Farmhouse Surgery

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed 5 Quality assessments assessing need; delivering evidence based care and treatment ; How staff teams and services work together; monitoring care and outcomes ; consent to care and treatment, Patients received effective care and treatment that met their needs. We observed from the clinical searches we carried out that the service delivered evidence-based care. However, recording of risk advice and some monitoring processes required review. They monitored and improved outcomes for patients by carrying out clinical audits. Staff, teams and services worked in a positive way to improve patient outcomes and worked with other care providers so support patients whose circumstances may make them vulnerable and also within their primary care network. For example, they had partnered with the Primary Care Network to support the older people in the locality. This involved reviewing patients over the age of 90 and if they hadn’t seen a GP for a while they would be contacted discussions held to see if any support could be given.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We didn't gather evidence for this evidence category. Therefore the previous scoring has been applied.

Leaders and staff told us staff would put an alert on the patient record to highlight people’s communication needs and any impairments. They had access to interpreter services and care navigator staff we spoke with told us that they would support patients with communication needs, for example, the practice utilised the NHS Dorset Easy read Pre health check questionnaire and Annual Health check form. The practice had systems and processes in place to identify people’s needs and preferences during the registration process.

The practice had a system in place to ensure people’s assessments were up-to-date and staff understood people’s current needs. People’s care needs were routinely reviewed however there were some identified shortfalls for patients with asthma and steroids. People with long term conditions were invited for an annual health check, however, there were some patients who were overdue their annual monitoring. The practice supported a care home and the GP would complete a weekly ward round and quarterly meetings were held. The practice also had access to ‘The Amber Team.’ The AMBER team is staffed by community nurses and healthcare assistants. Staff told us how patients were asked how best to communicate with them and if they required support to help support communication. There was an accessible communication tool in place to help people with communication challenges. Patient records were flagged to alert staff to individual needs and preferences.

We didn't cllect evidence for this category therefore the previous inspection score has been applied.

GPs told us they worked to current NICE guidance and local clinical protocols. People shared though the practice survey that they were happy with the care and treatment that they received. Staff discussed patient care at monthly clinical, safeguarding and integrated care team meetings. Staff had completed some clinical audits to ensure they were meeting clinical guidelines. The quality and safety group monitored the practices clinical performance monthly.

We observed from the clinical searches we carried out that the service delivered evidence-based care, although some recording of risk advice and monitoring processes required review. For example, the follow up of patients with asthma prescribed emergency steroids were not reviewed as per NICE guidelines within 48 hours Patients with long term conditions were offered an annual review however through the sample looked at through the medical searches there were gaps identified in the annual monitoring of patients. There was observation of 2 week cancer audits waits and there is one specific person who deals with these and the process is robust and clear and all referrals were current and up to date.

We didn't collect evidence for this category therefore the previous inspection score applies.

Senior staff attended regular multi-disciplinary team meetings to discuss patients whose circumstances may make them vulnerable, for example patients receiving end of life care.

Senior staff attended regular multi-disciplinary team meetings to discuss patients whose circumstances may make them vulnerable, for example patients receiving end of life care.

The practice was part of a primary care network (PCN) of practices who shared staff for the benefit of patients. For example, The “AdvantAGE” Project was started by the PCN as a way of actively seeking out the most vulnerable patients who may not be accessing the care and support that they need in later life. This project was at its early stage and the impact of this project will in time evolve.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Feedback from people using the practice was positive. People gave good feedback about timeliness of appointments and access to appointments.

Staff carrying out long-term condition reviews had received appropriate training for the role.

Clinical searches identified shortfalls in the monitoring of patients with long term conditions and those on high-risk medicines. The practice had not invited patients in for their long-term condition annual reviews. Once identified the practice completed the necessary checks and processes. We saw the practice had a system for reviewing patients test results in a timely manner.

Clinical searches identified patients not being reviewed in a timely manner. We observed referral letters to be actioned in a timely manner.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.