We were not able to obtain the views of patients regarding the outcomes we inspected because this is an out of hours GP services providing mostly one off appointments or visits

On the day of our inspection, the organisation was going through a major restructuring driven by NHS111. The NHS 111 service is part of the wider revisions to the urgent care system to deliver out of hours urgent care service, which meant most administrative staff were affected. We spoke with senior management staff and reviewed records to inform our judgements.

Through patient experience surveys, patient forums and related audits we were satisfied that the provider respected patients’ privacy and dignity.

We saw from care records that the provider’s system for assessments ensured clinical risk was reduced for out of hours patients, which meant patients experienced safe and appropriate treatment.

The provider had some arrangements in place, by way of relevant policies, staff training and Criminal Record Checks CRB checks to ensure patients were protected from abuse. We saw appropriate arrangements for obtaining, recording, safekeeping, safe administration and disposal of medicines and there was evidence that the provider followed the standard operating procedures (SOPs), which described the process for each arrangement.

The provider had an effective system to regularly assess and monitor the quality of service that people received

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