Archived: Barton Surgery

Updated 2 July 2015

Barton Surgery delivers primary care under a Primary Medical Services contract between themselves and NHS England. As part of the Devon Clinical Commissioning Group (CCG) they are responsible for a population of approximately 10000 patients.

There is a team of four GP partners (two female and two male), supported by two salaried GPs.

The practice GPs do not provide an out-of-hours service to their own patients. Patients are signposted to the local out-of-hours service when the surgery is closed at the weekends.

The practice is open six days a week and provides patient appointments between 830am and 6pm Monday to Friday. The practice also offers appointments between 6.30pm and 7pm four days a week for those people that are working. The practice is not a GP training practice at the moment but is hoping to be so again in the future.

The practice has a virtual patient representation group (PPG). This is a group that acts as a voice for patients at the practice.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

There were no previous performance issues or concerns about this practice prior to our inspection.

Updated 2 July 2015

Letter from the Chief Inspector of General Practice

We inspected Barton Surgery on 6th May 2015 as part of our comprehensive inspection programme. From all the evidence gathered during the inspection process we have rated the practice as good. The provider was rated as good for safe, responsive, caring, effective and well led services. It was also good for providing services for all of the population groups

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example working in partnership with the local consultant geriatrician.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice implemented suggestions for improvements and made changes to the way it

delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, which was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

The practice supported its patients and their families throughout difficult times. GPs carried out bereavement checks with patient’s relatives three months after the patient’s death to check how the relative was coping and to see if they needed any additional support.

The practice supported vulnerable patients by delivering the Violent Patient Scheme (VPS) to vulnerable patients in Torbay and South Devon. This was a scheme that was in place to protect staff from incidents of violence and aggression and to provide access to primary medical services for patients whose violent and aggressive behaviour has caused them to be removed from the GP practice list.

However, there were also areas of practice where the provider needs to make improvements.

In addition the provider should:

Update the practice handbook so that patients are aware the services offered by the practice and the opening times.

Introduce systems to ensure that portable equipment kept in GPs is routinely checked and testing equipment be kept in date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 July 2015

The practice is rated as good for the care of people with long term conditions. All patients were offered an annual review including a review of their medication, to check that their health needs were being met. When needed, longer appointments and home visits were available. Where possible, clinicians reviewed patient’s long term conditions and any other needs at a single appointment, to prevent them from attending various reviews. Emergency processes were in place and referrals were made for patients that had a sudden deterioration in their health. For those people with the most complex needs, a named GP worked with relevant health and care professionals to deliver multidisciplinary support and care.

Updated 2 July 2015

The practice is rated as good for the population group of families, children and young people. Systems were in place for identifying and following-up vulnerable families who were at risk. Staff were knowledgeable about child protection and proactive in raising concerns with the safeguarding lead to follow up on any identified. A GP took the lead for safeguarding with the local authority and other professionals to safeguard children and families.

Children and young people were treated in an age-appropriate way and were recognised as individuals. We saw that staff dealing with young people under 16 years of age without a parent present were clear of their responsibilities to assess Gillick competency. Sexual health, contraception advice and treatment were available to young people including chlamydia screening. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors who were based at the practice. Health visitors had access to the clinical system so notes could be made on records, or progress checked, easily. Immunisation rates were high for all standard childhood immunisations.

A primary care CAMHS (Children and Mental Health Service) worker held a clinic each week in the practice. During the clinic they had open access to GP’s for advice and or referral.

Updated 2 July 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population. It had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

GP’s had direct access to a care of the elderly consultant for advice on the best treatment and whether it was appropriate for the patient to stay in the community. The GPs were able to refer patients to the care of the elderly consultant’s rapid access clinics.

Data showed that 91% of patients received structured annual medication reviews for polypharmacy in the last year. The GPs worked with a pharmacy assistant (provided by the CCG medicines optimisation team) who visited the practice on a regular basis to review the prescribing data. This included running appropriate audits, assessing the prescribing data in comparison with local and national standards and feeding back to the whole practice on a regular basis.

Pneumococcal, influenza and shingles vaccination were provided at the practice for older people.

Having identified that many people with dementia remain undiagnosed, one of the GPs visited and screened patients in residential homes at risk of dementia and identified nine new cases, a 20% increase in numbers diagnosed at Barton surgery.

The practice is all on one level with lift access. Chairs in the waiting room include some with arm rests to assist patients to stand. They had a hearing loop fitted in reception, and a wheelchair on site. Staff had received training from the Alzheimer society and Torbay Dementia Alliance.

Updated 2 July 2015

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. 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. The practice provided travel advice and nurse led travel clinics within the practice. They were a designated Yellow Fever Vaccine Centre, so providing travel advice to patients who were not registered with this practice.

There was an easy to use appointment system, which supported patient choice and enabled the patients to access the right care at the right time. Extended hours telephone appointments were available each evening and pre-bookable face to face appointments on a Saturday morning.

There were telephone appointments available throughout the day rather than needing to attend the practice for face to face consultations. Patients had e-mail access to GP’s, and could book appointments by telephone, in person or on line. The practice used a text message reminder service for patients.

Updated 2 July 2015

The practice is rated as good for the care of people experiencing poor mental health. The practice held a register of patients experiencing poor mental health. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, to ensure their needs were regularly reviewed, and that appropriate risk assessments and care plans were in place. Patients were supported to access emergency care and treatment when experiencing a mental health crisis. Patients could be referred or refer themselves to the depression and anxiety services (DAS). DAS offered to see patients within the practice or at alternative venues where appropriate. Patients with mental health problems were encouraged to attend an annual review to include a discussion and review of their care plan and medicines.

Mental health medication reviews were conducted to ensure patients received appropriate doses, and blood tests were performed on patients receiving certain mental health medications.

The local consultant psychiatrist regularly attended practice meetings to ensure referral pathways and communication between the service and GP’s worked well, and to discuss individual cases where appropriate.

Updated 2 July 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including people with learning disabilities. Patients with a learning disability were offered an annual health review, including a review of their medication. When needed longer appointments and home visits were available. The practice was part of a local scheme to support the most vulnerable patients with the aim of managing their needs at home and avoiding unplanned hospital admissions. The practice worked with multi-disciplinary teams in the case management of people in vulnerable circumstances and at risk of abuse.

The practice supported vulnerable patients by delivering the Violent Patient Scheme (VPS) to vulnerable patients in Torbay and South Devon. This was a scheme that was in place to protect staff from incidents of violence and aggression and to provide access to primary medical services for patients whose violent and aggressive behaviour has caused them to be removed from the GP practice list.

Barton Surgery were working with the Citizens Advice Bureau on an initiative which involved a caseworker working in partnership with primary health teams at Barton surgery. They aimed to provide home visits to carers, disabled adults, families with children with disabilities and the frail elderly on complex non-medical issues. The aim of the post was to develop a linked, co-ordinated and holistic approach to support the carer (and cared for) to live well within their community through enabling better access to specialised advice, information, knowledge, skills, relationships and resources.

Patients with substance abuse problems could be referred or directed to open access clinics locally. GP’s could refer patients or encourage them to refer themselves to a primary care alcohol service.