Background to this inspection
Updated
21 May 2018
Barndoc Healthcare Limited Out of Hours Service (Barndoc OOH Service) provides urgent medical care and advice out-of-hours (OOH) for over one million residents of Barnet, Enfield and Haringey who are registered at general practices within these London Boroughs.
On 4 October 2016, five north central London Clinical Commissioning Groups: Barnet, Camden, Enfield, Haringey and Islington launched an integrated NHS 111 out of hours service. The contract to provide the service is held by London Central and West Unscheduled Care Collaborative (LCW).
The integrated NHS 111 out of hours service is delivered in partnership with Barndoc OOH Service who is a material subcontractor. Barndoc OOH Service is subcontracted by LCW to provide the GP out of hours element of the service for Barnet, Enfield and Haringey CCG areas. The service includes telephone clinical assessments with GPs and nurses, GP home visits and face to face consultations at primary care base locations in Barnet, Enfield and Haringey.
Together, Barndoc OOH Service and LCW work in partnership to deliver a single IUC service across North Central London.
The service is provided for registered patients and those requiring immediately necessary care when GP practices are closed; namely overnight, during weekends, bank holidays and when GP practices are closed for training.
Barndoc’s managerial and administrative staff are based at its operational headquarters in Cockfosters, Barnet. The service’s three primary care base locations are located at:
Enfield
Chase Farm Hospital
The Ridgeway
London
EN2 8JL
Barnet
Finchley Memorial Hospital
Granville Road
London
N12 0JE
Haringey
The Laurels
256 St Ann's Road
London
N15 5AZ
Barndoc OOH service’s staff team includes a chief operating officer, a medical director, a deputy medical director, a head of operations, a head of governance, a head of corporate services, a rotamanager, finance team, call handling staff, drivers, nurses and GPs. There is also an external pharmacy contractor for the management of medicines. The service employs sessional (self-employed contractor) GPs directly and occasionally through agencies.
The opening hours are seven days a week from 6:30pm to 8am and 24 hours at weekends and bank holidays. Barndoc OOH Service sees an average of 500 patients per week.
Patients access Barndoc OOH Service via the NHS 111 telephone service. Depending on their needs, patients may be seen by a GP at one of the service’s three base locations, receive a telephone consultation or a home visit. The service accommodates overnight walk in patients at one of its bases (Chase Farm Hospital).
Barndoc Healthcare Limited (Out Of Hours Service) is registered for the Regulated Activities of Transport services, triage and medical advice provided remotely; and Treatment of disease, disorder or injury. The service has been registered since January 2012.
This inspection was conducted to check that improvements planned by the service to meet legal requirements had been made.
Updated
21 May 2018
Letter from the Chief Inspector of General Practice
This service is rated as Good.
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Good
We carried out an announced comprehensive inspection at Barndoc Healthcare Limited Out of Hours Service (Barndoc OOH) on 20 and 22 February 2018. This inspection was to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 and 20 February 2017. At that time we rated the service as inadequate for providing safe services, requires improvement for providing effective services, good for providing caring services, good for providing responsive services and requires improvement for providing well led services. Overall we rated the service as requires improvement.
This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
At this inspection we found that:
- Risks to patients were well assessed and managed. For example, the provider had taken action to address infection prevention and control risks; and risks associated with medicines management which we had identified at our February 2017 inspection.
-
The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
-
The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
- The service’s three primary care base locations had good facilities and were well equipped to treat patients and meet their needs.
-
Primary care base GPs and receptionists treated people with compassion, kindness, dignity and respect.
-
Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
-
The provider was aware of and complied with the requirements of the duty of candour.
-
There was a strong focus on continuous learning and improvement at all levels of the organisation.
The areas where the provider should make improvements are:
-
Review the newly implemented procedure for monitoring the storage of medicines and equipment at primary care bases, to ensure that the risks of storage at temperatures outside of the recommended range are managed.
-
Review the way in which unused prescriptions are recorded following home visits, in line with its protocols.
-
Review the procedure for disposing of part used ampoules of controlled drugs on home visits.
- Revisit the risk assessment into its decision not to carry oxygen in home visit vehicles, so as to ensure that this takes into account all reasonable circumstances.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice