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Inspection Summary


Overall summary & rating

Good

Updated 22 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 25 August 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation 19 (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focussed inspection on 9 March 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This inspection did not include a visit to the practice. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Barnard Medical Group on our website at www.cqc.org.uk.

Overall the practice is rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing safe services.

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

  • Systems and processes were in place to keep people safe. The practice had taken steps to ensure risks to patients were assessed and well managed, specifically in relation to staff recruitment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 April 2016

The practice is rated as good for providing safe services.

Improvements had been made in the way the practice ensured risks to patients were assessed and well managed, specifically in relation to staff recruitment.

Effective

Good

Updated 29 October 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were above average for the locality. Staff referred to guidance from the National Institute for Health and Care Excellence and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

Caring

Good

Updated 29 October 2015

The practice is rated as good for providing caring services. Data showed that patients rated the practice similar to or slightly below the local area and national averages for its satisfaction scores on consultations with doctors and nurses, and responded positively to questions about their involvement in planning and making decisions about their care and treatment where the practice results were in line with local and national averages.

Most patients we spoke with during our inspection told us 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 29 October 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the local Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. 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 a virtual patient participation group (PPG).

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 29 October 2015

The practice is rated as good for being well-led. It had a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity. There were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. Staff had received inductions, regular performance reviews and attended staff meetings and events.

Checks on specific services

People with long term conditions

Good

Updated 29 October 2015

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

Clinical 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 medication needs were being met.

Data from QOF showed that the practice achieved maximum scores for its performance for indicators relating to the care of people with various long term conditions. These were higher than the local area and national averages. The practice had an established recall system for the management of the care of patients on their chronic disease registers, which took account people with multiple conditions. The practice provided, or hosted, phlebotomy services for annual blood tests at their practice sites.

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.

Families, children and young people

Good

Updated 29 October 2015

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 relatively high for all standard childhood immunisations. Nurse appointments were available on Saturdays for childhood immunisations assist working parents.

Access to a GP was available through a variety of means, including telephone consultations, urgent and pre-booked appointments. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors.

The practice provided a direct enhanced service for sexual health services, including the fitting of coils and contraceptive implants. Clinicians in the practice had also started sexual health training in partnership with Bexley Council, intending to offer further sexual health clinics in the future.

The practice achieved the highest detection rates for opportunistic chlamydia detection in Bexley despite comparatively low numbers of young adult patients registered.

Older people

Good

Updated 29 October 2015

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 and end of life care. The practice hosted monthly integrated care meetings to discuss patients with particular enhanced needs, including those near the end of life.

The practice provided care to the residents of two local care homes, and provided twice weekly planned GP ward rounds to the homes, as well as usual acute/urgent care via the Duty GP in core hours.

The practice had a high rate of planned deaths in the community (57% in 2014 compared to 20-30% in other surgeries). The practice data also showed that 78% of their patients died in their preferred place of care. The practice maintained a substantial palliative care register, which was slightly above expected figures, and included 0.5% of their practice population. Of the 156 patients who died in the previous year, 71 were on their palliative care register, and 52 of these had non cancer conditions.

It was responsive to the needs of older people, and offered home visits and rapid access appointments and telephone advice for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 29 October 2015

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. Pre-bookable GP and nurse appointments were available on Saturday mornings for a wide range of services including cryotherapy, minor surgery, travel vaccinations, cervical screening, and winter flu vaccination clinics.

People experiencing poor mental health (including people with dementia)

Good

Updated 29 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Of the patients on the practice mental health register, 76% had had a comprehensive care plan documented in the preceding 12months. Patients experiencing poor mental health also had their physical health monitored. For example, 85.7% had had their blood pressure checked with the preceding 12 months.

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. All clinical and non-clinical staff attended a half day Dementia Awareness course in June 2015 and became Dementia Friends.

The practice had committed to a CCG pilot to host social prescribing volunteer health champions. The Bexley CCG social prescribing initiative is a means by which GP practices will be able to help residents in need to access resources and support from the community and voluntary sector to improve their wellbeing.

People whose circumstances may make them vulnerable

Good

Updated 29 October 2015

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, and those with a learning disability. It had carried out annual health checks for people with a learning disability and they were offered seasonal flu vaccinations. The practice 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.

The practice maintained a register of carers, and there were 129 patients on the register at the time of our inspection. Carers were offered annual flu vaccinations, and prioritised appointments.