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.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Barcroft Practice on 5 May 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence-based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

We saw three areas of outstanding practice:

• A weekly ophthalmology clinic enabled opticians’ referrals to be seen within a week, at the practice, rather than patients waiting for an outpatient appointment. This led to an increase in diabetic eye screening and lower ophthalmology referral rates, relative to other local practices. Common anterior and posterior eye diseases were also managed in the clinic following referrals from other GPs in the practice.

• The practice set up and ran a coffee club for older people experiencing social isolation and mental ill health. We saw that the 10 week programme of events including exercise classes and was attended by the practice’s care co-ordinator and pharmacist. Due to demand, the practice scheduled further 10 week coffee clubs to run indefinitely.

• The practice employed a pharmacist in a jointly-funded initiative. The pharmacist was proactive in expanding their role to meet patient need. For example, we saw evidence that the pharmacist made direct contact with patients and their carers following discharge from hospital, to offer support with new and existing medication issues; and accompanied the practice nursing team on home visits to patients unable to attend the surgery, due to long term conditions such as asthma and diabetes.

The area where the provider should make improvement is:

The provider should seek support to recruit members to its patient participation group, to better reflect the patient population it serves.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

People expressed their views and were involved in making decisions about their care and treatment. We looked at the practice’s latest patient survey results which had been undertaken last year and had received over one hundred and forty responses. We saw from these results, most of the people that had responded had felt satisfied with the services the surgery provided.

There was a range of health professionals based at the practice who were employed by other providers which included health visitors and midwives. We spoke with these staff who confirmed they felt the working relationships with the surgery were very good. Other professionals such as district nurses, psychologists, mental health nurses and hospice staff would attend weekly clinical meetings to discuss patients and arrange appropriate support.

Staff were aware of their roles and responsibilities with regards to protecting people from abuse or the risk of abuse. All the staff we spoke with knew about and understood the safeguarding procedures, and what action should be taken if abuse was witnessed or suspected.

The practice trains GPs and we saw records to confirm there was a comprehensive induction programme which new GP Trainees completed. This included identifying specific training required by the individual.

The practice manager had collated and logged complaints as part of the monitoring process with the Commissioners. They completed an annual complaints report in order to analyse and identify trends in the occurrence of complaints and to review learning.

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