Farnham Integrated Care Services

The service is rated as Good overall and Good for providing safe services.

We carried out a comprehensive inspection of Farnham Integrated Care Services (FICS) in July 2019. Following this inspection, we rated the service as good overall, but requires improvement for providing safe services as we found concerns relating to the monitoring and tracking of blank prescription stationery and issues relating to the monitoring of fridge temperature checks and escalation processes.

We carried out a focused inspection of the service on 13 February 2020 to follow up on these concerns. We also followed up on areas where the service was not always following best practice standards.

Farnham Integrated Care Services is a federation of five NHS GP services. They provide support and additional services to the patients registered with these practices.

One of the GPs is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

• Blank prescription security had been improved and we saw evidence of tracking processes.
• The January 2019 intercollegiate guidance for child safeguarding had been embedded in the service policy and all staff had been trained to the appropriate level.
• Gaps in recruitment files had been reviewed and systems put in place to ensure these were checked as part of the recruitment process.
• The system for reviewing patient safety and medicines alerts had been improved and the provider ensured all relevant staff were informed when they were received.
• Fridge temperature checking logs had improved, although we noted there were repeat measurements noted over several days in the last two months, which may indicate non-compliance with re-setting procedures. There had been one episode of the fridge going out of the recommended range which had not been escalated using the appropriate process.

In addition to the areas above, we reviewed how the service monitored consent seeking processes. The provider showed us a consent audit which had reviewed patient records where formal consent had been gained. The consent forms used had been adopted from a local hospital trust and the provider had deemed they were in line with legislation and guidance for seeking consent. The service computer systems had an informed consent prompt which could not be bypassed when updating patient records.

Whilst there were no breaches of regulation, the provider should:

• Implement a review of the fridge temperature re-setting process to ensure it is being undertaken correctly.
• Inform staff of the appropriate escalation processes if the fridge temperature goes out of the recommended range (including the minimum and maximum temperatures recorded).

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? – Good

We carried out an announced comprehensive inspection at Farnham Integrated Care Services on 3 July 2019 as part of our inspection programme. This was the first inspection of this service.

Farnham Integrated Care Services is a federation of five NHS GP services. They provide support and additional services to the patients registered with these practices.

One of the GPs is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

• The service had systems in place to manage risk, so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
• Some processes required a review, such as oversight of checks of the cold chain for medicines and escalation processes, and tracking and monitoring of blank prescription stationery.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• The provider had reviewed the needs of the local population and offered integrated services to promote patient care and welfare. This had had a positive impact on the local health system. Their interventions had reduced GP call outs, ambulance call outs, attendance at the Emergency department and admission to hospital.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Review the intercollegiate guidance for child safeguarding (January 2019) and ensure this is considered in the service policy for safeguarding.
• Consider how gaps in employment are identified and managed during the recruitment process.
• Review the process for receiving and disseminating information to all clinicians relating to patient safety and medicines alerts. Consider how any actions (including awareness of the alerts) are recorded.
• Consider how consent can be monitored.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care