What is the Quality of Facilities at Fowey River Practice

Positive

"We saw several areas of outstanding practice including: • The practice is contributing to nurse education in the region with the aim of promoting primary medical services as a career option when general practice is facing significant challenges in recruiting nurses."

Positive

"The practice nurse had good links with secondary care for example a direct link to the respiratory nurse specialist at Treliske Hospital to gain advice about patients in pulmonary rehabilitation or to arrange chest xray."

Positive

"Training and opportunities for development had been taken by the practice nurses who spoke of the importance of learning and sharing good practice they had attended practice nurse meetings locally involving nurses from seven other practices for joint learning and developments days one example being an update about meningitis."

Positive

"The practice had a long history of promoting nurse led chronic disease management success in the work done with patients suffering from asthma had resulted in an award from a nationally known organisation."

Positive

"Friendly confidential and teenage specific services are available and run by a named advanced nurse practitioner at the practice."

Positive

"During our visit we spoke with two GP partners nurse partner who is an advanced nurse practitioner and prescriber a practice nurse health care assistant GP registrar and medical student and administrative and reception staff."

Positive

"The practice team included a dispensary manager who worked closely with GPs and nurse prescribers to ensure that staff were following current guidance and appropriately monitoring patients."

Positive

"The nursing team comprises of a nurse practitioner two practice nurses and two health care assistants."

Positive

"The practice enabled their nurses in attending a Cornwall based practice nurse conference to support their development."

Positive

"Meetings were held with the health visitor and school nurse to discuss vulnerable children every month."

Positive

"Patients who had more than one medical condition were given one appointment which could involve the nurse GP and health care assistant this avoided multiple visits to the practice and demonstrated a more holistic and personcentred approach."

Neutral

"Community based nurses were based at the practice which meant that GPs could liaise quickly with the end of life specialist nurse and community nursing team."

Neutral

"The practice had carried out an audit to determine whether there was enough nurse time allotted for annual check appointments."

Neutral

"The practice worked collaboratively with the community nursing team and end of life nurse specialist who all attended multidisciplinary meetings there."

Neutral

"Young people had access to information and could request chlamydia screening and be seen by a practice nurse specifically trained in these areas."

Neutral

"The practice liaised with the learning disability nurse specialist to ensure information was communicated in a person centred way for example in easy read or picture formats."

Neutral

"Staff had extended their qualifications which meant that two GPs and the nurse practitioner were able to deliver a home detoxification service for people who are addicted to alcohol."

Neutral

"The nursing staff received their clinical appraisal from the nurse practitioner partner andor a GP at the practice."

Neutral

"Close working links with the school nurse were used to gain a broader understanding of whether a young person had the maturity to make decisions and understand potential risks before advice or treatment was provided."

Neutral

"The practice offered new patients a health check with a nurse or with a GP if a patient was on specific medicines when they joined the practice."

Neutral

"Reception staff had received training and were able to describe how they recognised if a patient in the waiting room may need prompt attention by a nurse or GP."

Neutral

"Same day appointments were available throughout each day as there was always a duty GP or nurse present at the practice."

Neutral

"For example there was a lead nurse for infection control and a GP partner acting as lead for safeguarding children and adults."

Positive

"Staff had support to develop their skills to improve performance and provide effective health monitoring for patients at the practice."

Positive

"Management monitoring and improving outcomes for people The practice showed us a copy of the last teaching practice report by the Peninsula Medical Deanery which demonstrated that GPs used an evidence based approach and utilise every opportunity to review and improve their practice."

Positive

"They told us that the GPs and practice nurses were excellent and thorough when it came to diagnosis treatment and ongoing monitoring of long term health conditions."

Positive

"The practice team included a dispensary manager who worked closely with GPs and nurse prescribers to ensure that staff were following current guidance and appropriately monitoring patients."

Positive

"Learning and improvement from safety incidents There were systems for reporting recording and monitoring significant events and accidents."

Positive

"There was a system in place for the management of high risk medicines which included regular monitoring in line with national guidance."

Positive

"Staff across the practice had key roles in monitoring and improving outcomes for patients."

Positive

"However monthly monitoring of these patients needed further improvement."

Positive

"In some areas this exceeded the national average particularly with regard to monitoring vulnerable patients and those with long term conditions."

Positive

"At the time of our inspection the temperature in the dispensary was within the recommended temperature range for storing medicines however there were no records of temperature monitoring kept."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"Personal Care Plans PCPs had been completed for all patients that may have a higher risk of emergency hospital admission; this information had been gained from local intelligence and reports which enabled closer monitoring of this group of patients."

Neutral

"Both teams shared a ‘watch’ list of patients at risk so that early interventions such as additional support and monitoring could be put in place to avoid unplanned admission to hospital."

Neutral

"Staff told us about the arrangements for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs."

Neutral

"Designated staff were assigned the task of monitoring all patients on this medication and recalling them for blood tests."

Positive

"GPs told us that treatment escalation plans were always discussed with patients on the register and their wishes about end of life care needs recorded."

Positive

"The GPs told us they lead in specialist clinical areas such as respiratory disease end of life care diabetes and dementia."

Positive

"The practice undertook a search for patients who were on this particular medicine following the alert and where appropriate had discontinued or given an alternative medicine."

Neutral

"Staff told us that the particular medicine was now only prescribed to patients for short courses and patients were closely monitored whilst on it."

Neutral

"For example GPs had carried out two audits looking at patients taking a short term medicine primarily used to treat rheumatic conditions."

Positive

"Care planning and involvement in decisions about care and treatment Data showed that the practice was performing better with regard to maintaining a palliative care register for patients."

Positive

"The nearest hospice to the practice was in St Austell so the team of GPs worked closely with the palliative care team to support patients to be at home and receive services there."

Positive

"A palliative care register was held and reviewed regularly."

Neutral

"Issues were reviewed at the monthly clinical governance meetings."

Positive

"Following each clinical audit changes to treatment or care were made where needed and the audit repeated to ensure outcomes for patients had improved."

Positive

"We reviewed a number of policies induction policy and management of health and safety which were in place to support staff."

Positive

"Health and safety information was displayed for staff to see and there was an identified health and safety representative."

Positive

"Staff told us they had received an induction that covered health and safety matters such as fire safety."

Neutral

"There were cleaning schedules in place and cleaning records were kept."

Neutral

"For example cleaning services were carried out by an external contractor and the practice had copies of the audits completed each month."