Background to this inspection
Updated
15 June 2018
Mullion Health Centre is a GP practice which provides services for approximately 7927 patients. The main practice is situated in the rural and remote village of Mullion, Cornwall. There are three additional branches situated in the hamlets of Constantine, Lizard and Ruan Minor. These three branches have dispensaries. The practice provides dispensing services for patients who live further than one mile away from a pharmacy. This is approximately half of its population. (Constantine approximately 2000 patients, The lizard 1000 and Ruan Minor 1000.)
The practice population area is in the sixth decile for deprivation. In a score of one to ten, the lower the decile the more deprived an area is. The practice distribution and life expectancy of male and female patients is equivalent to national average figures. The practice had a significantly higher than average number of patients aged over 75 and 85 years, (13% of the practice list were over the age of 75 years compared to the national average of 8% and 4.2% of the patient list were over the age of 85 compared with the national average of 2%). Average life expectancy for the area is similar to national figures with males living to an average age of 82years and females living to an average of 84 years.
There is a team of seven GPs (two female and five male). Of the seven GPs six were partners and one was a salaried GP. The whole time equivalent (WTE) of GPs is just under six WTE.
The team also includes a practice manager, deputy practice manager, IT manager, two secretaries, three administration staff, eight reception staff, four healthcare assistants/phlebotomists, four practice nurses, six dispensary staff and two cleaning staff.
Patients using the practice have access to community staff including community nurses and health visitors. Patients could also access counsellors, depression and anxiety services, alcohol and drug recovery workers, voluntary services and other health care professionals.
The practice is a training practice for GP Registrars (doctors training to become a GP) and has received positive feedback from the medical school.
The GPs provide medical support to three residential care homes and a large nursing home in the area and provide weekly ‘ward rounds’ and annual health reviews for these patients.
The practice is registered to provide regulated activities which include:
Treatment of disease, disorder or injury, surgical procedures, family planning, maternity and midwifery services and diagnostic and screening procedures and operate from the location of:
Mullion Health Centre, Nansmellyon Road, Mullion. Cornwall, TR12 7DQ.
There are three branch surgeries located at:
Constantine Surgery, Bowling Green, Constantine, TR11 5AD
The Lizard Surgery, The Green, The Lizard, TR12 7NZ and
Ruan Minor Surgery, Glebe Place, Run Manor, TR12 7JW
We visited Mullion Health centre, Constantine Surgery and The Lizard Surgery on this inspection.
Updated
15 June 2018
This practice is rated as Outstanding overall. (The previous inspection was in February 2015 where we rated the practice as good overall)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Outstanding
Are services responsive? – Outstanding
Are services well-led? - Good
We carried out an announced comprehensive at Mullion Health Centre on Monday 23 and Tuesday 24 April 2018 as part of our inspection programme.
At this inspection we found:
- The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
- Medicines were managed well at the practice and prescribing rates and patterns were kept under review to ensure safety and cost effectiveness.
- Improvements within the dispensaries had taken place since the last inspection and were being monitored to further reduce any potential risks to patients and improve the quality of the service provided.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients gave strongly positive feedback about the care and treatment they received. Results from the July 2017 national GP patient survey, friends and family test results and independent survey results were all strongly positive. For example, in the national survey, the practice had performed better than Clinical Commissioning Group (CCG) and national averages for all 23 questions. Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
- There was a strong focus on continuous learning and improvement at all levels of the organisation. Staff said the practice was a good place to work and added that the leadership team were supportive and encouraged career development and learning to help improve patient safety.
- There was evidence of systems and processes for learning, continuous improvement and innovation. The practice had taken part in many local pilots to test new methodology.
We saw areas of outstanding practice:
Feedback from multiple sources - patients who use the service, those who are close to them and stakeholders - was continually and strongly positive about the way staff treat people, the service received and access to services. People commented staff “go the extra mile” and the care they receive exceeded their expectations.
The practice had recognised the geographical locations and isolation of the practice branches, the needs of the local population and associated restrictions for some patients accessing healthcare. The GPs and staff had reviewed this and offered additional support and services to reduce the need for long journeys, improved access to services. For example:
- Offering Saturday morning appointments with an aim to reduce unplanned hospital admissions and optimise care in the community,
- Providing same day interventions such as oxygen concentrators and antibiotics to elderly patients in need who would otherwise require admission to hospital
- providing a wide-range of soft-tissue and joint injections to its own patients, and to neighbouring practice patients to reduce secondary care burden and improve patient access.
- Providing a doppler service for patients with peripheral vascular disease (leg ulcers).
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice