Barn Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 23 February 2016. Breaches of legal requirements were found during that inspection within the safe domain. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the legal requirements. As a result, we undertook a desk based focused inspection on 6 December 2016 to follow up on whether action had been completed to deal with the breaches.

During our previous inspection on the 23 February 2016 we found the following areas where the practice must improve:-

• Ensure that all relevant staff has criminal record checks with the Disclosure and Barring Service (DBS).

• Ensure that all staff receive up to date safeguarding training.

Our previous report also highlighted areas where the practice should improve:-

• Review patient feedback on the difficulties with access to the service and monitor changes in this area alongside action taken.
• Continue with the programme of annual appraisal for all staff, ensuring that this is embedded in practice for future years.

We conducted a desk based focused inspection on 6 December 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. (A desk based focused inspection means the provider was able to send us evidence of the action taken to address the issues previously found rather than visiting the practice).

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

During this inspection we found:-

• The practice had updated their DBS records to ensure that all staff identified as requiring a check had received one.

• That all staff had attended safeguarding training at a level relevant to their role.

We also found the following in relation to the areas where we had told the practice they should improve:-

• The practice had installed a second phone line to improve access to the phone system for patients and to make improvements to appointment access. This had included an upgrade to the phone system to improve call quality. In addition, the practice had worked to improve the uptake of online access to the appointment system and 45% of patients now accessed appointments this way. The practice had also changed their walk in service to an appointment service and had introduced a nurse triage system.

• The practice had implemented an appraisal system where all staff would receive their appraisal annually in March. We saw that the practice manager had an alert in place to ensure that this was embedded in practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barn Surgery on 23 February 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 generally well managed although there was no record of a criminal record check via the DBS (disclosure and barring service) for one of the nurses and one of the healthcare assistants. In addition not all administrative staff or healthcare assistants had attended safeguarding training.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a GP and they were able to access on the day appointment through the practice walk in clinic. However the practice performed below average in terms of patient satisfaction at being able to see or speak to their preferred GP. The practice was aware of these issues and was addressing them through the recent appointment of a salaried GP.
• Some patients had experienced difficulties getting through to the practice by phone and the practice had worked to address this, for example by increasing awareness of online services.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was in the process of a programme of renovation to ensure the practice facilities continued to meet 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice had taken action to improve performance in diabetes care due to a high prevalence (2.88% above national average) by establishing a dedicated diabetic service. This included the practice nurse with the lead for diabetes holding a joint monthly clinic with a visiting diabetic specialist nurse. In addition the lead practice nurse for diabetes ran a mobile ‘hot line’ for all diabetic patients where they can call the line directly. The nurse also provided email support.

The areas where the provider must make improvement are:

• Ensure that all relevant staff has criminal record checks with the disclosure and barring service.
• Ensure that all staff receive up to date safeguarding training.

In addition the provider should:

• Review patient feedback on the difficulties with access to the service and monitor changes in this area alongside action taken.
• Continue with the programme of annual appraisal for all staff, ensuring that this is embedded in practice for future years.
• Continue to monitor and review patient satisfaction in relation to getting through to the practice by phone in relation to changes made and ensure improvements are achieved.
• Ensure that practice policies are reviewed before their due date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice