Letter from the Chief Inspector of General Practice

Barnfield Hill Surgery was inspected on Wednesday 1 October 2014. This was a comprehensive inspection.

Barnfield Hill provides primary medical services to people living in the city of Exeter, Devon and the surrounding areas. The practice provides services to a diverse population and is situated in a city centre location.

At the time of our inspection there were approximately 7,300 patients registered at the service with a team of six GP partners. GP partners held managerial and financial responsibility for running the business. In addition there was an additional salaried GP, three registered nurses, a phlebotomist, a practice manager, and additional administrative and reception staff.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

Our key findings were as follows:

We rated this practice as good. Patients reported having good access to appointments at the practice and liked having a named GP which improved their continuity of care. The practice was clean, well-organised, had good facilities and was well equipped to treat patients. There were effective infection control procedures in place.

The practice valued feedback from patients and acted upon this. Feedback from patients about their care and treatment was consistently positive. We observed a patient centred culture. Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. Views of external stakeholders were very positive and were aligned with our findings.

The practice was well-led and had a clear leadership structure in place whilst retaining a sense of mutual respect and team work. There were systems in place to monitor and improve quality and identify risk and systems to manage emergencies.

Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessment of a patient’s mental capacity to make an informed decision about their care and treatment, and the promotion of good health.

Suitable staff recruitment, pre-employment checks, induction and appraisal processes were in place and had been carried out. Staff had received training appropriate to their roles and further training needs had been identified and planned.

Information received about the practice prior to and during the inspection demonstrated the practice performed comparatively with all other practices within the clinical commissioning group (CCG) area.

Patients told us they felt safe in the hands of the staff and felt confident in clinical decisions made. There were effective safeguarding procedures in place.

Significant events, complaints and incidents were investigated and discussed. Learning from these events was communicated and acted upon, although the written evidence for this process did not always consistently show what learning and actions had taken place following such investigations.

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

The provider should:

Improve record keeping from accidents, significant events and complaints to show learning and actions taken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We visited Barnfield Hill Surgery and spoke with the practice manager, four administrative staff, two GPs and a practice nurse. We also spoke with eight patients who were visiting the surgery, one who was involved in the patient participation group. All of the patients told us they were very happy with the service they received and had been involved in the decisions made about their treatment. People told us staff were respectful. One patient said "I’ve personally found it extremely good. They discovered my illnesses through routine screening and the support was ace!” Another patient confirmed that staff were helpful and answered any questions they had and were professional in their approach.”

Staff were clear about what action they would take if they saw or suspected any abuse. Staff had completed some training in relation to this. Policies and procedures were in place to guide staff practice on their computer system and would be made more visible on the notice board for staff following our visit.

We talked with patients about their confidence in the staff. People told us that the surgery and staff were “lovely”, one patient adding that “It doesn’t feel clinical but friendly – it is like walking into someone’s own home.”

There were appropriate arrangements in place to ensure staff kept their knowledge and skills up to date. All staff spoke about how they enjoyed working at the surgery and the "good team work" and about working in a "supportive environment."

The surgery was organised and well managed. There were effective systems in place to regularly monitor the quality of the service provided and patients felt able to give feedback about the service they received knowing that they would be listened to.