Archived: Barndoc Healthcare Limited OOH - Churchwood House

Letter from the Chief Inspector of General Practice

This service is rated as 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

We carried out an announced comprehensive inspection at Barndoc Healthcare Limited Out of Hours Service (Barndoc OOH) on 20 and 22 February 2018. This inspection was to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 and 20 February 2017. At that time we rated the service as inadequate for providing safe services, requires improvement for providing effective services, good for providing caring services, good for providing responsive services and requires improvement for providing well led services. Overall we rated the service as requires improvement.

This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found that:

• Risks to patients were well assessed and managed. For example, the provider had taken action to address infection prevention and control risks; and risks associated with medicines management which we had identified at our February 2017 inspection.

• The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.

• The service 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 service’s three primary care base locations had good facilities and were well equipped to treat patients and meet their needs.

• Primary care base GPs and receptionists treated people with compassion, kindness, dignity and respect.

• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.

• The provider was aware of and complied with the requirements of the duty of candour.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

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

• Governance arrangements supported the delivery of safe and patient centred care.

The areas where the provider should make improvements are:

• Review the newly implemented procedure for monitoring the storage of medicines and equipment at primary care bases, to ensure that the risks of storage at temperatures outside of the recommended range are managed.

• Review the way in which unused prescriptions are recorded following home visits, in line with its protocols.

• Review the procedure for disposing of part used ampoules of controlled drugs on home visits.

• Revisit the risk assessment into its decision not to carry oxygen in home visit vehicles, so as to ensure that this takes into account all reasonable circumstances.

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 Barndoc Healthcare Limited Out of Hours Service (Barndoc OOH) on 16 and 20 February 2017. Overall the service is rated as requires improvement.

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

• Although overall, governance arrangements focused on the delivery of good quality care, we also noted that governance arrangements regarding infection prevention control (IPC) and medicines management did not always operate effectively.

• Risks to patients were generally assessed and well managed, although we noted that the absence of a proactive approach to managing infection prevention and control risks; and risks associated with medicines management.

• During our inspection we identified concerns regarding safeguarding training in that only 76% of GPs had up to date child safeguarding training to the appropriate level. Shortly after our inspection we were sent evidence confirming that that this had increased to 98%.

• There was an open and transparent approach to safety and an effective system in place for recording, reporting and learning from significant events.

• Clinical audits demonstrated quality improvement.

• Patients’ care needs were assessed and delivered in a timely way according to need. The service consistently met the National Quality Requirements and exceeded commissioner’s performance targets.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• There was a system in place that enabled staff access to patient records, and the out of hours staff provided other services with information following contact with patients as was appropriate.
• The service managed patients’ care and treatment in a timely way.
• Patients said they were treated with compassion, dignity and respect; and that 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.
• The service regularly audited its performance to ensure that any hospital referrals it made were appropriate. It also actively supported alternatives to hospital admission.
• The service had good facilities and base locations were well equipped to treat patients and meet their needs. The vehicles used for home visits were clean, well equipped and well maintained.
• There was a clear leadership structure and staff felt supported by management. The service 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. For example, we saw that things went wrong, the Chief Operating Officer was proactive in making contact with patients to apologise, offer reasonable support and outline the actions taken to minimise the chance of reoccurrence.

The areas where the provider must make improvement are:

• Ensure that regular IPC audits are taking place so as to identify, capture and manage infection risks.

• Ensure that arrangements are in place for the safe management of medicines including protocols for checking emergency medicines and equipment at primary care centre base locations; and as necessary, staff medicines management refresher training.

In addition the provider should:

• Ensure that safeguarding policies are regularly reviewed and kept up to date.

• Consider working with its patient group to see how it can increase the number of patients participating in its patient survey; and consider broadening the survey to seek patients’ views on the timeliness of being seen.

• Continue to liaise with the landlord of its Chase Farm Hospital Primary Care Centre to see how signage can be improved.

• Update its Medicines Policy to ensure that it reflects the provider’s current practice regarding emergency medicines held at primacy care base locations.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice