Letter from the Chief Inspector of General Practice

Bartongate Surgery is situated in the inner city area of Gloucester with approximately 9000 registered patients. Before visiting, we reviewed a range of information we held about the practice and asked other organisations to share what they knew. This included the Gloucester Clinical Commissioning Group (CCG), NHS England and Healthwatch.

We undertook a comprehensive announced inspection on 13 January 2015. Our inspection team was led by a Care Quality Commission (CQC) Lead Inspector and GP specialist advisor. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, safe, effective, caring and responsive services. It was also good for providing services for all of the population groups.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

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.

We saw several areas of outstanding practice including:

• Bartongate Surgery was proactive with future planning and development of services for patients and had introduced a triage system by a nurse practitioner which improve access to medical consultations for patients.
• The practice participated in innovative pilot programmes such as the Choice Plus project which increased patient access to urgent care appointments and chronic illness management.
• We were told special arrangements had been put into place by the practice for dealing with an expected death of a member of the local Muslim community which allowed for immediate funerals.
• The practice hosted regular meetings for carers and a specific six monthly open access clinic run by one of the GPs supported by the administrative team.
• Bartongate surgery had a weekly drop in clinic for young people aged 13 years and over who can be seen for confidential health and lifestyle advice. This service is open to all young people and not just those registered with Bartongate surgery

Action the provider SHOULD take to improve:

• The practice should have a patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Patients were positive about the level of care received at the surgery. One person said “they do everything really good” and someone else said “They treat us very well”. Urgent appointments could be made easily via nurse triage but routine appointments had longer waiting times than people wanted. Clinical staff used a number of information sources to ensure they were offering the best possible care.

People were positive about the way staff involved them in decisions and provided them with information. One person said “Doctor had me making a decision today – gave me a good explanation”. People also told us their dignity and confidentiality were maintained. One patient told us the nurses and doctors were “lovely and never made me feel rushed”.

The building was well maintained and clean. Consideration had been given to people with limited mobility. Safety checks were in place and plans had been developed to deal with major events. The limitations of the building meant some conversations could be overheard at reception.

Staff we spoke with knew what to do if they had a safeguarding concern. Policies and training supported staff. Systems were in place to monitor vulnerable patients.

The surgery used the patient satisfaction survey, complaints and significant events as an opportunity to learn and improve the service they offered. They were aware of areas of lower than average achievement in the satisfaction survey and had looked at ways of making improvements.

This practice is rated as Good overall. (Previous inspection: January 2015 – Good and January 2014- The provider met all the standards where they were inspected)

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 Bartongate Surgery on 4 April 2018 as part of our inspection programme.

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 reported that they were able to access care when they needed it urgently. However, there were longer waiting times for routine appointments.
• The practice worked with a local organisation to provide medical support for patients who were refugees from Syria.
• There was a focus on continuous learning and improvement at all levels of the organisation.

We saw one area of outstanding practice:

The practice recognised the needs of its local population with regards to their culture and background and proactively found ways to support them to maintain their health. They had organised a learning event to support patients of the Muslim faith so that patients could obtain useful information on how to better manage their long term condition during the fasting period.

The areas where the provider should make improvements are:

• Implement a schedule for regular fire drills to be undertaken.
• Record the temperature of the internal thermometer when the external thermometer of vaccine fridges shows reading outside of the normal range.
• Implement actions to improve the identification of carers.
• Review the current appointment systems to improve patient experience.
• Record all incidents, near misses and significant events so that trends can be analysed and actions implemented can be reviewed.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice