Farmhouse Surgery

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

There were positive staff cultures with all staff reporting that they felt supported by the GPs and management. Governance structures and systems were in place although some required review. For example, policies did not always reflect what was happening in the practice and improvement for example the recruitment policy referred to not all staff having DBS checks however the practice had changed their approach and all staff were DBS checked. The oversight of patients for review and monitoring also required review to ensure patients remained safe. The service was in breach of 1 regulation, good governance.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and leaders demonstrated a positive, compassionate, listening culture that promotes trust and understanding between them and the staff. Staff gave feedback that they felt listened to and their wellbeing was important to the leadership team. Staff considered the management team to be always available and held an open-door policy.

The provider had a business plan which had recently been completed therefore it was difficult to evidence progress of this. The practice were aware of patient feedback regarding access and were continually reviewing this and had started to resurrect the PPG group. Staff attended team meetings including, nursing, multidisciplinary and full team meetings. Meetings were minuted, these were shared with staff. The practice was able to evidence that most of the staff had received equality and diversity training. The practice had a raising concerns (whistleblowing) policy and there were systems to ensure compliance with the requirements of the duty of candour in place. we spoke with told us that there was a positive team culture within the practice and that they felt very supported by both the GPs and practice manager. They told us they were able to contribute to discussions about service improvements, incidents and complaints. All staff we spoke with were proud to work for the service and had a vision to deliver high quality patient care. They reported that they felt able to raise concerns with leaders without fear of retribution and they knew how to access the whistleblowing policy.

Staff told us they received appraisals and were given opportunities to discuss development and any training needs during their appraisal. They told us management had an ‘open door’ policy and they could approach leaders at any time if they required support. All staff reported that they had received the training they required for their role and were up to date with their training. Staff reported a positive, open culture. They all said they felt part of a team and could approach the practice manager and GPs with any queries or concerns. They all said they felt very supported.

Appropriate recruitment checks were completed for staff. We reviewed 5 personnel files and found appropriate checks had taken place including disclosure and barring (DBS) checks apart. Induction records were completed. Records showed 4 out of 5 staff had received an annual appraisal.

All staff knew who the Freedom to speak up person was and knew the process of referral if needed.

The provider had established positive processes for staff to be able to share concerns . Managers haled regular clinical meetings and emerging risks. Managers documented minutes however it there want a clear process for cascading shared leaning to the staff.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff were encouraged to attend staff meetings during which updates would be shared. Staff knew how to access practice policies. There was a suite of policies accessible to staff on the practice’s computer system, although we observed the recruitment policy did not correlate with what staff were doing or included inaccurate information. This was noted and addressed by the provider . There were named leads in place for key areas and staff were clear about their roles and responsibilities. Staff told us they could provide feedback and had opportunities to raise concerns or suggest new ideas to leaders.

The clinical searches we carried out on the practice’s clinical system showed good patient care, although some processes required review. For example, they did not have a system to ensure follow up of patients with asthma prescribed emergency steroids as recommended in national guidance. Some coding and recording in records required review. As part of the clinical searches, a concern was raised in regard to how patients had been alerted of a specific condition as alerts via Medicines and Healthcare products regulatory Agency MHRA. TThere were effective arrangements for identifying, managing, and mitigating risks with the exception of a risk assessment for one emergency medicine not stocked. When this feedback was given to the practice the emergency medicine was ordered and kept in stock. Team leaders and the practice manager had oversight of the administration systems and processes to ensure they ran smoothly. The meetings minutes however didn’t note previous meeting actions had been addressed. The practice had a business continuity plan in place and this provided guidance and information for staff. From the last assessment it was noted that there was an improvement in regard to how keys were stored and kept safe in the practice. This was reflected in a key holding policy. The Human resources manager had oversight of the training and due to the transition of the training platform areas of weakness were noted and we were not assured that all staff training was up to date.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told us that leaders encouraged development. For example, they had supported a healthcare assistant through the nurse associate course The practice were working with the local Primary care Network to be involved in a local incentive programme to support people of a certain age range ensuring they have all in place that they should and have sought medical support if needed. Staff feedback noted there was a lack of learning cascaded and staff were not aware of the process of learning from the leadership team.

Complaints were managed as per the complaints policy and people were sent the respective correspondence as per the timescales. Learning was noted as part of this process and apologies were sent to patients. The practice held monthly meetings to discuss complaints and significant events, and these were evidenced. Staff told us they were not shared learning from events.