Archived: Barley Surgery

Updated 25 July 2016

Barley Surgery is located in a village near to Royston in Hertfordshire. There is also a branch surgery called Market Hill.

The practice is run by a partnership of two GPs (two males). The practice employs 3 salaried GPs, a nurse practitioner, two practice nurses and a phlebotomist. The clinical team is supported by a practice manager and a team of seven administrative and reception staff. The practice dispenses to around 3500 patients and employs 3 dispensers to provide this service.

The registered practice population of 7,160 are predominantly of white British background, and. the practice deprivation score is low compared with the rest of the country. The practice age profile has higher percentages of patients over 65 years at 20% of the total registered patients, compared to the CCG average of 16%. It has lower percentages of patients under the age of 18.

Both Barley Surgery and Market Hill are open from 8.30am until 6.00pm Monday to Friday. Extended hours opening is available at Barley Surgery on a Monday evening until 8.15pm and on Saturdays 8.30am to 10.30am.

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed patients are directed to the 111 service.

The practice holds a General Medical Service (GMS) contract to provide GP services which is commissioned by NHS England. A GMS contract is a nationally negotiated contract to provide care to patients. In addition, the practice also offers a range of enhanced services commissioned by their local CCG: including minor surgery, facilitating timely diagnosis and support for people with dementia and extended hours access.

Updated 25 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barley Surgery on 5 May 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, and we saw evidence that learning was applied from events to enhance patient care and safety.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment, and clinicians had lead areas of responsibility.

• Patients expressed high levels of satisfaction with the practice, citing caring and attentive staff, ease of access and being involved in decisions. Figures from the national GP survey stated that 90% of patients would recommend the surgery to someone new in the area. Feedback from patients we spoke with and also on comments cards was overwhelmingly positive. Patients described practice staff who ‘went the extra mile’ to ensure that individuals’ needs were met..

• Most patients said they found it easy to make an appointment with a GP, and usually this was with a GP of their choice. Routine appointments could usually be booked up to three months in advance and demand for appointments was actively monitored so that additional consultations could be made available in periods of high demand. Urgent appointments were available the same day.

• The practice used clinical audits to review patient care and took action to improve services as a result.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice worked effectively with the wider multi-disciplinary team to plan and deliver high quality and responsive care to keep vulnerable patients safe.

• The practice had an active Patient Participation Group (PPG) and worked with them to review and improve services for patients.

• The practice made changes to the way it delivered services as a consequence of feedback from patients.

• Information about services and how to complain was available and easy to understand.

• There was a clear leadership structure and staff felt supported by management. The partners and practice manager worked collaboratively with other local GP practices and made an active contribution to Clinical Commissioning Group (CCG) work streams.

There were areas where the practice should improve:

• The practice should register to directly receive patient safety updates from the Medicines Health and Regulatory Authority (MHRA).
• The practice should provide refresher training to staff who chaperone to ensure that they are able to protect both patients and clinicians by following most recent best practice.
• The practice should consider placing chaperone notices in consultation and examination rooms.
• The practice should provide spillage kits to ensure that staff are fully protected from the risk of infection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 July 2016

The practice is rated as good for services for patients with long term conditions.

• All patients with a long-term condition had a named GP and nursing staff had lead roles in chronic disease management. For those patients with the most complex needs and associated risk of hospital admission, the practice team worked with health and care professionals to deliver a multidisciplinary package of care. The practice had lower attendance rates at Accident & Emergency (A&E) than other practices locally and nationally in 2014/15.
• A recall system ranging from six to 12 months was in place to ensure patients received a regular review of their condition. This included reviews being done on home visits by GPs.
• The practice had a higher prevalence for patients with asthma than local and national figures. However QOF indicator performance for asthma was higher than CCG and national averages. For example, 76.9% of patients with asthma received a review in the preceding 12 months, compared to the CCG average of 75.7% and the national average of 75.3%. This was achieved with a lower rate of exception reporting than the local and national averages.
• The practice employed a nurse who specialised in the management of patients with asthma. We saw that the nurse managed high demand for the service effectively and offered proactive and flexible care to patients. We received feedback from three patients who saw the nurse for asthma treatment and they all felt that the standard of care was exceptionally good because they were reviewed regularly and felt empowered to manage their condition well.
• The achievement for QOF indicators related to the management of diabetes at 100% was above both local and national averages (89.2% and 89.2% respectively). The practice had established a pre-diabetes register, and routinely tested bloods for patients with a long-term condition to assess any risks of them developing the disease. This enabled patients to be directed to support to reduce the risk of them going on to develop diabetes.
• A nurse at the practice specialised in the care of diabetic patients and offered insulin initiation support and advice for patients. She provided her weekend mobile number and email address to patients who were taking insulin for the first time. Patients told us that this had increased their confidence in using insulin as they could contact the nurse if they were at all concerned, including when the practice was closed.

Updated 25 July 2016

The practice is rated as good for services for families, children and young people.

• The practice had a slightly lower percentage of patients within this population group compared with local averages. For example, 19% of patients were under 18 (CCG average 21%).
• Urgent appointments were available on the day to accommodate ill children.
• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. Monthly liaison meetings were in place between the practice and the midwife and health visitor to discuss any child safeguarding concerns. Arrangements were also in place to liaise with school nurses.
• Immunisation rates were high for all standard childhood immunisations. For example, vaccination rates for children ranged from 93% to 100%, compared against a CCG average ranging from 88% to 96%. The practice achieved 100% vaccination rates in eight of the 15 immunisation categories for two and five year olds.
• The practice referred children and young people into an age-specific counselling service. This helped younger people manage traumatic experiences including bereavement.
• Contraceptive services and advice was available, and one GP provided a service to fit coils and contraceptive implants. Sexual health support was available for younger people, and the practice provided chlamydia self-testing kits.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments with the practice nursing team were available outside of school hours.

Updated 25 July 2016

The practice is rated as good for services for older people.

• Patients over the age of 65 accounted for 19.6% of the total registered practice population. This was higher than the average figure of 16.1% across the CCG.
• The practice ensured it prioritised care for their older patients and offered proactive, personalised care to meet the needs of older people. Care plans were in place for older patients with complex needs. All patients had a named GP.
• The practice was responsive to the needs of older people, and offered home visits either from a GP or nurse practitioner. Urgent appointments were available for those with enhanced needs.
• Meetings were held with the wider multi-disciplinary team to support patients to live in their own homes and ensure they were kept safe, and had their individual needs met.
• The practice accessed the Single Point of Access to organise additional support for patients, for example input from the community rehabilitation team, to meet their needs and avoid an admission into hospital. The practice ensured that patients in need of social support were referred into the single point of access (SPA) to access a range of voluntary services to support them to live in their homes.
• The practice provided primary medical services to over 100 residents who resided in local nursing and residential care homes. A GP undertook a weekly ward round at these homes. All the patients received a full assessment at the first visit and care plans were formulated. We spoke to a manager from one of the homes who was very satisfied with the level of care provided by the GPs, and described the relationship with the practice as extremely positive. They told us the practice were responsive and caring, that they accommodated the individual needs of their patients, and the practice achieved good outcomes for their residents.
• Flu vaccination rates for the over 65s were 79% which was higher than the national figure of 73%.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages.

Updated 25 July 2016

The practice is rated as good for services for working age people.

• The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. This included good access to appointments including telephone consultations. An extended hours surgery was available on a Monday evening until 8pm.
• The practice offered online access for patients to book GP appointments and to request repeat prescriptions.
• 90% of women aged 25-64 had had a cervical screening test in the preceding 5 years, which was above the CCG average of 82% and the national average of 82%.
• NHS Health checks were available to patients and 535 eligible patients had attended for a check since the service became available. 

Updated 25 July 2016

The practice is rated as good for services for people experiencing poor mental health.

• The practice achieved 86.2% for mental health related indicators in QOF, which was 6.2% below the CCG and 6.6% below the national average; although the rate of exception reporting was consistently lower than both the CCG and national averages.
• All 31(100%) patients with ongoing serious active mental health problems had received an annual health check during the past twelve months. The practice had worked hard to ensure that patients were supported and confident to attend their review.
• 85% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This compared to CCG and national averages of 83%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health and patients with dementia about how to access various support groups and voluntary organisations. Leaflets were available in the waiting area on a range of services available for patients and carers.
• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 25 July 2016

The practice is rated as good for services for vulnerable people.

• The practice had carried out annual health checks for people with a learning disability, and 100% had attended for an annual review during 2014-15. All these patients had supporting care plans. The practice offered longer appointments for people with a learning disability.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• Homeless people could register with the practice.
• The practice ensured that patients in need of support were referred into the single point of access (SPA) to access a range of voluntary services to support them to live in their homes.
• 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.
• The practice provided good care and support for patients at end of life, and worked within nationally recognised standards of high quality end of life care. Patients were kept under close review by the practice in conjunction with the wider multi-disciplinary team.