Archived: The Barn Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Barn Surgery on 14 February 2017 to assess the improvements made at the practice. Overall the practice is now rated as Good. 

We had previously inspected the practice during 17, 18 and 19 May 2016 when we rated the practice as inadequate overall. Specifically, the practice was rated as inadequate for safe and for well-led, requires improvement for effective, and good for caring and responsive.

Areas which did not meet the regulations following our inspection in May 2016 were:

• Patients were at risk of harm because systems and processes were not being followed to keep them safe. For example, appropriate fire drills and some training was not undertaken by all staff. The practice did not have assurance that infection control practice followed current guidance. Not all staff had received training in infection control, chaperone duties for those staff undertaking this role, basic life support and the Mental Capacity Act (2005).

• There was no evidence of consistent wider learning and effective communication with staff regarding incidents, near misses and concerns.

• Patient outcomes were low in some areas compared to the locality and nationally. No clinical audits had been carried out, so there was no effective system to manage performance and improve patient outcomes.

• Significant staff shortages across the GP team was leading to longer waits for routine appointments and delayed appointments at the practice.

• The practice had insufficient GP leadership capacity and limited formal governance arrangements.

On 14 February 2017, our key findings across all the areas we inspected are 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 the safe care of patients were now clearly monitored and managed.
• Patients who attended the practice had their needs assessed and care was delivered in line with current evidence based guidance.
• Staff had the skills and experience to deliver effective care and treatment, but not all had received the training they needed to perform their roles effectively. For example, there were still gaps in training undertaken for infection control and The Mental Capacity Act (2005).
• Information about services and how to complain was available and easy to understand. Complaints were investigated appropriately and in a timely manner.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Clinical audits focussing on safe prescribing had been completed.
• There was a clear leadership structure and most staff felt supported by management.
• The practice proactively sought feedback from staff and patients, which it acted on. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The provider was aware of and complied with the requirements of the Duty of Candour.

However, there remain areas where the provider must make improvement. The practice must:

• Ensure staff complete all training the practice considers to be mandatory at the required frequency, to enable them to undertake their role safely and effectively.

The areas where the provider should make improvement are:

• Review process for team meetings to ensure all staff attend relevant meetings.
• Continue to identify carers so they can receive appropriate care and support.

I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Following our inspection undertaken on 17, 18 and 19 May 2016 of all practices at Christchurch Medical Centre, we rated the Barn Surgery practice overall as inadequate. The domains of caring and responsive were assessed as providing good services. The domains of safe and well led were rated as inadequate and the effective domain required improvement. We placed the practice in Special Measures and received an action plan from the practice outlining the steps they would take to improve the service. The ratings published in August 2016 will remain in place until we have been assured all concerns have been rectified. 

We carried out an announced focused inspection at the Barn Surgery on 14 December 2016. This was to check compliance to the serious concerns we found during a comprehensive inspection of the Barn Surgery in May 2016 which resulted in the Commission issuing a Warning Notice in regard to Regulation 17, Good Governance.  Other areas of non-compliance found during the inspection undertaken in May 2016 will be checked by us for compliance at a later date.

This report covers our findings in relation to the warning notice requirements only and should be read in conjunction with the comprehensive inspection report published in August 2016. This  can be done by selecting the 'all reports' link for the Barn Surgery on our website at www.cqc.org.uk

At this inspection, we checked the progress the provider had made to meet the significant areas of concern as outlined in the Warning Notice dated 25 July 2016, for a breach of Regulation 17 (Good Governance). We gave the provider until 30 November 2016 to rectify these concerns about governance of the practice. This Warning Notice was issued because we found there were inadequate systems or processes to effectively reduce risks to patients and staff covering:

• Systems in support of effective communication were not in place between all staff teams; particularly in regard of sharing learning from significant events, complaints, medicines and healthcare products alerts, prescribing guidelines, audits and service feedback.

• Effective governance arrangements were not in place to monitor and improve the quality of services provided to patients.  This included: lack of clinical audits and systems in support of training to address gaps in a timely way;

• There was a significant shortage of GPs, with GP partners working excessive hours, which could increase risks for patients.

• Systems were not in place to ensure staff undertaking chaperone duties were trained to undertake this role.

• The practice did not have a system to monitor whether prescriptions were collected in a timely way.

At our inspection on 14 December 2016 we found the provider had complied with the warning notice and was now compliant with the regulation 17 as set out in the warning notice.

Our Key findings were:

• Systems in support of effective communication had been implemented between all staff teams; particularly in regard of sharing learning from significant events, complaints, medicines and healthcare products alerts, prescribing guidelines, audits and service feedback.

• Effective governance arrangements were in place to monitor and improve the quality of services provided to patients.  Clinical audits focussing on safe prescribing had been completed and systems in support of training to address gaps in a timely way were in place.

• The practice had taken steps to reduce any potential risks for patients resulting from a shortage of GPs.  Extended hours services and new patient registrations had been temporarily suspended. Named locum staff were working at the practice on longer term contracts.

• Systems implemented ensured that staff undertaking chaperone duties were trained to undertake this role.

• The practice had set up a system to monitor whether prescriptions were collected in a timely way.

The other key lines of enquiry will be reassessed by us at a later date as a comprehensive inspection when the provider has had sufficient time to meet the outstanding issues.

The outstanding issues that the practice must address are:

• Ensure all staff receive training in infection control and the practice must introduce and undertake comprehensive infection control audits.

• Ensure systems are put in place so that all staff receive up to date training in fire safety and undertake regular fire drills.

• Ensure systems in support of recruitment are effective so that roles requiring a Disclosure and Barring service check or risk assessment are appropriately assessed.

• Ensure systems and processes are established and operated effectively to prevent the possible abuse of service users, including providing up to date Safeguarding and Mental Capacity Act 2005 training for all staff, and chaperone training for those staff undertaking this role.

Ensure measures such as clinical audits and re-audits are put in place to improve patient outcomes and reduce any safety risks. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice