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Barton Family Practice Good Also known as Dr White & Partners

Inspection Summary


Overall summary & rating

Good

Updated 1 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barton Family Practice on 4 July 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
  • Risks to patients were assessed and well managed.
  • 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.
  • Feedback from patients about their care was consistently positive and the practice scored higher than local and national averages in all questions included in the GP National Patient Survey.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Investigations were made to the quality of care as a result of complaints and concerns. Results including learning outcomes were documented and shard with all staff.
  • Patients complimented the practice on acess to appointments with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice had excellent facilities and was well equipped to treat patients and meet their needs. These included a dedicated minor surgery suite.
  • There was a clear leadership structure and staff felt supported by management. There was positive comments from staff on teamwork and the practice proactively sought feedback from staff and patients, which it acted on.

  • The provider was aware of and complied with the requirements of the Duty of Candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 1 September 2016

The practice is rated as good for providing safe services. There was an effective system in place for reporting and recording significant events. Lessons were shared to make sure action was taken to improve safety in the practice. When things went wrong patients received reasonable support, relevant information and an apology. They were also told about any actions to improve processes to prevent the same thing happening again. The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from the risk of abuse. Risks to patients were assessed and well managed.

Effective

Good

Updated 1 September 2016

The practice is rated as good for providing effective services. Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were consistently above the locality and the national average. Staff assessed needs and delivered care in line with current evidence based guidance. Clinical audits demonstrated quality improvement. 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. Staff worked with other health and social care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 1 September 2016

The practice is rated as good for providing caring services. Data from the national GP patient survey showed patients rated the practice above local and national avearges for all aspects of care. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information for patients about the services available was easy to understand and accessible. We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality. Patients were encouraged to let the practice know whether they were a carer and were asked to complete information forms online or in paper format with their details. Patients could be referred by the practice or could self-refer to the Carers Hub. The Carers Hub delivered one to one sessions ever two weeks in the practice to help support carers and their needs. This information helped to ensure that the carer received appropriate support, for example annual health checks and flu vaccinations were offered to all carers. Priority appointments were available for carers and patients who were cared for. The practice had arranged for a dedicated section on the school noticeboard to promote services available to young carers.

Responsive

Good

Updated 1 September 2016

The practice is rated as good for providing responsive services. Practice staff 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.

Patients said they found it easy to make an appointment with a named GP and 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. Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 1 September 2016

The practice is rated as good for being well-led. The practice had a clear vision and strategy. The use of family in the name of the practice related to deliver high quality care and develop strong connections with the patients. Staff were aware of the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by the management. The practice had a number of policies and procedures to govern activity and held regular governance meetings. There was an overarching governance 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 partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken. The practice proactively sought feedback from staff and patients, which it acted on.

The patient participation group was established and actively involved in working with the practice to produce annual action plans that included a health awareness day and patient educational events. The practice had established an 800 strong virtual patient group and used this medium of communication to promote health initiatives, education and awareness. For example, the practice achieved high immunisation uptake rates and attributed this to the promotion done using the database of patients. There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 1 September 2016

The practice is rated as good for the care of people with long-term conditions (LTCs). The GPs and nursing staff had lead roles in chronic disease management. The practice used a risk stratification tool to identify two per cent of patients most at risk of hospital admission. A care plan had been completed for each of these patients and was reviewed at least annually. The practice was a consistent high achiever for the quality outcomes framework (QOF) indicators. The latest data from 2014/15 showed that patients with long term conditions received regular reviews. For example, 99% of patients on the diabetes register had received a foot check and a risk classification in the preceding 12 months (the national average is 88%). QOF is a system intended to improve the quality of general practice and reward good practice. The practice had a robust patient recall system and used health awareness days and education events specific to an LTC to support a patient centred, empowerment approach to chronic disease.

Daily emergency appointments, longer appointments and home visits were available when needed for these patients. A structured annual review to check their health and medicines needs were being met was carried out and patients had a named GP. The practice had two dedicated chronic disease management nurses, one for asthma and chronic obstructive pulmonary disorder (COPD) and one for diabetes care. For those patients with the most complex needs, the named GP and nursing staff worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice worked with the Adult Ability Team to reduce hospital admissions and provide respite to carers.

Families, children and young people

Good

Updated 1 September 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 who were at risk, for example, children and young people were coded after an A&E attendance so that reports could be produced to identify any patterns of regular attendance. All staff had received training in child safeguarding. Same day appointments were provided for children and were available outside of school hours. We saw positive examples of joint working with midwives and health visitors. Health visitor led baby clinics were held on the premises for child health surveillance and the practice provided postnatal checks for mother and six week baby checks. For convenience and whenever possible, the practice aimed to offer both mother and baby checks at convenient times on the same day. As part of the registration process, the practice established if a patient had parental responsibility. The practice supported mothers who wished to breastfeed their child by providing a private room and a dedicated baby changing room was available within the building. The practice worked with Changes to provide additional support to 16-25 year olds. Changes is a mental health charity that aims to promote recovery and mental wellbeing.

Older people

Good

Updated 1 September 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 and all patients aged 65 years and over had a named GP. The practice offered home visits at designated times and urgent appointments for those older patients who had difficulty attending the surgery. The practice had high levels of older patients who lived independently. Practice staff and members of the community team we spoke with on the day described good communication spoke of a close working relationship between the practice and the healthcare staff based in the community. Detailed medication reviews were carried out on discharge from hospital and the Clinical Commissioning Group (CCG) pharmacist linked to the practice assisted in the completion of medication reviews for patients aged over 65 years. The practice achieved high uptake rates on vaccinations offered to the elderly patient cohort, for example, 100% of patients had received or declined the shingles vaccination.

Working age people (including those recently retired and students)

Good

Updated 1 September 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. Appointments could be booked up to two months in advance and patients told us of an effective telephone GP and nurse consultation service that provided a same day response. The practice was proactive in offering online services which included repeat prescription ordering and access to patient records. A full range of health promotion and screening that reflected the needs for this age group was also available.

People experiencing poor mental health (including people with dementia)

Good

Updated 1 September 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients diagnosed with dementia were invited for annual face to face reviews and care plans were completed. The practice regularly worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia. The practice offered patients who experienced poor mental health continuity of care and appointments with the same GP and a GP partner was the lead in managing patients with complex mental health conditions. Staff had a good understanding of how to support people with mental health needs and dementia. All staff had received training in how to deal with mental health.

People whose circumstances may make them vulnerable

Good

Updated 1 September 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 identified as vulnerable and all reception staff had received training in safeguarding and how to deal with vulnerable patients. A register of patients with a learning disability was held and there were seven patients on the register. All were offered an annual health check with the support of the local community learning disability team, three had attended. Longer appointments were offered to patients with a learning disability. Staff were aware of their responsibilities regarding confidentiality, information sharing, documentation of safeguarding concerns and how to contact relevant agencies. 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.