Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Dr Steven Nimmo (Barton Surgery) on 10 October 2017. Overall the practice is rated as good.

We carried out an announced comprehensive inspection at Barton Surgery on 8 December 2015. At this inspection the overall rating for the practice was requires improvement. The domains of effective, caring and well led were rated as requires improvement. The domains of safe and responsive were rated as good.

We then carried out an announced focused follow up inspection on 6 September 2016. This was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations from the previous inspection in December 2015. We focused on the three domains which had been found to require improvement; effective, caring and well led. At that inspection the overall rating for the practice was good. The three domains of effective, caring and well led were rated as good.

We carried out this inspection on 10 October 2017 as an announced focused follow up inspection to establish whether changes seen in 2016 were embedded within the practice. This report covers our findings and any additional improvements made since our last inspection.

The reports on these inspections can be found by selecting the ‘all reports’ link for Dr Steven Nimmo (Barton Surgery) on our website at www.cqc.org.uk.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an inspection at Dr Steven Nimmo (known as Barton Surgery) on the 6 September 2016. This inspection was performed to check on the progress of actions taken following an inspection we made in December 2015. Following the inspection in December 2015 the provider sent us an action plan which detailed the steps they would take to meet their breaches of regulation. During our latest inspection on 7 September 2016 we found the provider had made the necessary improvements in delivering effective, caring and well led services.

This report covers our findings in relation to the requirements and should be read in conjunction with the comprehensive inspection report published in March 2016. This can be done by selecting the 'all reports' link for Dr Steven Nimmo on our website at www.cqc.org.uk

Our key findings across the areas we inspected in this focused follow up inspection were as follows:

• The practice had improved their service through the introduction of a structured approach to the reporting and recording of significant events and complaints. This included regular meetings and shared learning to address these.
• Risks to patients were assessed and well managed.
• Clinical audits were being undertaken and demonstrated quality improvement.
• Staff had the skills, knowledge and experience to deliver effective care and treatment. The practice now had an overview of training which specified what training staff had received or required.
• Systems were in place to obtain consent for treatment. Joint injection examples provided evidence of recorded verbal consent.
• Emergency equipment was in place, was easily accessible and was checked on a regular basis.
• The practice had improved their provision of caring services through an analysis of the GP Patient Survey results from July 2015 to July 2016 and the identification of required improvements. Survey results were now in line with CCG and national averages.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had a new recruitment procedure in line with current guidance. We saw evidence of complete staff files including a new member of staff. Staff were only recruited following a thorough recruitment process.
• A set of policies and procedures had been made available to staff, including a staff handbook.
• Patient feedback was sought and acted upon.
• Staff feedback had also been sought and acted upon. Staff we spoke with told us they felt listened to and their suggestions had been acted upon.

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 Dr Steven Nimmo (Known as Barton Surgery) on Tuesday 8 December 2015. We had previously inspected the practice in April 2015 when we found serious concerns. As a result the practice was rated as inadequate and put into special measures. Following the inspection the practice sent us an action plan of how they were going to address the issues. The practice has made significant improvements in relation to safety; they are continuing improve their effectiveness, responsiveness and leadership. At this inspection we have rated the practice as overall requiring improvement.

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

• There had been improvements since the last inspection. However, the approach to service delivery and improvement continued to be reactive and focused on short term issues. Further improvements were not always identified.
• There was a more structured approach to the reporting of and recording of significant events and complaints.
• 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.
• There had been improvements in the recruitment procedure. Staff were only recruited following a robust recruitment process.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Clinical areas had been tidied and reorganised. Infection control audits had now taken place.
• Information about services and how to complain continued to be available and easy to understand.
• A set of policies and procedures had been made available to staff, these were being developed further.
• Patients said they found it easy to make an appointment with a GP, although they had to wait longer to see the GP of their choice. Patients also said urgent appointments were available the same day.
• Processes were in place for maintaining clinical equipment, although some emergency equipment was not in place, but was sourced by the next day.
• Patient feedback was sought and acted upon.
• Staff had access to whistleblowing policies, had attended safeguarding training and the practice had advertised chaperoning services.
• Checks had been introduced to ensure fridge temperatures and emergency equipment were checked.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvement are to:

• Introduce systems to show that consent is obtained and, where appropriate, recorded in line with relevant guidance and legislation and includes details of risks prior to minor surgery and invasive procedures, including excisions being performed.

• Ensure the governance and audit systems are proactive and focussed on improvement and used to identify issues and drive improvements.

The areas where the provider should make improvement are:

• Introduce a system to maintain an overview of significant events and complaints which could be used to and identify and monitor any trends.

• Demonstrate that the remaining patient group directive has been fully adopted by the GP provider to allow nurses to administer the shingles vaccine in line with legislation.

• Introduce systems to ensure the strategic plan is kept under review to ensure it contained up to date details of partners.

• Act upon the national patient GP survey results published in July 2015.

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 focused inspection at Dr Steven Nimmo (Barton Surgery) on 10 October 2017. Overall the practice is rated as good.

We carried out an announced comprehensive inspection at Barton Surgery on 8 December 2015. At this inspection the overall rating for the practice was requires improvement. The domains of effective, caring and well led were rated as requires improvement. The domains of safe and responsive were rated as good.

We then carried out an announced focused follow up inspection on 6 September 2016. This was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations from the previous inspection in December 2015. We focused on the three domains which had been found to require improvement; effective, caring and well led. At that inspection the overall rating for the practice was good. The three domains of effective, caring and well led were rated as good.

We carried out this inspection on 10 October 2017 as an announced focused follow up inspection to establish whether changes seen in 2016 were embedded within the practice. This report covers our findings and any additional improvements made since our last inspection.

The reports on these inspections can be found by selecting the ‘all reports’ link for Dr Steven Nimmo (Barton Surgery) on our website at www.cqc.org.uk.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out this inspection in order to follow up on non-compliance we had identified at the scheduled inspection carried out in September 2013. The non-compliance related to supporting staff and staff training at the practice.

We did not speak with any patients on this occasion.

During this inspection of 29 September 2014, we found that significant improvements had been made relating to supporting staff and training and were continuing with these changes.

The practice had responded to the findings of the previous CQC inspection report and had taken action to successfully achieve compliance.

We spoke with seven people who used this service. Overall we received good feedback about the staff. Comments included "urgent response with children [very good]", and "new forward looking [GPs]". People said they were treated with dignity and respect by staff, and they felt involved in their treatments because options were discussed with them.

Four people expressed dissatisfaction with the appointment system and availability of appointments. They also described long waiting times after their appointment time to see their GP.

We spoke with six staff. None had attended safeguarding training and none was planned. They were however confident about what to do, and we saw evidence of appropriate action that had been taken about a safeguarding concern.

There were not robust training arrangements in place. Clinical staff were responsible for their own training to meet their roles and registration requirements. We found there was no system to identify training staff had completed or that would need to be refreshed on an annual basis, for example, infection control. Only the provider had completed safeguarding vulnerable adults training. All the GPs had completed child protection training. The non clinical staff were not provided with an opportunity to discuss their work, any training needs, and their professional development.

There were systems in place to monitor the quality of the service provided and patients were able to give feedback about the service they received.