Dr R N Barnett and Partners

This practice is rated as Good overall. (Previous inspection October 2015 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

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 Dr R N Barnett and Partners on 16 May 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However, the system for the dissemination of patient safety alerts required improvement.
• The practice had systems to safeguard children and vulnerable adults from abuse.
• The practice had arrangements to ensure that facilities and equipment were safe and in good working order.
• The practice routinely reviewed the effectiveness and appropriateness of the care provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the open access appointment system easy to use and reported that they were able to access care when they needed it.
• 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.
• Staff worked well together as a team, knew their patients well and all felt supported to carry out their roles.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice had an active Patient Participation Group (PPG) who worked closely with staff to monitor and develop services.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• The practice provided a GP service to patients who were short term asylum seekers and vulnerable people who have been victims of human trafficking. We heard the practice faced a number of challenges when providing support to this population group. Some patients needed support urgently because they had complex physical and psychological heath needs and this had to be accommodated by the practice at short notice. The open access system for appointments was particularly important in enabling patients to be seen by a GP promptly and we found practice staff responded quickly and sensitively when urgent registrations were needed. Feedback from the support agencies was very good about how responsive and caring the practice was to this vulnerable patient group.

The areas where the provider should make improvements are:

• Review the forms in place for reporting significant events to ensure consistency. Ensure that all staff have access to the learning that takes place when such events occur. Ensure all significant events are analysed on a yearly basis to identify trends.
• Review the training of staff with regards to Sepsis management in an emergency situation.
• Review the system for acting on external safety events as well as patient and medicine safety alerts, to ensure records are made of the actions taken by staff.
• Consider the development of a clinical audit calendar.
• Review the systems in place for ensuring all nurses working at the practice are covered with appropriate medical indemnity insurance.
• Review and develop the systems in place for ensuring all clinicians are up to date with current evidence-based practice.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice