Archived: Barnsley Road Surgery

Updated 7 January 2016

Barnsley Road Surgery is located in Sheffield. The practice is based in two storey converted house and an annex. There are 2738 registered patients at the practice. Access for patients with a disability is limited to the ground floor and there are shallow steps to the entrance. The practice has a comparable national average population of patients aged 40 to 75 year olds.

The practice provides Primary Medical Services (PMS) under a contract with NHS England. It also offers a range of enhanced services such as extended hours, remote care

monitoring, minor surgery, facilitating timely diagnosis and support for people with dementia, learning disabilities and childhood vaccination and immunisations.

Barnsley Road Surgery has one male GP and one female salaried GP. There is one female nurse and two healthcare assistants. These are supported by a practice manager and an experienced team of reception/administration staff.

The practice is open between 9.00am to 5.45pm Monday to Friday, with the exception on Thursday when the practice is closed at 12.30pm. Appointment times are Monday to Friday 9.00am to 5.30pm, with the exception on Thursday when the last appointment is 11.30. Extended hours are Thursday 6.45am to 11.30am. When the practice is closed, out-of-hours services are provided by Sheffield GP Collaborative.

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barnsley Road Surgery on 13 October 2015. Overall the practice is rated as inadequate.

Our key findings across all the areas we inspected were as follows:

• Staff generally understood and fulfilled their responsibilities to raise concerns and to report incidents, near misses and any identified safeguarding issues.
• Staff had received role specific training to improve and extend services for patients.
• Information about services and how to complain was available and easy to understand.
• Urgent appointments were available for patients the same day as requested, although not necessarily with a GP of their choice.
• Patients said they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.
• The practice acted on feedback from patients through complaints, NHS Choices website GP national survey and the Friends and Family test and had focused on improving the patient experience of the services provided.

The areas where the provider should make improvement are:

• Ensure staff receive annual appraisals.
• Ensure there is access for patients with mobility difficulties and/or wheelchair users.
• Ensure clinical staff receive supervision.
• Ensure there is written information available for carers so they understood the various avenues of support available to them.
• Ensure there is a Patient Participation Group.

The provider must make improvements in the following areas:

• The practice had limited formal governance arrangements.
• Systems and processes were not in place to assess, monitor and mitigate risks to patients. Incidents were not always recorded and significant events were not reported to the appropriate authorities. A fire risk assessment had not been completed annually. Fire drills had not been carried out. There was no ongoing programme of clinical audits to monitor quality and systems and identify where action should be taken. There was no system in place for recording verbal complaints.
• There were policies in place, however there were no dates of implementation or review dates.
• The practice did not have a system to share information about new clinical guidelines produced by the National Institute for Health and Care Excellence (NICE).
• Processes to ensure the safe storage of vaccines were applied inconsistently and records were not adequately maintained. Appropriate action had not been taken to mitigate risk when vaccines had been exposed to temperatures above recommended levels.
• The practice did not have oxygen for dealing with emergencies
• Systems and processes for infection prevention and control (IPC) were not adequate.
• Staff had not received training or regular updates relevant to their role such as, health and safety, fire safety, consent, information governance, safeguarding vulnerable adults and children and infection prevention and control.
• Disclosure and barring checks (DBS) had not been undertaken for health care assistants, Salaried GP and non clinical staff. Non clinical staff and a healthcare assistant acted as chaperones. The practice had made the decision not to carry out a DBS check for the non clinical staff, and could not provide a clear rationale as to why.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

The provider was rated as inadequate for safety, effective and for well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All patients had a named GP and a structured annual review to check their health and medication needs were being met. For those people with the most complex needs, the named clinician worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 7 January 2016

The provider was rated as inadequate for safety, effective and for well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

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 accident and emergency (A&E) attendances. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice told us all young children were prioritised and the under-fives were seen on the same day as requested. Patients we spoke with during our inspection told us children and young people were treated in an age-appropriate way and were recognised as individuals. The practice provided sexual health support and contraception, maternity services and childhood immunisations. Data showed immunisation uptake rates were higher for the locality.

Updated 7 January 2016

The provider was rated as inadequate for safety, effective and for well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Nationally reported data showed that outcomes for patients were similar to others in the local CCG area for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of older people in its population. Longer appointments, home visits and rapid access were available for those patients with enhanced needs. The practice worked closely with other health and social care professionals, such as the district nursing team and community matron, to ensure housebound patients received the care they needed.

Updated 7 January 2016

The provider was rated as inadequate for safety, effective and for well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible. The practice provided extended opening hours. For example, the practice had extended hours on Thursday mornings from 6.45am to 8.00am. The practice also offered online services, telephone triage/consultations and a full range of health promotion and screening that reflected the needs of this age group.

Updated 7 January 2016

The provider was rated as inadequate for safety, effective and for well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

All patients had a named GP. Annual health checks were offered for these patients and data showed 100% had received one in the last twelve months. The practice actively screened patients for dementia and maintained a register of those diagnosed. It carried out advance care planning for these patients. Training had not been provided for staff relevant to consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.

The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example the local mental health team. It provided readily available on how to access various support groups and voluntary organisations, such as Age UK and the domestic abuse charities. The practice also hosted Improving Access to Psychological Therapies programme (IAPT) to support patient’s needs.

Updated 7 January 2016

The provider was rated as inadequate for safety, effective and for well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice had a system to alert staff of patients living in vulnerable circumstances, including those who had a learning disability and they carried out annual health checks for people with a learning disability. Longer appointments were available for patients as needed.

We reviewed staff training records. Staff had undertaken child protection training in 2007. There was no evidence that staff had completed safeguarding adults training. However, staff knew how to recognise signs of abuse in adults and children. They 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 worked with multidisciplinary teams in the case management of this population group. It provided information on how to access various support groups and voluntary organisations.