Archived: Drs Whiting, Harvey and Ashley Also known as Trevithick Surgery

Updated 15 February 2017

Drs Whiting, Harvey and Ashley has one registered location providing general medical services at:

Trevithick Surgery, 2-6 Basset Road, Camborne TR14 8SL

At the the time of the inspection there were 4477 patients registered at the practice. Information published by Public Health England rates the level of deprivation within the practice population area as two on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. There is a slightly higher proportion of babies and children on the patient list compared with other practices in the area. 38.4% of the patient population are under 18 years and 39.8% are over 65 years.

Since 2015, the partnership of the practice has changed through retirements and ill health. The practice is managed by one remaining GP (female) working as an informal federation with the nearby practice Carn to Coast Health Centre. The managing GP is supported by a seconded general manager, a salaried GP (male) and GP partners from Carn to Coast Health Centre. The practice is using named GP locums for continuity of patient treatment. The nursing team consists of three female nurses, of which two are qualified nurses. The practice has an administrative team, which is managed by the practice manager.

The practice at Trevithick Surgery is open 8am to 6.30pm Monday to Friday. Phone lines are open during opening hours, with the out of hours service picking up phone calls outside of these times. GP appointment times are from 8.50am to mid-day and 2.30pm to 5.30pm every weekday. Extended opening hours have been temporarily suspended following discussions with the Clinical Commissioning Group. However, GPs provided flexible appointments to meet patient’s needs where requested. Information about opening times are listed on the practice website and patient information leaflet. Patients requiring a GP outside of normal working hours are advised to contact the out of hours service in Cornwall. The practice closes for three days a year for staff training and information about this is posted on the website.

The practice has a general medical services (GMS) contract.

The following regulated activities are carried out at the practice: Treatment of disease, disorder or injury; Surgical procedures; Family planning; Diagnostic and screening procedures; Maternity and midwifery services.

Updated 15 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the location Drs Whiting Harvey and Ashley known as Trevithick Surgery on 6 October 2016. 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• All 34 patients providing feedback at the inspection 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. Improvements were made to the quality of care as a result of complaints and concerns.
• All 34 patients responding in writing or person said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice 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. Staff retirements and ill health had placed the practice under significant pressures in the last 12 months and the practice had asked for early help from stakeholders such as NHS England and the Clinical Commissioning Group. The impact on the delivery of patient care was minimised because of these actions and was further illustrated by the positive feedback we received from 34 patients during the inspection. This verified that the practice was open with them about the challenges, had discussed necessary changes and had put in safeguards to ensure continuity for patients by using a small number of named locum GPs.

However there were areas of practice where the provider should make improvements:

• The practice should undertake clinical audits and ensure that re-audits are put in place to improve patient outcomes.

• Review the processes for identifying carers in the practice to increase those being identified and to offer carers support and guidance about available services.

• The practice should look at ways to increase engagement with patients with schizophrenia, bipolar affective disorder and other psychoses to facilitate the development of a comprehensive care plan for each person.

• The practice should look at ways to improve patient experience by using the feedback received to make practical changes where ever possible.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 February 2017

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.

• Performance for diabetes related indicators was comparable to the national average. For example, 86.7% of patients on the diabetes register had a record of a foot examination and risk classification within the preceding 12 months (national average 88.3%).

• 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. The practice had retained the services of the same small group of locum GPs to cover sessions during a period of instability.The locum GPs were allocated named patients and responsible for monitoring at risk patients so that there was continuity of care.For those patients with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Safety net systems were in place to monitor patients on high risk medicines.Patients told us that they had regular appointments for blood checks and their GP closely monitored these results.

Updated 15 February 2017

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. Staff demonstrated by example that they made safeguarding referrals in a timely way, which had resulted in protection plans being implemented to protect at risk children.

• Immunisation rates were comparable with those seen in the Clinical Commissioning Group (CCG) area 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 practice’s uptake for the cervical screening programme was 75%, which was below the CCG average of 83% and the national average of 82%. In addition to the national screening recall of eligible women, practice nurses used all patient contacts as opportunities to promote cervical screening.

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

Updated 15 February 2017

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

• All patients had a named GP to promote continuity of care and when attending their appointments were collected by the GP or nurse from the waiting room.

• Monthly meetings were held between community staff, so that vulnerable older people were closely monitored and given timely support.

Updated 15 February 2017

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.

• Extended opening hours were normally provided but had been temporarily suspended due to the significant pressures the practice had been under. However, patients were able to access early nursing appointments every day between 8am and 8.30am and GPs provided later appointments by arrangement. Information about this is listed on the practice website and patient information leaflet.

• 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. This included repeat prescription and appointment requests.

Updated 15 February 2017

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

• 65.9% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was below the national average of 84%.  A number of patients with dementia lived in adult social care homes in the area and were reviewed regularly there instead of at the practice.
• Performance for mental health related indicators was below the national average. For example, 15.9% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (national average 88.5%). The practice demonstrated that actions to improve performance in this area were being taken. This included improved accuracy in the use of clinical codes and a GP had been tasked to review all care plans for patients. We saw that patients with mental health needs, including those diagnosed with dementia were being closely monitored and cared for. Examples of effective care and treatment was seen and care plans that had been reviewed were comprehensive.

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

• All of the staff had a good understanding of how to support patients with mental health needs and dementia and shared several examples of how they had done so.  A calm, welcoming atmosphere was evident at the practice and staff demonstrated they were skilled in de-escalating any issues.

Updated 15 February 2017

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

• The practice held registers of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. They worked closely with a nearby hostel run by a charity for homeless people and had systems in place to enable patients to register temporarily or receive communications via the practice address.

• The practice offered longer appointments for patients with a learning disability. Reasonable adjustments made, including providing patients with easy read health plans following their annual review.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.