We carried out an announced comprehensive inspection at White House Farm Medical Centre on 10 May 2016. The overall rating for the practice was good with requires improvement for being well-led. An announced focused follow up inspection was carried out on 19 January 2017. The overall rating for the practice was good with requires improvement for people experiencing poor mental health (including people living with dementia). The full comprehensive report for the inspection of 10 May 2016 and the focused follow up report of 19 January 2017 can be found by selecting the ‘all reports’ link for White House Farm Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 12 March 2018 to review in detail the actions taken by the practice to improve the quality of care for people experiencing poor mental health (including those living with dementia). This report covers our findings in relation to those areas identified and also additional improvements made since our last inspection.

Overall the practice is rated as good and good for people experiencing poor mental health (including those living with dementia).

Our key findings were as follows:

• The care provided to patients experiencing poor mental health (including those living with dementia) had been reviewed. A recall system had been implemented to ensure patients were offered an annual review of their care and this review was recorded in their medical record.

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 comprehensive inspection of this practice on 10 May 2016. The overall rating for the practice was good with requires improvement for being well-led. The full comprehensive report for the inspection of 10 May 2016 can be found by selecting the ‘all reports’ link for White House Farm Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 19 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 10 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good for being well-led and remains requires improvement for those people experiencing poor mental health (including people living with dementia).

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

• The partners had reviewed the governance framework to support the performance of the practice. There was a clear staffing structure and staff were aware of their own roles and responsibilities. Practice specific policies were implemented and were available to all staff on the desktop of computers and as paper files. At the time of our inspection two practice managers had been employed temporarily to support the practice as the practice manager post was vacant. They were currently in the process of recruiting a new practice manager.

• We were shown records of incidents reported since our last inspection. Incident forms were completed and included a review of relevant policies and procedures. Staff told us they were aware how to report incidents and also were briefed about learning points from them when it involved their role.

• The GPs had reviewed the clinical performance of the practice which was now discussed at clinical meetings. Overall outcomes were under review as part of the practice's clinical performance monitoring. Staff we spoke with were aware of the practice achievement for Quality Outcomes Framework (QOF) for 2015/16. We noted there had been improvement in some areas, for example:
• Asthma indicators had improved from 61% in QOF 2014/15 to 80% in QOF 2015/16.
• Chronic obstructive pulmonary disease outcomes had improved from 73% in QOF 2014/15 to 77% in QOF 2015/16.

• The practice had improved the recording of alcohol consumption for those with complex mental health illness from 44% in QOF 2014/15 to 80% in QOF 2015/16.

However, there had been a decline in other indicators . For example:

• Of those with complex mental health illness 78% had a comprehensive agreed care plan in their record in the last 12 months in QOF 2014/15 which had declined to 28% in QOF 2015/16.

There was an area of practice where the provider should make improvements:

• Review the care provided to those people experiencing poor mental health (including people living with dementia) to ensure annual reviews take place and are recorded.

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 comprehensive inspection at White House Farm Medical Centre on 10 May 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. We noted some events were discussed at the clinical meeting but not captured within the incident reporting process

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• Risks to patients were assessed and managed.

• Staff assessed patients needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were mostly treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Feedback from patients reported that access to a named GP and continuity of care was not always available quickly, although urgent appointments were usually available the same day. The practice had recently introduced a new telephone system to address telephone access concerns raised by patients and the patient participation group.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• A comprehensive understanding of the clinical performance of the practice was not maintained. GPs took the lead for named clinical areas and were responsible for monitoring performance and a programme of internal audit for that area. There was no evidence overall clinical performance was monitored.

• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Review the incident reporting process to ensure all events and near misses are captured as part of the practice reporting and investigation process.
• Review and implement a process to monitor the practices clinical performance and in doing so contribute to a programme of clinical quality improvement.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Patients expressed their views and were involved in making decisions about their care and treatment. We saw that patients were given information and support with regards to treatment options and that staff maintained patient’s privacy and confidentiality.

Patients who spoke with us said they were treated with respect and the care they received was “Very good”, “Responsive to what I want” and “Excellent.” Two patients told us they were very happy with their experience of the practice and said “This is a really good service, the GP’s listen to you and answer all your questions” and “The nurses are professional. You are never rushed through your appointment and they explain everything to you.”

We found the environment to be clean, tidy and organised. We saw there were appropriate systems in place to reduce the risk and spread of infection. Two patients who spoke with us told us they felt the hygiene and cleanliness of the practice was of a high standard.

Staff had received appropriate professional development and training to ensure they could meet the needs of the patients who used the service. Staff could tell us who they would contact if they were concerned about child protection issues or abuse of patients. The practice had systems in place to assess and monitor the quality of the service that patients received.