The Care Quality Commission
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  • GP practice

Frome Medical Practice

Overall: Good read more about inspection ratings

Frome Medical Centre, Enos Way, Frome, Somerset, BA11 2FH (01373) 301301

Provided and run by:
Frome Medical Practice

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Frome Medical Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Frome Medical Practice, you can give feedback on this service.

28 April 2022

During a routine inspection

We carried out an announced inspection at Frome Medical Practice on 28 April 2022. Overall, the practice is rated as Good.

Set out the ratings for each key question

Safe - Good

Effective -Good

Caring-Good

Responsive-Good

Well-led - Good

Following our previous inspection on 9 June 2021, the practice was rated Requires Improvement overall and for the safe and well-led key questions. Effective, caring and responsive key questions were rated Good.

A warning notice was served related to regulation 12 and a desk based review was carried out on 20 October 2021 to check compliance with the notice. This desk based review was not rated. We found the practice had complied with the warning notice.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Frome Medical Practice on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a focused comprehensive inspection which covered the following:

The key questions of safe, effective and well-led.

The ratings for the caring and responsive key questions of Good were carried forward from our previous inspection.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

  • Continue to encourage uptake of childhood vaccinations.
  • Continue to encourage uptake of cervical screening

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

20 October 2021

During an inspection looking at part of the service

We carried out a desk-based review of Frome Medical Practice on 20 October 2021 in response to issuing a warning notice. This inspection was focused around the areas in the warning notice only and therefore not a rated review. Therefore the ratings from the previous inspection remain.

Safe - Requires Improvement

Effective - Good

Caring - Good

Responsive - Good

Well-led – Requires Improvement

Following our previous inspection on 09 June 2021 the practice was rated Requires Improvement overall and for all key questions except for the effective, caring and responsive key questions which were rated as Good.

We issued the provider with warning notices for breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, related to safe care and treatment.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Frome Medical Practice on our website at www.cqc.org.uk

Why we carried out this review

Following the issuing of a warning notice for regulation 12 we undertook a desktop review to gain assurances that the practice were now compliant with the areas they were in breach of regulation. We are mindful of the impact of the COVID-19 pandemic and therefore as the assurances related to clinical searches and patient safety we were able to obtain our assurances remotely through a desktop review. This was undertaken on 20 October 2021.

Our findings

We found that:

  • The practice had made improvements in all areas identified in the warning notice and were now compliant.
  • The practice had clear systems and processes to keep patients safe.
  • The practice had appropriate systems in place for the safe management of medicines.
  • There was a process in place for monitoring patients’ health in relation to the use of medicines including high risk medicines (for example, warfarin (a medicine to prevent blood clots), methotrexate (a medicine to treat rheumatoid arthritis) and lithium (a mood stabilising medicine) with appropriate monitoring and clinical review prior to prescribing.
  • The practice managed safety alerts and provided evidence that patient medicine alerts were actioned and managed appropriately.

Following this review, we determined that the shortfalls identified in the warning notice had been met.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

09 June 2021

During a routine inspection

We carried out an announced inspection at Frome Medical Practice on 9 June 2021. Overall, the practice is rated as requires improvement.

Safe – Requires Improvement .

Effective - Good.

Caring - Good.

Responsive - Good.

Well-led – Requires Improvement .

Following our previous inspection on 26 November 2019, the practice was rated Requires Improvement overall and for the effective and responsive key questions. They were rated as good for safe, caring and well-led services. They were rated as requires improvement in all the population groups.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Frome Medical Practice on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection to follow up on:

• The five key questions - safe, effective, caring, responsive and well-led.

• ‘Shoulds’ identified in previous inspection.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements. This included:

• Conducting staff interviews using video conferencing

• Completing clinical searches on the practice’s patient records system and discussing findings with the provider

• Reviewing patient records to identify issues and clarify actions taken by the provider

• Requesting evidence from the provider

• A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected

• information from our ongoing monitoring of data about services and

• information from the provider, patients, the public and other organisations.

We have rated this practice as Requires Improvement overall, for the safe and well-led key questions and for the long term conditions population group. We have rated this practice as Good for caring, effective and responsive and for the older people; Families, children and young people; working age people; people whose circumstances make them vulnerable; and, people experiencing poor mental health population groups as good.

We found that:

  • The practice did not provide care in a way that kept patients safe and protected them from avoidable harm. Not all patients on high risk medicines were appropriately monitored and safety alerts had not always been acted on.
  • Action had been taken to improve patient outcomes in relation to the Quality Outcomes Framework, however, personalised care adjustments were higher than average in relation to diabetes, asthma and hypertension.
  • The governance systems had failed to ensure patients prescribed high risk medicines had appropriate monitoring or that all safety alerts had been acted on. However, there were clear leadership roles and responsibilities in operation.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • Staff recognised and respected people’s needs. People’s emotional and social needs are seen as being as important as their physical needs.
  • Staff recognised the impact of social issues on health and wellbeing and took action to address this. Action included working collaboratively with other services to support patient’s needs.

We also found the following areas of outstanding/notable practice:

  • The practice operated a health connection model of social prescribing and had developed the model across the Mendip region since 2015. There was evidence of a positive impact on emergency hospital admissions since this time.
  • The practice had been the leading practice for four years in the UK and organised the first primary care conference in ‘green impact’ and sustainability and had successfully bid to receive climate action national lottery funding. They had appointed a ‘green’ Health Connector to the practice as part of this work, who had a focus on supporting patients with healthy and sustainable living. They were also in the process of transferring patients to inhalers with a lower environmental impact.

We found one breach of regulations. The provider must:

  • Ensure safe care and treatment.

The provider should:

  • Continue to review QOF performance with a view to reducing personalised care adjustments for patients with diabetes, asthma or hypertension.
  • Continue to improve uptake of cervical screening.
  • Review uptake of childhood immunisations in relation to coverage with a view to increasing uptake.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

26 Nov 2019

During a routine inspection

We carried out an announced comprehensive inspection at Frome Medical Practice on 26 November 2019 as part of our inspection programme.

Our previous inspection report had been published in August 2015. At that time we had rated the practice as Outstanding. Since 2015 there had been a decline in ratings for a number of reasons. Many of the outstanding features had become common practice nationally. Treatment for patients with long term conditions such as diabetes required improvement. The practice had received challenging feedback in the recent national GP patient survey around accessing the service. The practice was in the process of carrying out an improvement plan to address these areas.

We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected

• information from our ongoing monitoring of data about services

• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall for providing services because:

• Patients did not always receive effective care and treatment that met their needs.

• Patients experienced difficulties in accessing the practice via the current telephone system.

• Staff dealt with patients with kindness and respect and involved them in decisions about their care and developments at the practice.

• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

• The practice utilised all feedback and opportunities to network, share and implement current best practice.

We rated all the population groups as requires improvement overall. This is because of the feedback highlighted in the national GP patient survey report regarding accessing the service, affects all patients in all of the population groups.

In addition we rated the population groups of long term conditions, working age people and people with poor mental health requires improvement in the effective domain. This was because we were not assured that all patients in these population groups were receiving appropriate care and treatment.

• The practice should continue to monitor and review patient satisfaction regarding telephone access and demonstrate improvement.

• The practice should continue to review its care of patients with diabetes, asthma and mental health issues to ensure improvements in this area were embedded

• The practice should continue to focus on cervical cancer screening in order to reach the 80% national target; and on reviews for patients diagnosed with cancer to improve performance.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

10 and 11 of June 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Frome Medical Practice on the 10 and 11 June 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for providing safe, responsive, effective services and for being well led. They were also outstanding for providing services for all the population groups. They were good at providing caring services to patients.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice had a hub team to reduce hospital admissions, which worked well to provide support to high risk patients and working in collaboration with the multi-disciplinary teams.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patient’s needs.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
  • The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

  • There were comprehensive systems in place to keep patients safe from harm and the team actively reviewed their safeguarding systems in order to do this. This included regular bi-weekly review of domestic violence notifications with all GPs.
  • There was a comprehensive system in place to keep patients safe when taking high risk medicines. The system included when it was determined patients required outstanding diagnostic tests, patients had ease of access of the daily nurse led drop in clinic to enable them to have these checks completed quickly and enable them to continue with their medicine safely.
  • The practice had a dedicated unplanned admissions hub team and had 3.5% of care plans completed working alongside multidisciplinary teams to aid the reduction in being urgently admitted to hospital. The practice had seen a slower rise in admissions in comparison to the previous year and had a lower percentage of admissions than other local practices in the area.
  • The newly developed Health Connections Mendip service which was based in the practice and partly facilitated by the practice to build patients confidence to manage their own conditions and to develop and use services available to them for support. This had benefitted patients who have specific and not necessarily common conditions by new support groups being established and successfully represented by these patients.
  • The safe use of innovative and pioneering approaches to care and how it was delivered were actively encouraged. Nurses led minor surgery clinics within the practice, 89% of patients seen in the last year had minor surgery completed by a trained nurse. They had been running since 2002 and received a practice nurse award in 2002 for making a difference.
  • The practice had increased carer registration from 250 in January 2012 to 850 in May 2015. They linked with the local community hospital to increase awareness of the service provided by the practice and encouraged carers to register. The practice had a trained carers champion and often linked with Carers UK for advice and updates on information to provide to patients. All new carers were contacted by the carers champion and had a direct dial number to contact them in the future. New carers were provided with a carers information pack and there was an information stand for carers displayed in the practice.
  • The practice had set up a weekly ‘leg ulcer club’ through The Lindsay Leg Club foundation in October 2014. The leg club was held in a non-medical setting enabling patients and others to receive a high standard of care for patients experiencing problems with their legs including leg ulcers. This occurred in a social and friendly setting that promoted understanding, peer support and informed choices. The practice funded the attendance of health care professionals during these clinics and the foundation funded the use of the facilities and refreshments. Since October 2014, 90 patients from the practice had been seen at the club for on-going treatment. The lead nurse for the leg club received a Mayor’s Civic Award on 1 April 2015 for outstanding contribution to the community and was a reflection of how many leg club members were attending in a short period of time proving the club to be already successful.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice