This practice is rated as requires improvement overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

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 retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people living with dementia) - Requires Improvement

We carried out an announced inspection at Barnsley Healthcare Federation, Highgate Surgery on 6 March 2018 as part of our inspection programme. We also carried out an announced comprehensive inspection at Barnsley Healthcare Federation CIC head office based at Oaks Park Medical Centre on 13 and 14 February 2018 to look at governance as part of our inspection programme.

At this inspection we found:

• There was no open and transparent approach to safety and no effective system in place for recording, reporting and learning from significant events.
• The practice did not routinely review the effectiveness and appropriateness of the care it provided. There was limited evidence of audits and quality improvement activities to demonstrate monitoring and assessment of the patient outcomes was being undertaken since the service registered in July 2016.
• We saw minimal evidence of mechanisms for recording actions taken in relation to best practice guidance.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients told us through CQC questionnaires, that they felt listened to and supported by staff and had sufficient time during consultations to make an informed decision about the choice of treatment available to them.
• There was a lack of overarching governance arrangements in place that meant patients were not always kept safe from avoidable harm.
• There was a leadership structure but communication between staff and management needed improvement and some staff felt unsupported by the senior management team.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure governance arrangements are in place to keep patients safe from avoidable harm.
• Ensure that there is an accessible system for identifying, handling. Investigating and responding to complaints made about the service.
• Ensure individual care records are written and managed in a way that keep patients safe

The areas where the provider should make improvements are:

• Consider a centralised practice induction pack is available for all staff and clinicians who may not be completely familiar or up to date with practice processes.
• Consider a lone working policy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Background

We carried out a focused announced inspection of this service on 22 August 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The Care Quality Commission planned the inspection following feedback from members of the public, who raised specific concerns about the numbers of staff and continuity of patient care.

This inspection report relates to the specific areas we reviewed because of the feedback received. We visited the Shafton Surgery site. We did not look at the overall quality of the service therefore have not provided a quality rating of the service.

The provider for BHF Highgate Surgery is Barnsley Healthcare Federation CIC (BHF). BHF also provides general medical services at three GP surgeries and an out of hours service.

CQC registered BHF Highgate Surgery on the 16 August 2017. It provides general medical services to 3,434 patients. BHF Highgate Surgery is situated in Grimethorpe on the outskirts of the Barnsley. The area is rated in one of the third most deprived areas in the UK. The surgery has a branch :-

• Shafton Surgery

  Unit 5

  Two Gates Way

  High Street

  Shafton

  Barnsley

  S72 8WL

The surgery is managed by a central team from Barnsley Healthcare Federation CIC. Allocated to BHF Highgate Surgery and Shafton branch are two male part time GPs and two female part time advanced nurse practitioners. They are supported by two practice nurses, a nursing assistant and a team of receptionists.

The surgeries are open from 8am to 6.30pm, Monday to Friday.

When the surgeries are closed or patients are unable to access an appointment, staff refer patients to the Iheart Barnsley 365. This service is open from 9am to 10pm Monday to Friday and 9am to 1pm on Saturday and Sunday. The service offers urgent and routine appointments, telephone and email consultations with a nurse or GP. During the out of hour’s period, the patient is directed to the out of hours service or call NHS 111, who direct them to the most appropriate service.

Our key findings across the areas we inspected on 22 August 2017 were as follows:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations reviewed. This was because:-

• The surgery had carried out the necessary recruitment checks.

• There were arrangements for planning and monitoring the number and mix of staff needed to meet patients’ needs.

• BHF had recently recruited two permanent part time GP's for the surgeries.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations reviewe

d. This was because:

• Most staff had completed the necessary mandatory training.
• To enable locum GP to follow a consistent approach, the provider had information available  about how to follow clinical protocols. at Barnsley Healthcare Federation.

• To ensure continuity of patient care, the information needed to plan and deliver care and treatment was available to relevant staff in a timely and accessible way through the surgeries patient record system and the intranet system.

There were areas of practice where the provider needs to make improvements.

• The provider should make sure that the carpets at the Shafton Surgery meet the infection prevention and control standards.