.
• Same day appointments were available for children. Parents raising concerns about a seriously ill child were encouraged to attend the practice immediately and received a priority appointment.

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

• The practice had established a local multi-agency project that supported children and young people with emotional, psychological and mental health needs that did not meet the criteria for hospital referral. 

Updated 22 July 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 patients in its population.

• All patients had a named GP.

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

• The practice nurses carried out home visits for annual and other health checks for those who were unable to attend the practice.

• The practice is part of the Penwith Pioneer Project / Living Well project. Frail patients were offered support from an Age UK worker to develop a care plan set by the patient.

• There was a system in place to highlight patients requiring end of life support who contacted the practice and prioritised appointments or home visits were made.

• A similar system was in place to notify the duty GP where a patient died at home so that certifying the death could be done in a timely way avoiding further distress for family members.

Updated 22 July 2016

The practice is rated as outstanding  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 reflected the needs for this age group.

• The branch practice in Newlyn catered for a significant proportion of the local fishing community and offered tide and weather dependent flexibility with appointments for these patients.

Updated 22 July 2016

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

• 85.37% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84.01%

• 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.

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

• 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. Staff had been instrumental in establishing a project that encouraged local businesses to become more dementia aware.

• The practice identified and supported military veterans with service related mental health issues.

Updated 22 July 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.

• Multi-disciplinary team (MDT) meetings took place monthly and involved a range of other professionals we noted the uniqueness of this approach to MDT meetings and heard how the practices approach had been singled out locally and nationally as a model of best practice.

• 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.

• The practice issued food bank vouchers on behalf of a local charity in Penzance.