- GP practice
Farmhouse Surgery
All Inspections
23 March 2023
During an inspection looking at part of the service
We carried out an announced focused inspection at the Farmhouse Surgery on 20 – 22 March 2023. Overall, the practice is rated as inadequate.
Safe - inadequate
Effective - requires improvement
Caring – Not inspected
Responsive - good
Well-led - inadequate
Following our previous focussed inspection on 15 December 2016 the practice was rated good overall and for all key questions. At this inspection, we found that those areas previously regarded as good had not been continued. While the provider had maintained some good practise, the threshold to achieve a good rating had not been reached. The practice is therefore now rated inadequate.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for the Farmhouse Surgery on our website at www.cqc.org.uk
Why we carried out this inspection.
We carried out this inspection to follow up concerns reported to us.
How we carried out the inspection
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.
This included:
- Conducting staff interviews using video conferencing.
- Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
- Reviewing patient records to identify issues and clarify actions taken by the provider.
- Requesting evidence from the provider.
- A staff questionnaire.
- A 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 found that:
- The practice did not have clear systems and processes to keep people safe and safeguarded from abuse. There were gaps in systems to assess, monitor and manage risks to patient safety and staff did not have the information they needed to deliver safe care and treatment. The practice did not always share learning or improvements when things went wrong.
- Appropriate standards of cleanliness and hygiene were not met.
- Some aspects of medicine management did not ensure patient safety.
- Patients’ needs were assessed but care and treatment was not consistently delivered in line with current legislation, standards and evidence-based guidance. The staff were not always supported by clear pathways and tools.
- There was limited monitoring of the outcomes of care and treatment. The practice did not have a comprehensive programme of quality improvement activity and did not routinely review the effectiveness and appropriateness of the care provided.
- The practice could not demonstrate that all staff had the skills, knowledge and experience to carry out their roles.
- People were able to access care and treatment in a timely way and the practice organised and delivered services to meet patients’ needs. The practice always obtained consent to care and treatment in line with legislation and guidance. Complaints were listened and responded to. However. it was not clear how learning from complaints was shared to improve the service.
- Leadership was not effective at all levels. The practice did not have a clear vision and credible strategy to provide high quality sustainable care. The practice culture did not effectively support high quality sustainable care.
- The overall governance arrangements were ineffective. The practice did not always act on appropriate and accurate information and there were no clear and effective processes for managing risks, issues and performance. The practice involved the public and staff to a limited extent. There was little evidence of systems and processes for learning, continuous improvement and innovation.
We found 4 breaches of regulations. The provider must:
- Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences,
- Ensure care and treatment is provided in a safe way to patients. The registered persons had not done all that was reasonably practicable to mitigate risks to the health and safety of patients receiving care and treatment.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure enough suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
The provider should:
- Take action to inform patients of the use of CCTVs outside the building.
- Take steps to ensure that the records requiring summarising are prioritised to support vulnerable patients.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA
Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services
15 December 2016
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
We carried out a focused follow up inspection of the Farmhouse Surgery on 15 December 2016. This inspection was performed to check on the progress of actions taken following an inspection we made on 17 and 18 May 2016. These included;
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Having effective procedures to ensure the security of prescription forms used in printers when consulting and treatment rooms are not in use.
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Ensuring staff receive appropriate support, training and professional development.
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Having effective governance arrangements to monitor and improve the quality of services provided.Specifically, the practice needed to have effective systems to identify training needs and to monitor and address any training gaps in a timely way.
Following the inspection in May 2016, we rated the practice as requires improvement overall. 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 15 December 2016, we found the provider had made the necessary improvements in delivering good safe and well led services. Overall the practice is now rated as good because of the domains of effective, caring and responsive were previously assessed as being good.
This report covers our findings in relation to the requirements and should be read in conjunction with the comprehensive inspection report published in September 2016. This can be done by selecting the 'all reports' link for Farmhouse Surgery 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:
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There were effective procedures ensuring the security of prescription forms used in printers when consulting and treatment rooms were not in use.
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The practice had systems to ensure staff received appropriate support, training and professional development.Training that staff had completed since May 2016 raised awareness about the Mental Capacity Act, fire safety and chaperone duties for named staff who were undertaking this role.A diary system was in place and appraisals had taken place for all staff or were planned to take place later in the year.
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There was an effective system to identify needs, monitor and address any staff training gaps in a timely way.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
17 and 18 May 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Farmhouse Surgery located at Christchurch Medical Centre on 17 and 18 May 2016. Overall the practice is rated as requires improvement.
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.
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The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.However, we found some gaps in these systems.For example, some mandatory training updates had not been provided for staff.Records for recruitment and vetting of locum staff did not provide assurance of appropriate checks being undertaken. The security arrangements of prescription stationary was not secure enough.
- Risks to patients were assessed and well managed. In conjunction with the two other practices situated at Christchurch Medical Centre vulnerable older patients and those at risk with chronic health conditions were monitored by the Action Management Before Emergency Risk team (AMBER). The team was providing early interventions and support so that patients avoided unplanned hospital admissions.
- 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. For example, staff had extended their skills with advanced qualifications such as the Diploma in Spirometry to care for people with respiratory disorders.
- Thirty one patients provided written and verbal positive feedback at the inspection and 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.
- Patients 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 impact of staff shortages, particularly in the nursing team had been minimised where possible for patients by working collaboratively with the other practices based at the medical centre.
- 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 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.
The areas where the provider must make improvement are:
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Ensure the security of prescription forms in printers when consulting and treatment rooms are not in use.
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Ensure staff receive appropriate support, training, professional development, supervision as is necessary to enable them to carry out duties they are employed to perform. Provide up to date infection control, safeguarding and Mental Capacity Act 2005 training for all staff, and chaperone training for those staff undertaking this role.
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Ensure systems are put in place so that all staff receive annual appraisals and up to date training in fire safety and undertake regular fire drills.
Areas of should
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Ensure that accurate records of the checks undertaken are held when recruiting and vetting locum staff.
- Risk assess and review the overflow refrigerator arrangements for cold chain storage of vaccines in line with current guidelines.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
14 May 2014
During an inspection looking at part of the service
Following our inspection completed in January 2014, Farmhouse Surgery provided us with an action plan detailing how they would address the shortfalls and stated that they would be compliant in all areas by April 2014.
This inspection found Farmhouse Surgery treated people with respect and dignity. We found people who used the service were cared for by staff that were properly qualified and able to do their job and Farmhouse Surgery had quality checking systems to manage the risks and assure health, welfare and safety of people who used the service.
21 January 2014
During a routine inspection
People said they were treated with respect and involved in making decisions about their care. For example, one person commented that their doctor 'discusses things with me'.
However, people's dignity could be compromised because consultation and examination rooms did not all have privacy curtains around the examination couches.
People experienced care and treatment that met their needs and protected their rights. People expressed confidence in the surgery. For example, one person said, 'I've found them very supportive'. However, several people said that it was sometimes difficult to contact the surgery on the telephone.
Patients using the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.
Not all the recruitment information required by the Regulations was available.
The surgery did not have an effective system to assess and manage risks to people's health, safety and welfare. We saw equipment past its expiry date. Some staff were unable to tell us about correct infection control procedures.