The Barcroft Practice Also known as Barcroft Medical Practice

This practice is rated as Good overall. (At our previous inspection in March 2018 they were rated as requires improvement overall).

The key questions at this inspection are rated as:

• Are services safe? – Good
• Are services effective? – Good
• Are services caring? – Good
• Are services responsive? – Good
• Are services well-led? - Good

When we inspected The Barcroft Practice on 8 March 2018 we found some breaches in the regulations relating to safe care and treatment, good governance and staffing. We issued requirement notices to the practice setting out the areas they were required to improve. The full report of our inspection on 8 March can be found by selecting the ‘all reports’ link for The Barcroft Practice on our website at www.cqc.org.uk. Following publication of our report, the practice sent us a plan setting out the actions they were taking to rectify the regulatory beaches we had found.

This report covers the announced comprehensive inspection we carried out at The Barcroft Practice on 20 September 2018. We carried out this inspection to follow up on the breaches we found at our previous inspection.

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.
• The practice routinely reviewed the effectiveness and appropriateness of the care it 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 appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw two areas of outstanding practice:

• The practice ran weekly ophthalmology and dermatology clinics. These enabled patients with common eye complaints and skin conditions respectively to be seen closer to home, usually within a week, rather than waiting for an outpatient’s appointment.
• The practice held regular coffee mornings at a local hotel that were run by the practice Elderly Care Facilitator for older people who were at risk of becoming isolated and lonely. There was a programme of speakers and activities were arranged to meet these patients’ needs. Clinical staff, also attended these events. Patients who attended the group spoke highly of the mornings. The practice had data which showed that of 100 older patients who had attended the coffee club in the past year, 74% said they had benefited from attending. They also ran a carers’ coffee mornings four times a year. Information about these was on the practice website and on a notice board in the surgery. These were run in partnership with the local Wiltshire Carers trust, who had staff in attendance at these events to provide support and advice.

There were areas where the provider should make improvements. The provider should:

• Ensure all staff are aware of the need to remove their security cards from computers when they leave the workstation.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

This practice is rated as Requires Improvement overall.

(At our previous inspection in May 2016 they were rated as good overall.)  

The key questions are rated as:

• Are services safe? – Requires improvement
• Are services effective? – Good
• Are services caring? – Good
• Are services responsive? – Outstanding
• Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

• Older People – Requires improvement
• People with long-term conditions – Requires improvement
• Families, children and young people – Requires improvement
• Working age people (including those recently retired and students – Requires improvement
• People whose circumstances may make them vulnerable – Requires improvement
• People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced comprehensive inspection at Barcroft Medical Centre on 8 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had 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 practice system did not ensure the lessons learnt were always shared with all appropriate staff, or that the fire log book was kept up to date.
• The practice 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 practice worked to achieve good outcomes for their patients. For example, childhood immunisations rates were above the target percentage of 90%, with an average of 95% across the four target groups, compared to the national average of 91%.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation. However, not all staff had received training considered as essential in nationally recognised guidance, such as safeguarding training or equality and diversity training.

We saw two areas of outstanding practice:

• The practice ran a weekly ophthalmology clinic and  a weekly dermatology clinic. They enabled patients with common eye complaints and skin conditions respectively  to be seen closer to home, usually within a week, rather than waiting for an outpatients appointment.
• The practice held regular coffee mornings at a local hotel that were run by the practice elderly care facilitator. Clinical staff, also attended these events. They ran a weekly coffee morning for older people who were at risk of becoming isolated and lonely. There was a programme of speakers and activities were arranged to meet these patients’ needs. Patients who attended the group spoke highly of the mornings. The practice had data which showed that of 98 older patients who had attended the coffee club in 2017,  74% said they had benefited from attending the club. They also ran a  carers’ coffee mornings four times a year. Information about these was on the practice website and on a notice board in the surgery. These were run in partnership with the local Wiltshire Carers trust, who had staff in attendance at these events to provide support and advice.

The areas where the provider must make improvements are:

• The provider must ensure all that is reasonably practicable to mitigate risks to the health and safety of service users is done.
• The provider must ensure they have a clear governance framework to support the delivery of good quality care and have adequate documentation relating to the planning and monitoring of services or the identifying, capturing and managing of issues.
• The practice did not ensure staff receive such appropriate support, training, professional development and supervision as is necessary to enable them to carry out the duties they are employed to perform.

The areas where the provider should make improvements are:

• The provider should review the circumstances in which non-clinical staff are asked to attend a consultation in a non-chaperone role and develop a process to support this.
• The provider should continue the development of a business continuity plan.
• The provider should review their policies and procedures in relation to incidents to ensure lessons learnt are shared with all appropriate staff.​

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice