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BARDOC - Waters Meeting Health Centre Good

Inspection Summary

Overall summary & rating


Updated 23 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Waters Meeting Health Centre (part of Bolton,Bury and Rochdale Doctors on Call Out of Hours service – BARDOC) on 7 February 2017. Overall the practice is rated as good.

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

  • The provider demonstrated an open and transparent approach to safety and systems were in place for reporting, recording and providing feedback on significant events. Staff at this site completed details on the BARDOC ‘hub’ Staff at other sites used the BARDOC ‘web’ or gave shift leads the information. Staff we spoke with were aware of their responsibilities to raise concerns and report incidents.
  • The service was monitored against the National Quality Requirements (NQRs) and Key Performance Indicators (KPIs). The data provided information to the provider and commissioners about the level and quality of service being provided. Where variations in performance were identified, the reasons for these were reviewed and action plans implemented to improve the service.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff received appropriate training and updating which provided them with the skills, knowledge and experience to deliver effective care and treatment.
  • Clinical supervision and appraisal processes were in place. Clinicians received regular audit of their clinical practice using the Royal College of GPs urgent care tool the ‘Clinical Guardian’ system, and were provided with feedback, including areas for improvement. Call handling staff of all disciplines received regular call audits to monitor effectiveness and safety standards.
  • Patients were triaged by clinicians at Moorgate Primary Care Centre or Waters Meetings Health Centre, and appointments offered at Waters Meeting Health Centre when appropriate, in accordance with the disposition (outcome) of the assessment.
  • Information about services and how to complain was available on the provider website. We saw that verbal complaints were recorded as ‘patient feedback’. Complaints were investigated and patients received an apology and explanation of actions taken following their complaint
  • Staff had access to comprehensive safeguarding policies and procedures, and received training appropriate to their role. Staff demonstrated their awareness of their safeguarding responsibilities in relation to vulnerable children and adults; including frequent callers to the service.
  • Vehicles used to transport GPs to home visits were clean, well maintained and appropriately equipped.
  • There was strong and clear leadership from a clinical and senior management perspective. Staff felt supported by management who were visible on shifts on a daily basis to support the smooth running of the service.
  • The provider proactively sought feedback from staff and patients, which it acted on.
  • There were systems in place to provide integrated person-centred care. Special patient notes were used to record relevant information about patients who were nearing end of life or those with complex medical and/or social needs.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

  • Vulnerable citizens’ packs were in use, and carried in each of the cars in the fleet. These contained basic essential items such as water and a blanket; they also contained details of where out of hours treatment and dispensing centres were located. These were issued to members of the public who appeared to be vulnerable or in need, observed by the driver or visiting doctor en route to home visits.

  • We saw evidence that inappropriate referrals to accident and emergency at Bolton hospital had been reduced betweenFebruary 2016 and October 2016. This had been achieved by raising awareness amongst staff, training, and the additional clinical support provided by clinical floor walkers.

The areas where the provider should make improvement are:

  • Consider taking steps to standardise and streamline the incident reporting system to create one system for all staff to use. At the time of our visit the method of reporting incidents varied according to level of connectivity with the main server.

  • Review their arrangements for monitoring working hours for GPs and other staff working on a sessional basis.

  • Maintain clear communication with facilities and premises management to ensure that premises’ risk assessments are appropriately updated and identified actions completed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas



Updated 23 May 2017

The provider is rated as good for providing safe services.

  • There were systems in place for reporting and recording incidents and significant events.

  • Lessons were shared to make sure action was taken to improve safety in the organisation.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The provider had systems in place to ensure that people seeking to work at BARDOC out of hours service (OOH) were appropriately recruited and vetted to ensure their eligibility and suitability for their role. We saw that medical indemnity was checked for all GPs. The provider told us it was the responsibility of the individual practitioner to ensure that their indemnity covered them for their total number of hours worked.

  • The provider had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from harm and abuse.

  • Risks to patients were assessed and managed. We were informed that the facilities and premises management teams undertook risk assessments relating to the premises.

  • Medicines were safely and securely stored. Systems were in place to safely monitor the use of prescriptions.

  • Vehicles used to take clinicians to patients’ homes for consultations were well maintained, cleaned and contained appropriate emergency medical equipment and medicines.

    Emergency equipment held at Waters Meeting Health Centre was appropriately maintained and regular checks were carried out.



Updated 23 May 2017

The provider is rated as good for providing effective services.

  • Data from the National Quality Requirements (NQRs) and Key Performance Indicators (KPIs) showed the provider outcomes were at or above average compared to the national average.

  • We saw that systems were in place to ensure all clinicians were up to date with National Institute for Health and Care Excellence (NICE) guidance, as well as other locally agreed guidelines.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Staff received monthly audits of their call and prescribing activity. Staff were assessed against a set of standard criteria. Following audits, staff were given feedback on their performance, with indicators of where improvement needed to be made. This was monitored to check that improvement was sustained.

  • The provider undertook clinical audits which demonstrated improved patient outcomes.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff received training and updates relevant to their role and systems were in place to monitor uptake of mandatory training for all staff.

The service worked closely with patient’s own GPs and other healthcare providers. Information was shared between these and the out of hours service



Updated 23 May 2017

The provider is rated as good for providing caring services.

  • Data showed that patients rated the service similar to others in relation to the care and treatment they received.

  • Patients said they were treated with compassion, dignity and respect by helpful, polite and caring staff. They told us they were satisfied that they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.



Updated 23 May 2017

The provider is rated as good for providing responsive services.

  • The provider undertook continuous engagement with patients to gather feedback. Changes were considered to the way it delivered services as a consequence of this feedback. Patient satisfaction, patient safety, friends and family test results and Healthwatch information was also discussed.

  • The service understood the needs of the population it served, and engaged with local Clinical Commissioning Groups (CCGs) to provide services which were responsive to the needs of their population.

  • Plans were developed by the patients’ own GPs and shared with the out of hours GP service for those patients with complex needs; including people with long term conditions and complex physical and mental health needs. Special notes were used to record relevant information about patients.

  • Patients said they were offered appointments at a time and location which was convenient to them.

  • Information about how to complain was available and easy to understand. Evidence showed the service responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.



Updated 23 May 2017

The provider is rated as good for being well-led.

  • The provider had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • The service was responsive to feedback and used performance information to support service redesign and development.

  • The views of patients were taken into account and acted upon through close liaison with Healthwatch.

  • A nominated whistleblowing lead had been appointed to ensure transparency and efficiency in dealing with any whistleblowing incidents.

  • The provider had a range of policies and procedures to govern activity. Regular governance meetings were held.

  • There was an overarching governance and performance management framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the duty of candour. The senior management team encouraged a culture of openness and honesty.

    The service had systems in place to record and manage safety incidents, and ensured this information was shared with staff, and any necessary action was taken.

  • There was a strong focus on continuous learning and improvement at all levels.

    We saw that staff were facilitated to continuously learn and enhance their skills.

  • We saw staff treated patients with kindness and respect, during face to face and telephone interactions. We saw that patient and information confidentiality was maintained.

  • Staff described several examples of where the provider showed flexibility in accommodating staff requirements in relation to caring responsibilities, family crises or other personal issues.