Barton House Group Practice

Updated 18 January 2018

The Barton House Group Practice operates from 233 Albion Road, Stoke Newington, London

N16 9JT. The practice provides NHS primary medical services through a Primary Medical Services contract to just over 12,800 patients in the City and Hackney area. The practice is part of the City and Hackney Clinical Commissioning Group (CCG) and a Federation of 43 practices.

The practice has three male GPs and nine female GPs (this included one female locum and a female registrar). The GPs provide a combined total of 60 sessions or 69 sessions including the registrar. There were two practice nurses, two healthcare assistants, a practice clinical pharmacist, a practice manager, deputy practice manager, two reception supervisors and a reception / administrative team of twelve staff. The practice is a training practice. At the time of inspection there was one GP registrar placement. The practice also employs two part time counsellors and a Bengali speaking advocate. A Turkish translator attends the practice two days a week.

The practice has level access from the pavement and consultations are all provided on the ground floor level. There are good bus links close to the practice and some parking spaces for disabled people close by. It has a waiting room in front of the main reception desk.

It has a high proportion of patients who are non-English speaking or whose first language is not English and a higher younger than the average London population but a lower than average older population although this is higher than average within Hackney.

The practice is in an area with a high deprivation weighting. The Indices of Multiple Deprivation score is four. The lower the Indices of Multiple Deprivation decile, the more deprived an area is.

The practice is registered with the CQC to provide the regulated activities Diagnostic and screening procedures, Family planning, Maternity and midwifery services, Surgical procedures and Treatment of disease, disorder or injury.

The practice has a website which provides a range of information about the practice and services provided. It can be accessed here www.bartonhousegrouppractice.co.uk

The practice reception and surgery opening hours are:

Monday to Friday: 8.30am – 6.30pm

Saturday and Sunday: Closed

Early morning and late evening surgeries are available each day of the week. Extended access to nurse and GP appointments are available throughout the week giving the option of early (7am to 8am) or late (6:30pm to 8pm) appointments. Extra ‘overspill ‘ appointments for routine booking are also available at the local access hub seven days a week from 8am to 8pm. Telephone advice is available throughout the working day (8.30am to 6.30pm) via a duty doctor system.

Extended appointments can be made on any day when the practice is open. If the practice is closed there is a number patients can call to obtain the Out of Hours service contact details. This is also on the practice leaflet and website.

Updated 18 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous comprehensive inspection 01 October 2015 – 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

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at The Barton House Group Practice on 20 November 2017. The practice was previously inspected in October 2015. All key questions and population groups were rated as good and this inspection was to ensure that the practice were maintaining standards. At that inspection there were no areas identified that the provider needed to improve.

At this inspection we found:

• The practice 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 practice proactively sought feedback from staff and patients, which it acted on.

• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• Staff involved and treated patients with compassion, kindness, dignity and respect, although we did observe the potential for privacy to be compromised when patients discuss appointments or other issues at reception.

• The practice had clear systems to manage risk so that safety incidents were less likely to happen, although there were actions to follow up in respect of fire and health and safety risk assessments and the frequency of the electrical fixed installation should be verified. When incidents did happen, the practice learned from them and improved their processes.

• There was a strong focus on continuous learning and improvement at all levels of the organisation. The level of child safeguarding training that staff had achieved was not clear.

• We found the practice had not clearly displayed its previous inspection ratings but they confirmed they had experienced technical problems with doing this but would try and remedy without delay.

The areas where the provider should make improvements are:

• Review the risk assessments carried out for fire and health and safety and follow up any outstanding actions and the frequency of the electrical fixed installation testing should be verified.

• Review the reception area privacy arrangements.

• Review display of the CQC rating on the practice website.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

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. Nurses and GPs ran clinics for patients with diabetes, heart failure and Chronic Obstructive Pulmonary Disease (COPD). Nurses provided 30 minute appointments with patients with multiple long term conditions, to allow additional time for patients to discuss their needs. Home visits were also 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.

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. Immunisation rates were 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. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice held a baby clinic twice weekly, offering pre-bookable appointments as well as a walk-in service. We saw good examples of joint working with midwives, health visitors and local support services.

Updated 14 January 2016

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 and had a range of enhanced services, for example, in dementia. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice held a monthly multi-disciplinary team meeting with the palliative care team, district nurses and local support organisations to review the needs of older patients.

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, extended hours appointments, as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 14 January 2016

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

Performance for mental health related indicators was better than the national averages. For example, 94.48% of patients with schizophrenia, bipolar affective disorder and other psychoses had an agreed care plan from the preceding year on record, compared to a national average of 86.04%. Further, 96.2% of patients had their alcohol consumption recorded in the preceding year, compared to the national average of 88.61%, and 95.96% had their smoking status recorded in the preceding year, compared to the national average of 95.28%.

The practice employed two counsellors to provide support to those suffering poor mental health, and had demonstrated that this service was having a positive impact on patient care, with 87% of patients who completed a course of counselling reporting a significant improvement in symptoms. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

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 had carried out annual health checks 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.

One of the practice GPs spoke Polish fluently, and took a lead in supporting the local Roma community. The practice had identified that this group of patients could experience difficulties in registration and continuity of care, so offered a flexible approach to registration and the booking of appointments.