Farmhouse Surgery

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed and inspected against the five quality statements, During our assessment of this key question, safeguarding systems, processes and practices had been implemented. Staff had received safeguarding training relevant to their role and understood how to report concerns. Recruitment checks were carried out in accordance with regulations, however there were a few gaps in some recruitment records. Safe staffing levels were in place. Staff training was in the process of transition from one training provider to another. It was therefore difficult to evidence full staff training records and completion of these. Staff had received induction, annual appraisal and clinical supervision. Safe systems, pathways and transitions were in place. Referrals to specialist services were appropriate and monitored and there was a documented approach to the management of test results. Appropriate systems for the safe management of medicines including emergency medicines and equipment and medicines optimisation required review.. The location of emergency medicines were in various places erratic, and staff were not always sure where emergency medicines were located. Staff knew how to identify and report concerns, safety incidents and near misses however there was evidence lacking on how these were discussed with the wider team.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us that they had opportunities to provide feedback and they knew how to make a complaint. There were feedback forms in the practice and information on how to make a complaint was available on site and on their website.

Leaders told us they used incidents and complaints to improve systems and processes. Staff understood their duty to raise concerns and report incidents. The practice didn’t have established processes to embed learning as a result of significant incidents and complaints. For example staff told us they felt able to raise concerns when things went wrong however staff also informed us that learning from significant incidents and complaints were not shared. Staff also informed us that team meetings were not held regularly, and no formal agenda was shared. There is a Patient Participation Group however this remains in the process of reestablishing in person following a period of having remote communications only.

We identified that the practice had logged 11 complaints and 27 significant events in the last 12 months. The practice had a significant event policy and complaints policy which was accessible to all staff members. The practice had a duty of candour policy and involved people when managing significant events and errors. The practice had a clear system in place to record and investigate complaints. From the sample of complaint records we reviewed; we found the practice responded to peoples’ complaints in a timely manner. The practice offered apologies to people when appropriate, lessons were learnt from individual concerns and complaints and action was taken as a result to improve the quality of care. The practice had a system in place to monitor significant events. Meetings were held monthly with the senior management team to discuss improvements. There were not an clear/established systems and processes to ensure staff were receiving feedback regarding lessons learnt and there was a lack of regular team meetings to utilise this process Feedback from staff informed us that there was a lack of sharing of learning from Significant events and complaints therefore staff were not able to be engaged with the process of shared learning from events and incidents. The practice had a system in place to monitor medicine safety alerts which included a policy and a log of the actions completed from this. Locum’s had full access to the practice system to see all journals and alert icons.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not receive any concerns from commissioners or other system partners about safeguarding systems and processes. Staff told us they had received training in safeguarding children and adults. They knew who the safeguarding lead in the practice was and how to raise concerns.

Leaders told us they used incidents and complaints to improve systems and processes. Staff understood their duty to raise concerns and report incidents. The practice didn’t have established processes to embed learning as a result of significant incidents and complaints. For example staff told us they felt able to raise concerns when things went wrong however staff also informed us that learning from significant incidents and complaints were not shared. Staff also informed us that team meetings were not held regularly, and no formal agenda was shared. There is a Patient Participation Group however this remains in the process of reestablishing in person following a period of having remote communications only.

We identified that the practice had logged 11 complaints and 27 significant events in the last 12 months. The practice had a significant event policy and complaints policy which was accessible to all staff members. The practice had a duty of candour policy and involved people when managing significant events and errors. The practice had a clear system in place to record and investigate complaints. From the sample of complaint records we reviewed; we found the practice responded to peoples’ complaints in a timely manner. The practice offered apologies to people when appropriate, lessons were learnt from individual concerns and complaints and action was taken as a result to improve the quality of care. The practice had a system in place to monitor significant events. Meetings were held monthly with the senior management team to discuss improvements. Feedback from staff informed us that there was a lack of sharing of learning from Significant events and complaints therefore staff were not able to be engaged with the process of shared learning of events and incidents. The practice had a system in place to monitor medicine safety alerts which included a policy and a log of the actions completed from this. Locum’s had full access to the practice system to see all journals and alert icons.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff we spoke to were able to tell us where the emergency medicines and resuscitation equipment was. These were located in the nurses room as well as there being a resuscitation trolley. Staff were able to tell us that work had been undertaken to renew elements of the practice and this included painting and decorating. There is a maintenance programme in place to also include the renewal of the seating benches in the reception area.

Whilst reviewing the practice we noted that there was evidence of internal decorating and the practice looked clean and tidy. We noted however, that the clinical waste area stored in the open car park was not secured to anything concrete. Fire equipment was observed to have been checked May 2024. It was also noted that the bench seating in the reception area was in a continued need of repair and there are plans to renew the reception area seating. There were sepsis, chaperone and mission statement posters in the reception area. It was noted however that the latest CQC inspection summary was not visible. Where these were observed and noted these were rectified immediately.

The service had a fire risk assessment in place. This was due for review November 2023 and at the time of the assessment this had not been reviewed. An audit of the fire risk assessment was due for the end of June and this was completed

People could feedback their experience of the service via the GP patient survey results and out of the 254 surveys sent out 109 were returned. We identified overall feedback from patients was good and there was positive feedback about patients feeling they were given enough time for their appointments and the patients had confidence and trust in the health care professional they spoke to. Staff told us they attended meetings however the feedback from staff as to the frequency of these appeared vague and evidence of these indicated infrequent team meetings.

Leaders told us they had recently expanded and recruited to the nursing team in October 2023. Staff told us they had received training relevant to their role and they had access to clinical supervision where appropriate. They told us they received regular appraisals and that their development and training was discussed in the appraisal. Staff told us they attended regular team meetings. Leaders told us they were supporting staff to develop.

The provider had appropriate recruitment processes in place. We reviewed 5 personnel files during the site visit and found recruitment checks had been carried out, including disclosure and barring (DBS) checks. We did note gaps of evidence missing however these were noted and actioned for example there were missing copies of a qualification certificate however this was located when requested. We reviewed the training records and found all staff were receiving training. However due to the transition of training platforms, it was difficult to fully ascertain staff completion of all mandatory training. When training was discussed with management there remained to be ambiguity regarding the current status of this. Clinical staff had access to regular clinical supervision, and we saw competency checks were being carried out for staff new in roles. There were regular meetings including clinical meetings and we observed minutes of these. Out of the 5 staff file checks we completed 4 out of the 5 had received an annual appraisal. There were gaps in staff vaccinations and where these were present no risk assessment was in place to mitigate these.

We could not collect sufficient evidence to score this evidence category. Information in relation to peoples experience of Infection prevention and control (IPC) was not covered within the national GP patient survey. Information was also not available via the Friends and family feedback via the practice.

Staff we interviewed had no concerns about the cleanliness of the building. The IPC lead informed us that they completed audits of the cleanliness of rooms with the practice including equipment and clinical rooms, which we observed during our assessment.

During our site visit we observed clinical rooms, emergency equipment to all be clean and auditing of equipment all in date. The environment was seen to be clean and tidy with no offensive odours.

The practice had an Infection prevention (IPC) policy for staff to follow. The practice had an IPC lead and had received the relevant training to support their role. The practice had a building risk assessment tool kit which included assessing IPC management. The practice held a hand hygiene audit in January 2024 and scored 100% compliance. Cleaning contracts were in place and the practice had recently changed their cleaning contract provider. The cleaning schedules and COSHH were reviewed and all in place. The environment was observed to be clean and tidy. Clinical waste was available in each of the clinical rooms. Sharps boxes were dated and signed in use and were not overfilled. Clinical waste bins were held in the open car park area. It was noted however that the clinical bins were not padlocked to something concrete and could therefore be moved from its place. There was evidence of internal IPC audits and these were being completed on a monthly basis. One had been completed in June 2024 and the practice scored and overall 99%. Infection prevention control training was detailed as part of the mandatory training however due to the transition of the training system it was difficult to evidence if all staff had completed their IPC training.

During our clinical searches we found medicine reviews had not been carried out for patients on high risk medications. We identified some areas that required review but these related to processes. For example, coding and recording in the clinical record. The practice had systems in place to receive, review and act on medicine alerts although they did not keep a monitoring overview of these.

Leaders told us they had recently recruited to the practice nurse position, and they were now clinically fully staffed. They told us they received regular appraisals and that their development and training was discussed in the appraisal. Staff told us they attended team meetings.

During our clinical searches we found structured medicine reviews were carried out and patients on high-risk medications were appropriately monitored, however, there were some noted gaps overdue monitoring. One of the searches highlighted a discrepancy in reviews however the practice quickly prepared a plan of action to rectify this and on the day of assessment had already been able to reduce the figure by half. The practice had systems in place to receive, review and act on medicine alerts, although they did not keep a monitoring overview of these. During our checks we found all medicines were stored securely throughout the main practice and branch site. The practice held appropriate emergency equipment and emergency medicines at the main practice and branch site, with the exception of 5 emergency medications. There was a risk assessment in place for one of the medicines however it wasn’t robust to cover the potential harm that could be caused should the treatment need emergency medicine. We found equipment and medicines were monitored to ensure medicines were not used past their expiration dates. We raised this with the provider and after the assessment, assurances were sought to ensure the emergency medicines not present on site at the time of the assessment were delivered immediately. Systems and processes were followed to ensure the monitoring of fridge temperatures holding vaccinations were safe. The recording of the temperature was recorded via an electronic system and where there were variances n temperature there was a reason noted as to why for example – re stocking of the fridge.

Staff and leaders told us they had systems and processes in place to support the safe prescribing of medicines. The practice employed 1 clinical pharmacist who supported the GPs in the practice. Prescribing and medicines management were discussed regularly at clinical meetings. The practice had a policy in place for the management of medicines including repeat prescribing. The practice had good systems in place for the safe and effective management of clinical correspondence. Accurate and up-to-date information about people’s medicines was available, particularly when they moved between health and care settings. The practice had up-to-date Patient Group Directions (PGDs) in place for nurses carrying out specific vaccinations and healthcare assistant staff had a good understanding of Patient Specific Directions (PSDs).

During our checks we found all medicines were stored securely throughout the main practice, although the medicines were stored in various cabinets. The practice held appropriate emergency equipment and emergency medicines at the practice apart from 5 Emergency medicines. This was discussed with the practice nurse and actions were put in place to ensure these were in stock. Emergency equipment and medicines were checked on a regular basis. Vaccinations were ordered and stored in accordance with national guidelines and the practice had systems in place to monitor the temperature of vaccinations fridges. As noted as part of the remote medicine searches there were shortfalls identified in patient monitoring on certain medications.