Barrowford Surgery Limited

Updated 12 June 2017

Barrowford Surgery is located in Barrowford on the outskirts of Colne, Lancashire. The practice has 3473 registered patients. There is a higher than national average population of patients aged 40 -70 years.

The practice provides Personal Medical Services under a PMS contract with NHS England. The practice is also contracted to provide a number of enhanced services, which aim to provide patients with greater access to care and treatment on site. They offer enhanced services in; extended hours, supporting people with dementia, childhood vaccinations and minor surgery. They are also a GP training practice, providing support and guidance to trainee GPs.

There are two male GPs; a female practice nurse who can prescribe medication and female healthcare assistant. Clinicians are supported by a practice manager and an experienced team of reception/administration staff. A pharmacy technician from the clinical commissioning group (CCG) works closely with the practice.

The practice is open between 7:30am and 6:30pm Monday to Friday, with extended hours on a Monday evening until 7:30pm. The practice has opted out of providing out of hours services (OOHs) for their patients. When the practice is closed patients use the 111 service to contact the OOHs provider. Information for patients requiring urgent medical attention out of hours is available in the waiting area, in the practice information leaflet and on the practice website.

Updated 12 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barrowford Surgery on 2 February 2016. The overall rating for the practice was requires improvement.

During that inspection we identified breaches of regulation 12 (Safe Care and Treatment), regulation 17 (Good governance) and regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The breaches resulted in the practice being rated as requires improvement for being safe, and well-led and good for being effective, caring and responsive. Consequently the practice was rated as requires improvement overall. The full comprehensive report on the 2 February 2017 inspection can be found by selecting the ‘all reports’ link for Barrowford Surgery on our website at www.cqc.org.uk.

At this announced comprehensive inspection on 27 March 2017 we checked whether improvements had been made since our inspection in February 2016.

The practice is now rated as Good.

We found improvements had been made in respect of;

Safe;

• Emergency medicines were in place to ensure the safety of patients in an emergency.

• We found that the registered person operated an effective recruitment system. The staff files we checked contained references, disclosure and barring service (DBS) checks, CV or application form and a check of professional registration.

• There was a system in place to monitor the use of blank prescriptions.

• The practice had produced consent forms for use when carrying out invasive procedures such as; excisions and joint injections. Where a patient gave verbal consent this was recorded on the patients’ records.

• The practice nurse was infection control lead and had completed infection prevention and control training to levels 1 and 2.

Well-led;

• Risk assessments had been carried out by specialist contractors in respect of the practice environment, fire safety and legionella and copies were held in the practice.

Our key findings at this inspection 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.
• Comprehensive care plans were developed to ensure patients’ needs were identified and met.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had received training that provided them with the skills, knowledge and experience to deliver effective care and treatment.
• Regular clinical and whole practice meetings were held.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 provider was aware of and complied with the requirements of the duty of candour although some staff were not familiar with the term duty of candour.

However, there were also areas of practice where the provider should make improvements.

• Consider fitting a lock to the door of the new consulting room to ensure this room and its contents were secure when not in use.
• Carry out a review of drugs held in the practice for managing medical emergencies.
• Continue efforts to develop the patient participation group.
• Obtain paediatric pads for the defibrillator.
• Formalise and record all audit activity to demonstrate audits were embedded in practice and used to improve patient outcomes.
• Continue to obtain written consent for minor surgery.
• Carry out a review of patient group directions to check they are all countersigned by the practice manager.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 June 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Patients discharged from hospital were contacted by the practice to review their health needs
• 81% of patients with diabetes, on the register, had an IFCCHbA1c of 64 mmol/mol or less recorded in the preceding 12 months (01/04/2015 to 31/03/2016) which was comparable to the CCG and national average of 81% and 78% respectively.
• The practice was working in partnership with a new integrated neighbourhood team which included a care co-ordinator, district nurses, physio and occupational therapists and social services.
• The practice nurse had an interest in Diabetes and was able to initiate insulin.
• The practice nurse had a prescribing role for chronic disease management.
• The practice nurse and healthcare assistant (HCA) had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice had developed detailed care plans for those patients at high risk of unplanned hospital admissions. These patients were offered urgent same day appointments and the practice liaised with the integrated neighbourhood team to prevent hospital admissions.
• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 12 June 2017

• The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates for 0 - 2 year olds ranged from 28% to 72% for all standard childhood immunisation which was below the CCG and national averages.
• Immunisation rates for 5 year olds ranged from 51% to 93% for all standard childhood immunisations which were comparable with the CCG rates.
• A baby clinic was held every Tuesday and led by a GP and the practice nurse.
• 85% of women aged 25-64 had received a cervical screening test in the preceding 5 years (01/ 04/2015 to 31/03/2016) which was better than the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

Updated 12 June 2017

The practice is rated as good for the care of older people.

• The practice was responsive to the needs of older people, and offered home visits and dispensing services.
• They provided vaccination and blood pressure checks at community facilities for the convenience of their patients.
• The practice worked in partnership with the care coordinator to ensure patients are contacted regularly and upon discharge from hospital.
• The practice worked to the gold standard framework for end of life care, using regular reviews and multidisciplinary working.
• They routinely offered all patients aged 75 and over at least fifteen minute appointment times. There was a named GP for all patients over 75 years old.
• Same day appointments were prioritised for elderly and vulnerable patients.
• The practice provided care and treatment to elderly patients from a nearby nursing home and carried out regular visits to the home.

Updated 12 June 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• Extended hours appointments were offered each week day from 7.30am – 8am with a GP and the healthcare assistant.
• Telephone appointments were available for patients preferring this option.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered a range of NHS health checks and contraceptive services.

Updated 12 June 2017

The provider is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients living with dementia.
• 100% of patients diagnosed with dementia whom had their care reviewed in a face to face meeting in the last 12 months, which was significantly better than the CCG and national average 86% and 84% respectively.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example a nominated GP from the practice visited a local residential home on a regular basis. Patients with a new diagnosis of dementia were offered an appointment with the practice nurse to discuss support services in the locality and an information pack on local services was provided.
• 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate. This was better than the CCG and national average of 87% and 88% respectively.
• The practice advised patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• A Pharmacy technician worked closely with the practice as part of the medicines management scheme. (Medicines management supports more cost-effective prescribing in primary care).

Updated 12 June 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.

• Regular health checks were offered to patients with a learning disability on a recall system and patients were involved in developing and agreeing their care plans.