We carried out an announced comprehensive inspection at Farrow Medical Centre on 5 December 2018 as part of our inspection programme.

Farrow Medical Centre was last inspected on 4 November 2014 and was rated as good.

Our judgement of the quality of care at this service is based 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 inadequate overall.

We rated the practice as inadequate for providing safe services because:

• The provider could not demonstrate that suitable arrangements were in place to prevent the spread of infection at the practice.
• The provider had failed to assess the risks to the health and safety of staff and patients at the practice.
• Systems and processes were not in place to keep patients safe and protected from abuse.

We rated the practice as inadequate for providing effective services because:

• The practice was unable to demonstrate that staff were suitably trained or had the skills, knowledge and experience necessary to carry out their roles.

This issue affected all areas of the service. Therefore, we rated all population groups as inadequate.

We rated the practice as inadequate for providing well-led services because:

• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance. For example; we saw that the processes in place to manage complaints, significant events, safety alerts and patient group directions were ineffective.
• The practice could not demonstrate that the relevant policies and procedures were in place to support the good governance of a GP practice. A small number of policies were available but the majority did not contain up to date or relevant information and the practice could not assure themselves that they would direct staff to the best course of action.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure that persons employed by the service are suitably trained as is necessary to enable them to carry out the duties they are required to perform.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review and improve the identification of carers to ensure that they are able to meet the needs of this vulnerable group.
• Continue to review the immunisation status of the staff team in line with the requirements of Immunisation against infectious disease (The Green Book).
• Ensure that DBS checks are undertaken in line with practice policy.

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.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice:

We carried out an announced inspection visit on 4 November 2014 and the overall rating for the practice was good.

Our key findings were as follows:

• The practice provided good, safe, responsive and effective care for all population groups in the area it serves.

• Where incidents had been identified relating to safety, staff had been made aware of the outcome and action taken where appropriate, to keep people safe.

• All areas of the practice were visibly clean.

• Patients received care according to professional best practice clinical guidelines. The practice had regular information updates, which informed staff about new guidance to ensure they were up to date with best practice.

• The service was responsive and ensured patients received accessible, individual care, whilst respecting their needs and wishes.

• We found there were positive working relationships between staff and other healthcare professionals involved in the delivery of service.

We saw areas of outstanding practice including:

• An additional Saturday morning surgery is taking place during the winter months; November 2014 to March 2015, to help reduce weekend pressure on the local Accidents and Emergency department. The practice is working with GPs from eight other practices in meeting this initiative.

• Each patient aged 75 years and over and those patient who were at risk of hospital re-admission, has a named GP who they mostly see at an appointment. They also contact their patients personally with any follow up information about their treatment or care.

• The practice is providing a service to local hostels; including the homeless, and mother and child. The mother and child hostel was a short term facility which meant they should have been registered as temporary patients with the practice. To improve the care provision, availability and access to services, the practice registered them as permanent patients.

• The practice is working with The National Institute of Clinical research to screen patients for Hepatitis B & C.

• When patients experiencing poor mental health turn up at the practice for a repeat prescription, they are accommodated instead of them having to give the standard 48 hours’ notice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice