Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection September 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Barton House Medical Practice on 15 March 2018 as part of our inspection programme.

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 had safe systems and processes in place within the dispensary and had improved the service based on patient need through the development of blister packs and a delivery service.
• 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 had a focus on quality improvement and demonstrated improved prescribing practices as a result of prescribing audits.
• The practice had introduced an integrated nurse practitioner role that provided improved support for frail patients and carers.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice had systems in place to identify carers and provide support to them.
• The practice had systems in place to obtain feedback from patients and had taken action on this.
• 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.

The areas where the provider should make improvements are:

• Review how the temperatures of the vaccine fridges are monitored.
• Review the infection control lead’s training.
• Review systems to improve the results recorded for the uptake of childhood immunisations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barton House Medical Practice on 2nd September 2015. Overall the practice is rated as good. Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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 that 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.

However there were areas of practice where the provider needs to make improvements. Importantly the provider should:

• Follow policies and procedures with regards to the disposal of controlled drugs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Barton House is a purpose built practice located at Beaminster, Dorset DT8 3EQ. The building was designed to meet the needs of disabled people and had full wheelchair access. Services were provided by three GPs, a registrar GP and a small team of practice nurses. A dispensing service was available within the practice. A practice manager had responsibility for the oversight of day to day practice activities. The service was supported by an active patient participation group.

The practice comprised of one location in the centre of Beaminster, Dorset. The regulated activities we inspected were Diagnostic and screening procedures; Maternity and midwifery services; Surgical procedures and Treatment of disease, disorder or injury.

Our inspection took place on Tuesday 3 June 2014 and involved four inspectors over a nine hour period. We found the provider had taken steps to ensure their service was safe for the patients it provided services to as well as to the staff employed there. There were systems in place to ensure effective patient care and we heard about a high level of patient satisfaction with the services provided. Patients were treated with dignity and respect in a purpose built environment which was accessible and ensured their privacy. Appointments were available at times which suited the majority of patients. In the event of patients requiring to be seen urgently there was provision to accommodate their needs. Information was available for patients who required out of hour’s care on the provider’s website, in the practice and on their telephone system. The practice was well led by the registered manager and their partner GPs and nursing team. They were supported by an engaged practice manager and staff team.

We spoke with 18 patients and received comment cards from a further 22 patients. We also spoke with three representatives of the patient reference group. All the views expressed by these people about the practice were very positive with a collective view that patients were at the centre of the practices service delivery.

Our inspecting GP spoke with the provider and the other GPs about patient groups as defined by the NHS and used as part of the Care Quality Commission’s new methodology. The patient groups were;

• Older People
• People with long-term conditions
• Mothers, babies, children and young people
• The working-age population and those recently retired
• People in vulnerable circumstances who may have poor access to primary care
• People experiencing a mental health problems

They told us they recognised these groups as being important to the NHS and that they provided services to all of these groups. However, they told us they found it difficult to identify specific services which could be applied to these groups as many patients fell into multiple groups at the same time.

The provider cited their carers group as being a strong example of their approach. Other examples included vaccination services, diabetes services, extended opening hours and access to a GP of choice and gender through GPs holding individual patient lists.