The Penryn Surgery

Updated 13 February 2019

The partnership of GPs registered as the Penryn Surgery runs three registered locations and a branch surgery at the university in Falmouth. The Penryn Surgery, incorporating all three locations was inspected over two days on 4 and 5 December 2018. The practice locations are:

• Penryn Surgery, Saracen Way, Penryn, Cornwall TR10 8HX

• Stithians Surgery, Crellow Lane, Stithians TR3 7BA

• Mawnan Smith Surgery, The Square, Mawnan Smith, Falmouth, TR11 5EP

The practice also has a consulting room at the nearby Penryn Campus that is open each day during the student term times.

The practice group provides primary medical services to 20268 patients of a diverse age group, with 25% being young adults many entering higher education at the local university for the first time. The practice population is in the fifth deprivation decile for deprivation. In a score of one to ten the lower the decile the more deprived an area is. The practice area covers a mixed socio-economic demographic, and has a large care home and over 75 population, all with complex health needs. There is a practice age distribution of male and female patient’s equivalent to national average figures. Average life expectancy for the area is similar to national figures with males living to an average age of 80 years and females to 84 years.

The partnership at the practice comprises of twelve GPs partners and a managing partner (five male and seven female). They are supported by a salaried GP (female) and a retainer GP (female). The retainer scheme helps support GPs who might otherwise leave general practice to stay practising, for example during periods of parenting. The team are supported by a practice manager, three advanced nurse practitioners, a trainee advanced nurse practitioner, eleven practice nurses, four healthcare assistants, a practice based pharmacist and pharmacy technician. There are administrative and reception staff.

Penryn Surgery is an approved training practice providing vocational placements for GPs registrars. Two GP partners are approved to provide vocational training for GPs, second and third year post qualification doctors. Teaching placements are provided for medical students. At the time of the inspection there was a GP registrar on placement at the practice.

Patients using the practice also have access to community nurses, mental health teams and health visitors. Other health care professionals visit the practice regularly.

The practice is open between 8am and 6:30pm Monday to Friday. Branch surgery opening times are listed on the practice website. Patients can choose to attend any one of the three practices for appointments and at a time to suit them. Extended hours opening is available across all sites providing early morning and late evening appointments. Extended hours surgeries are pre-bookable only and appointments made between one week and up to 48 hours before the surgery was held, via reception, during normal surgery hours. Outside of these times patients are directed to contact the out of hour's service by using the NHS 111 number.

The practice is SAVVY approved (Young people friendly service). Friendly, confidential and is available and run by nurses at the practice. Emergency contraception, coils and implants, free condoms, contraceptive advice and any health or well-being advice is provided as needed. Appointments are available by request or after school or college. Urgent same day appointments and telephone advice are available. Young people are able to choose who they wish to consult with.

Flu clinics are held throughout the Autumn and Winter as advertised on the practice website and in waiting rooms at Penryn, Stithians and Mawnan Smith Surgeries.

The practice is registered to provide the following regulated activities: Diagnostic and screening, Surgical procedures, Family planning services, Maternity and midwifery services and Treatment of disease, disorder or injury

This report is specifically about the registered location at Penryn Mawnan Smith Surgery, The Square, Mawnan Smith, Falmouth, TR11 5EP

Updated 13 February 2019

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

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Penryn Surgery, visiting all three locations including the dispensaries at Penryn Surgery, Mawnan Smith Surgery and Stithians Surgery on 4 and 5 December 2018. The inspection was a routine inspection as part of our inspection schedule.

At this inspection we found:

• The practice focussed on safety. The majority of systems were clear facilitating the management of risk across all three registered locations. The practice thoroughly investigated safety events and learned from them improving processes. However, there was a lack of consistency in the way complaints and significant events were documented, which could affect the governance of these processes by the practice.
• Audit was embedded, with the practice routinely reviewing the effectiveness and appropriateness of the care it provided. Care and treatment was always delivered according to evidence-based guidelines.
• All the feedback from 12 patients at the inspection was positive about staff treating them with compassion, kindness, dignity and respect.
• People’s individual needs and preferences were central to the planning and delivery of flexible tailored services. For example, patients could attend any of the practice sites in Penryn, Mawnan Smith or Stithians for an appointment at a time to suit them.
• Patient feedback about the appointment system had been listened to. The practice had significantly increased patient access to appointments online facilitating easier access for working people.
• The practice continued to provide a daily on-site clinic at the local university to meet the needs of the students (25% of the practice population). Students were able access to a GP without disrupting their academic studies. They liaised closely with student support services to provide additional mental health support and monitoring.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. Proactive succession planning based on staff development and training of future GPs, doctors and practice nurses was evident at this training practice.
• The practice was an active research practice in the Southwest, supporting and recruiting patients for research studies to improve care and treatment outcomes for patients.

We saw two areas of outstanding practice:

The practice had responded to increasing numbers of patients presenting with gender dysphoria, for whom there were limited local and regional services available. An information pack had been developed for patients, including signposting to national support agencies, referral processes to the regional gender dysphoria clinic, transition and post-surgery health screening (female to male ongoing eligibility for breast and cervical screening).

The practice held an immunisation event, with children’s entertainer, aimed at hard to reach families to increase immunisation uptake. The first event lead to seven children being vaccinated. Children were given a bag with presents for being immunised, making it a positive experience for them. The practice planned further such events and intended to hold these at the weekend.

There were areas where the provider could make improvements and should:

Review the significant event (SEA) and complaints processes to ensure there is consistent documentation of risks, actions, change and embedding for safe governance.

Develop a consistent style of response to complaints providing both empathy and timeline information for patients.

Review the arrangements for storing and monitoring of blank prescription stationery at Stithians Surgery to ensure that best practice guidance is being followed and risks minimised.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 13 February 2019

Updated 13 February 2019

Updated 13 February 2019

Updated 13 February 2019

Updated 13 February 2019

Updated 13 February 2019