Barkantine Practice

Updated 14 February 2017

Barkantine Practice provides GP primary care services to approximately 19,000 people living in the Isle of Dogs area, London Borough of Tower Hamlets. The practice is also a member of the Healthy Island Partnership (HIP), a CCG sub-group of four GP surgeries in the local area.The practice has an Alternative Personal Medical Services (APMS) contract for providing general practice services to the local population. Alternative Personal Medical Services (APMS) are time limited, locally agreed contracts between NHS England and a provider, usually, though not necessarily, a GP practice.

Information published by Public Health England rates the level of deprivation within the practice population group as sixth on a scale of one to ten. Level one represents the very highest levels of deprivation and level ten the lowest. This information also shows that Income Deprivation Affecting Older People (IDAOPI) is 38% which is higher than the national average of 16%. Income Deprivation Affecting Children (IDACI) is 33% (national average 20%).

There are currently six GP partners, two male and four female, all of whom are full time. There are seven salaried GPs, three male and four female. Three of the salaried GPs work full time and three work part time. The practice provides a total of 80 GP sessions per week. The practice is a training practice with one trainee GP at the time of the inspection.

There is one full time and two part time advanced nurse practitioners, three full time practice nurses, one full time and two part time health care assistants. The health care assistants are also trained as phlebotomists (Phlebotomists are specialist healthcare assistants who take blood samples from patients for testing in laboratories). There is also a full time practice manager and a total of twenty four administrative and reception staff and four apprentice staff who undertake a range of administrative duties.

The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, treatment of disease, disorder or injury and surgical procedures.

The practice is located in a modern purpose built, three storey building which was designed to be a polyclinic (a polyclinic is a health centre, typically independent of a hospital, where both general and specialist examinations and treatments are available to outpatients). Consulting rooms are located on two floors. Patients are able to access upper floors via a lift.

The practice opening hours for the surgery are:

Monday 8:00am to 8:00pm

Tuesday 8:00am to 8:00pm

Wednesday 8:00am to 8:00pm

Thursday 8:00am to 8:00pm

Friday 8:00am to 8:00pm

Saturday 8:00am to 8:00pm

Sunday 8:00am to 8:00pm

Patients can book appointments in person, on-line or by telephone. Patients can access a range of appointments with the GPs and nurses. Face to face appointments are available on the day and are also bookable up to four weeks in advance. Telephone consultations are offered where advice and prescriptions, if appropriate, can be issued and a telephone triage system is in operation where a patient’s condition is assessed and clinical advice given. Home visits are offered to patients whose condition means they cannot visit the practice.

The practice has opted not to provide out of hours services (OOH) to patients and these were provided on the practice’s behalf by a nominated provider. The details of the how to access the OOH service are communicated in a recorded message accessed by calling the practice when it is closed and details can also be found on the practice website.

The practice provides a wide range of services including clinics for diabetes, weight control, asthma, contraception and child health care and also provides a travel vaccination clinic. The practice also provides health promotion services including a flu vaccination programme and cervical screening.

The practice was inspected in December 2013 using our previous inspection methodology and was found to be meeting the required standards in place at the time.

Updated 14 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barkantine Practice on 24 November 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Home visits by GPs, nurses and health care assistants were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice including patients with long term conditions. This included visits for annual health checks, chronic disease management and phlebotomy.
• The practice was co-located with an NHS birth centre and one GP had trained to become a community gynaecologist and offer ultrasonography services which meant that patients could have continuity of care during pregnancy.
• 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.

We saw the following areas of outstanding practice:

• The practice had a track record of providing career progression opportunities for staff and had encouraged and supported staff to engage with ambitious training programmes. The practice also participated in wider training initiatives for clinicians as well as for younger people not in education or employment.
• The practice had a salary bonus scheme in place through which staff who performed well against agreed objectives could be rewarded with a bonus of up to 10% of annual salary. For instance, in the current financial year, some staff could achieve an element of the bonus by contributing to an increase in uptake of health screening programmes.

The areas where the provider should make improvement are:

• Review arrangements for managing vaccines to ensure that there is sufficient capacity to store stock safely.
• Continue to address issues identified in the national GP survey in order to improve patient satisfaction around involvement in care panning and making decisions about their care and treatment.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 14 February 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.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. 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.
• Home visits were available for patients with long term conditions who had difficulty attending in person. These included GP visits as well as visits by nurses and health care assistants who could undertake diabetes management, NHS health checks and phlebotomy services.

Updated 14 February 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 were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Cervical screening appointments were available from 8:00am to 8:00pm, seven days per week. The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 79% and the national average of 82%.
• One GP at the practice had trained as a community gynaecologist and ultrasonographer and patients who required these specialist services could be seen at the practice and benefit from improved continuity of care.

• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 14 February 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Longer appointment times could be arranged for patients with complex care needs.
• The premises were suitable for older people, including those with hearing difficulties and wheelchair users.

Updated 14 February 2017

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

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was open between 8am and 8pm seven days per week which provided access to people who found it difficult to attend during normal office hours.
• The practice provided telephone consultations every day and had put in place an online consulting service which was used by approximately 20 patients per week.
• 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.
• There were arrangements in place which involved a consultant dermatologist providing specialist advice online in situations where a GP was unsure if a patient required a referral to secondary care. This involved providing the specialist with images of skin conditions as well as details of any other symptoms.

Updated 14 February 2017

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

• 94% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 87%.
• 89% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record.
• 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 with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 February 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• The practice hosted a benefits advisor at the practice for two days every month. This service had been used by more than 60 patients in the previous 12 months.