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Inspection Summary


Overall summary & rating

Good

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barnby Gate Surgery on 22 October 2015. Overall the practice is rated as good.

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

  • The practice had robust arrangements to deal with information about safety. Staff were aware of responsibility to report incidents and concerns and knew how to do this. Information relating to safety was documented, monitored and reviewed; however details of investigations related to significant events needed to be more thorough.
  • Risks to patients were assessed and well managed with the exception of those relating to recruitment checks.
  • The practice demonstrated the use of best practice guidance to assess patients’ needs and plan their care. Staff had received relevant role specific training and further training needs were identified for staff through appraisals although we found that one member of staff had not undergone an appraisal.

  • Patients told us staff treated them with compassion, dignity and respect and involved them in decisions about their care.
  • Information about how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

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

  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw one area of outstanding practice:

  • The practice worked to support their practice population and their wider community. For example the practice undertook collections for their local food bank. In addition to this, the practice worked with their patient participation group to undertake initiatives which promoted the wellbeing of their patients. The PPG had a successful allotment project and fresh produce from the allotment was offered to patients for free or in exchange for a small donation.

The areas where the provider should make improvement are:

  • The practice should ensure that records of investigations of all significant events and incidents are thorough and reflect discussions and learning outcomes

  • The practice should ensure all staff receive annual appraisals

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 January 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events; however the practice needed to ensure reviews and learning from events were documented in all instances.

  • Learning from significant events was shared within the practice and staff were able to give examples of recently discussed events.

  • The practice had systems and processes in place to ensure that staff and people using services were kept safe. These included robust arrangements to safeguard children and vulnerable adults.

  • Risks to patients and staff were assessed and generally well managed. However, we identified one instance where the practice had not followed its policy in respect of obtaining references for a new member of non-clinical staff.

Effective

Good

Updated 14 January 2016

The practice is rated as good for providing effective services.

  • Information we reviewed showed that outcomes were mainly in line with the locality. The practice was aware of areas which required improvement and showed evidence of working to address these. For example data showed that the practice had improved performance in respect of hypertension monitoring.

  • Staff had access to local and national guidelines and used these routinely to plan and deliver patient care.

  • We saw evidence that the practice was undertaking clinical audits and these were being used to drive improvements.

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

  • There was evidence of appraisals and personal development plans for all staff with the exception of a member of the nursing staff.

  • We saw evidence of effective multidisciplinary working with external organisations. For example, the practice worked closely with a wide range of health and social care professionals to ensure their patients had the appropriate care in place to avoid admissions to hospital.

Caring

Good

Updated 14 January 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice highly for several aspects of care.

  • Patients told us they were treated with compassion, dignity and respect.

  • Patient survey data and patient comments indicated that patients felt involved in decisions about their care and treatment.

  • The practice provided a range of information about services which was easy to understand and accessible.

  • We observed that staff treated patients with kindness and respect.

  • The practice demonstrated a caring attitude towards their patient population and their wider community. For example the practice undertook collections for the local food bank and raised money for local charities. In addition to this, the practice supported the work of their patient participation (PPG) group in running an allotment project to benefit the community

Responsive

Good

Updated 14 January 2016

The practice is rated as good for providing responsive services.

  • It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example the practice was working to make improvements to its premises to increase space and capacity.

  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. However, patients were only able to book routine appointments one week in advance.

  • 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 and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 14 January 2016

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

  • The practice had clearly documented aims to treat all patients as individuals and to deliver a high quality of service provision. Staff were clear about the vision and their responsibilities in relation to this.

  • There was a clear leadership structure and staff felt supported by partners and management.

  • The practice had a wide range of policies and procedures to govern activity and held regular governance meetings.

  • The partners encouraged a culture of openness and honesty and staff felt supported to raise issues and concerns.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was well established and met regularly. The PPG worked closely with the practice to benefit the wider community by running an allotment project and a walking group.

Checks on specific services

People with long term conditions

Good

Updated 14 January 2016

The practice is rated as good for the care of people with long-term conditions.

  • 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 these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • We saw evidence that the practice was aware of areas for improvement and was actively working with staff to improve recording. Data demonstrated that

Families, children and young people

Good

Updated 14 January 2016

The practice is rated as good for the care of families, children and young people.

  • 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 A&E attendances. The practice held regular documented safeguarding meetings with external professionals.

  • Immunisation rates were relatively high for all standard childhood immunisations.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • Rates for cervical screening were in line with local and national averages

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • Children were given priority in duty surgeries to minimise waiting times.

Older people

Good

Updated 14 January 2016

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice had an active PPG who had a successful allotment for patients of the practice and organised a walking group to promote patient wellbeing.

  • The practice worked effectively with the multi-disciplinary team to identify patients at risk of admission to hospital and to ensure their needs were met.

  • The percentage of people aged 65 or over who received a seasonal flu vaccination was 72.8% in line with the national average of 73.2%.

Working age people (including those recently retired and students)

Good

Updated 14 January 2016

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.

  • Appointments were bookable in person, online and by telephone and telephone consultations were offered where appropriate.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • 84.7% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was 3.3% above the CCG average.

  • The practice held monthly multi-disciplinary teams to discuss the case management of people experiencing poor mental health, including those with dementia.
  • The practice told patients experiencing poor mental health how to access various support groups and voluntary organisations.

  • The practice had systems in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff had a good understanding of how to support people with mental health needs and dementia and told us there were no barriers to patients accessing their services.

People whose circumstances may make them vulnerable

Good

Updated 14 January 2016

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 homeless people, travellers and those with a learning disability.

  • It offered longer appointments for people with a learning disability.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • It had told vulnerable patients about how to access various support groups and voluntary organisations.

  • 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.