Archived: Barkingside Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barkingside Medical Centre on 11 November 2015. Overall the practice is rated as requires improvement.

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

• The practice had faced considerably uncertainty since the senior partner announced in June 2015 their intention to retire from general practice at the end of the year and that the practice was required to vacate the premises. This uncertainty was ended on 05 November 2015 when the CCG confirmed the practice would not close and that a new location for the practice had been found. The new premises would be provided by NHS Property Services.

• Data showed patient outcomes were low for the locality. Although some audits had been carried out, few were completed audits and there was little evidence that audits were driving improvement in performance to improve patient outcomes.

• Among the patient records we reviewed of eight patients chosen at random we saw instances of inadequate recording of history and examination, inadequate recording of a working diagnosis or no diagnosis recorded, inadequate clinical management, and pathology results that appeared not to have been acted on. We also saw instances of accepted clinical guidelines not being followed. NHS England were advised of our concerns.

• There was an open and transparent approach to safety and a system was in place for reporting and recording significant events. The provider however did not have policy and procedures in place to guide staff in the handling of notifiable safety incidents in accordance with the Duty of Candour.

• Risks to patients were assessed and managed, with the exception of those relating to recruitment checks. Fire, legionella and control of substances hazardous to health (COSHH) risk assessments were not in place. The provider was aware of these shortfalls in their current premises which they would be vacating at the end of December 2015.

• National GP survey results published in July 2015 showed comparatively few patients felt they were treated with care and concern.

• Information about services and how to complain was available and easy to understand.

• The practice had worked hard to improve the responsiveness of the service and there was anecdotal evidence on the day of our inspection that patients were finding easier to make an appointment to see a GP. However, there was no formal evidence that the practice had improved on its below average results in the national GP survey in this area.

• Urgent appointments were available on the day they were requested.

• There was a clear leadership structure and staff felt supported by management. However capacity and capability to run the practice and ensure high quality care was stretched.

• The practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

• Ensure systems are in place to monitor and improve patient outcomes and the performance of the practice.

• Ensure processes are in place so that national guidelines are used to secure consistent, high quality, evidence based care for patients

• Ensure recruitment arrangements include all necessary employment checks for all staff and that information in relation to each person working for the service as specified in Schedule 3 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 is available for staff who joined the practice after 01 April 2013.

• Ensure patient records fully document the care and treatment that has been provided.

In addition the provider should:

• Put in place policy and procedures in place to guide staff in the handling of notifiable safety incidents in accordance with the Duty of Candour.

Put arrangements in place so that patients can book appointments and order repeat prescriptions online.

We carried out an announced comprehensive inspection at Barkingside Medical Centre on 11 November 2015. Overall the practice is rated as requires improvement.

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

• The practice had faced considerably uncertainty since the senior partner announced in June 2015 their intention to retire from general practice at the end of the year and that the practice was required to vacate the premises. This uncertainty was ended on 05 November 2015 when the CCG confirmed the practice would not close and that a new location for the practice had been found. The new premises would be provided by NHS Property Services.

• Data showed patient outcomes were low for the locality. Although some audits had been carried out, few were completed audits and there was little evidence that audits were driving improvement in performance to improve patient outcomes.

• Among the patient records we reviewed of eight patients chosen at random we saw instances of inadequate recording of history and examination, inadequate recording of a working diagnosis or no diagnosis recorded, inadequate clinical management, and pathology results that appeared not to have been acted on. We also saw instances of accepted clinical guidelines not being followed. NHS England were advised of our concerns.

• There was an open and transparent approach to safety and a system was in place for reporting and recording significant events. The provider however did not have policy and procedures in place to guide staff in the handling of notifiable safety incidents in accordance with the Duty of Candour.

• Risks to patients were assessed and managed, with the exception of those relating to recruitment checks. Fire, legionella and control of substances hazardous to health (COSHH) risk assessments were not in place. The provider was aware of these shortfalls in their current premises which they would be vacating at the end of December 2015.

• National GP survey results published in July 2015 showed comparatively few patients felt they were treated with care and concern.

• Information about services and how to complain was available and easy to understand.

• The practice had worked hard to improve the responsiveness of the service and there was anecdotal evidence on the day of our inspection that patients were finding easier to make an appointment to see a GP. However, there was no formal evidence that the practice had improved on its below average results in the national GP survey in this area.

• Urgent appointments were available on the day they were requested.

• There was a clear leadership structure and staff felt supported by management. However capacity and capability to run the practice and ensure high quality care was stretched.

• The practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

• Ensure systems are in place to monitor and improve patient outcomes and the performance of the practice.

• Ensure processes are in place so that national guidelines are used to secure consistent, high quality, evidence based care for patients

• Ensure recruitment arrangements include all necessary employment checks for all staff and that information in relation to each person working for the service as specified in Schedule 3 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 is available for staff who joined the practice after 01 April 2013.

• Ensure patient records fully document the care and treatment that has been provided.

In addition the provider should:

• Put in place policy and procedures in place to guide staff in the handling of notifiable safety incidents in accordance with the Duty of Candour.
• Put arrangements in place so that patients can book appointments and order repeat prescriptions online.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice