Letter from the Chief Inspector of General Practice

Lower Farm Health Centre was inspected on 18 May 2016 and was found to be inadequate for providing safe, effective and well-led services, and requires improvement for providing caring and responsive services. As a result of our findings during the May 2016 inspection, the practice was placed into special measures. Since our May 2016 inspection, a new provider took over the practice in September 2016 and put in place a new practice management team in October 2016. Since the changes in the management structure, there has been significant improvement.

We carried out an announced comprehensive inspection at Lower Farm Health Centre on 31 July 2017. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• A system was in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents. All opportunities for learning from internal and external incidents were maximised. Records showed that the practice had responded and learned from safety incidents.

• The practice had clearly defined and embedded systems to minimise risks to patient safety. For example, effective systems were in place for receiving and acting on local and national alerts from the Medical and Healthcare products Regulatory Agency (MHRA).

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.

• A comprehensive chronic disease strategy drove quality improvement initiatives. The practice carried out a number of quality improvement activities such as clinical audits, which demonstrated areas where improvements had been achieved.

• Results from the latest national GP patient survey published July 2017 showed variations’ in patients’ satisfaction regarding being treated with compassion, dignity and respect, including level of involvement in their care and decisions about their treatment. Staff were aware of survey results and were taking action to improve patient satisfaction.
• The practice was aware of areas of low patient satisfaction and had developed an action plan to improve patient satisfaction. Patients we spoke with during the inspection told us that they were treated with compassion, dignity and respect; and were happy with the care provided over the last 12 months.
• Information about services and how to complain was available. Improvements had been made to the quality of care as a result of complaints and concerns.
• Patients we spoke with during the inspection 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 practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a clear vision, which had quality and safety as its top priority. The strategy to deliver this vision had been produced with the involvement of practice staff and was regularly reviewed and discussed during meetings.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. Innovative methods were used to achieve continuous improvements.

The provider should make improvements in the following areas:

• Continue to encourage patients to attend national screening programmes such as breast cancer screening.

• Continue to monitor and ensure ongoing improvement to patient satisfaction in line with local and national averages.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating July 2017 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We previously undertook a comprehensive inspection of Lower Farm Health Centre on 31 July 2017. The overall rating for the practice was Requires Improvement with the Caring and Responsive domains being rated as Requires Improvement. This was because the GP Survey results for the practice were lower than the local and national average, and the number of patients attending breast screening within six months of invitation was low.

We carried out an announced comprehensive inspection at Lower Farm Health Centre on 4 September 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice had systems to keep patients safe and safeguarding from the risk of abuse. The practice maintained registered of children and adults assessed as vulnerable and their care was discussed at the monthly practice meetings.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• The practice had a strategy for monitoring patients with long term conditions, which ensured all patients were offered an annual structured review.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice had introduced a new telephone system, which enabled the volume of calls to be monitored as well as the number of calls waiting.
• The practice had introduced a triage system for patients requesting a home visit or urgent appointment.
• Patients told us they could usually get an appointment when they needed one.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Continue to identify and offer support to carers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.