Farrier House Surgery

Updated 30 August 2018

Farrier House Surgery provides services for patients living in Worcester City and students at the local university. At the time of the inspection the practice served a population of 5,100 patients.

Farrier House Surgery was previously a walk in centre and had changed in April 2015 to a new provider (SW Healthcare) to provide GP services. The practice is managed by SW Healthcare GP Federation providing support with administration, education and governance, as well as back office functions. A GP federation is formed of a group of practices who work together to share best practice and maximize opportunities to improve patient outcomes.

SW Healthcare holds an Alternative Provider Medical Services (APMS) contract with NHS England for the provision of services. The APMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. The practice is an active member of the South Worcestershire Clinical Commissioning Group (CCG).

The practice has mainly a younger, transient population with a lower than average older population of 4% compared with the local average of 34% and the national average of 27%. Services are provided to a student population at a nearby university, to a local hostel and to homeless people at a nearby day centre.

There is a lead GP, three salaried GPs and a regular locum GP (two male and three females) at the practice. The GPs are supported by a practice manager, two advanced nurse practitioners, a clinical pharmacist, a practice nurse, a healthcare assistant, administration and reception staff.

Opening hours are from 8am to 6.30pm on Monday to Friday each week with appointments between these times. The practice is closed at weekends. Extended hours appointments are available for pre-bookable appointments from Monday to Friday evenings from 6.30 to 8pm. Three additional clinics per week are held at the university to provide an onsite service for students. Appointments at two of these clinics are with the Advanced Nurse Practitioners (ANPs) with appointments with a GP at one of the clinics. A clinic is held each week at the homeless drop in day centre.

The practice does not provide an out-of-hours service but has alternative arrangements for patients to be seen when the practice is closed. For example, if patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on the circumstances. Information on the out-of-hours service (provided by Care UK) is available in the patient practice leaflet and on the website.

Home visits are available for patients who are housebound or too ill to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and book appointments with GPs.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as lung diseases, asthma and diabetes. Other appointments are available for health checks, childhood vaccinations and contraception advice.

Updated 30 August 2018

We carried out an announced comprehensive inspection at Farrier House Surgery on 13 June 2017. The overall rating for the practice was good. The practice was found to be requires improvement in providing a caring service and in providing effective services for the population group of working age people (including those recently retired and students). The full comprehensive report on the September 2017 inspection can be found by selecting the ‘all reports’ link for Farrier House Surgery on our website at www.cqc.org.uk.

This inspection was an announced desk top review carried out on 31July 2018 to confirm that the practice had carried out their plan to make the improvements that we identified in our previous inspection in June 2017. 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.

Our key findings were as follows:

• The practice had continued the work already in progress to identify more patients who were carers and provide appropriate support.
• Action taken to address patient feedback had continued to be monitored and reviewed.
• Monitoring had continued to be carried out in areas of Quality Outcome Framework (QOF) where results were lower than average to identify areas for improvements. Action had been taken to ensure coding was accurate and that patient registers were correct so that patients were monitored on a regular basis.
• Patients continued to be encouraged to take part in national screening programmes for breast and bowel cancer.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 11 August 2017

The practice is rated as good for the care of patients with long-term conditions.

• The practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Nursing staff had received appropriate training in chronic disease management, such as asthma and diabetes.
• Longer appointments and home visits were available when needed.
• All patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met.
• Performance for diabetes related indicators was lower than the local and national average. For example, patients with a record of a foot examination and risk classification at 88% was comparable to the CCG and the national averages of 92% and 89% respectively. The practice exception rate of 11% was above the CCG and the national averages of 6% and 8%. Unpublished data for 2016/2017 showed that the practice had made improvements on the results of previous data achieving 96% (an increase of 8%).
• Clinical staff had close working relationships with external health professionals to ensure patients received up to date care.
• Patients were encouraged to manage their own conditions with support from community teams and pain management clinics.

Updated 11 August 2017

The practice is rated as good for the care of families, children and young people.

• The practice was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs of this age group.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Staff had been trained to recognise signs of abuse in vulnerable adults and children and the action they should take if they had concerns. There was a lead GP for safeguarding adults and children. GPs were trained to an appropriate level in safeguarding adults and children.
• There were systems to identify and follow up children living in disadvantaged circumstances and who were considered to be at risk of harm. For example, children and young people who had a high number of accident and emergency (A&E) attendances.
• The practice worked with midwives, school nurse teams and health visitors to coordinate care.
• The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
• Childhood immunisation rates for the vaccinations given were comparable to local and national averages.
• The practice offered a number of online services including requesting repeat medicines and booking appointments.
• Baby changing facilities and breast feeding rooms were available to those who needed it.
• Mother and baby checks were carried out as part of the postnatal mother and eight week baby checking processes.
• Confidential contraception services were provided for children and young people.

Updated 11 August 2017

The practice is rated as good for the care of older patients.

• The practice offered personalised care to meet the needs of the older patients in its population. It was responsive to the needs of older patients.

• A range of enhanced services was offered by the practice, such as dementia and unplanned admissions to hospital.
• Monthly multi-disciplinary meetings were held and included discussions on patients receiving end of life care.
• Support was provided for isolated or house bound patients. This included signposting to support services or volunteer services including local community groups or charities such as Age UK. Home visits and telephone consultations were available and used on a daily basis.
• Health promotional advice and material was available to help older patients maintain their health and remain as independent as possible.
• The practice had a dedicated care navigator who was able to provide information on how to access various services to help older patients sustain their health and wellbeing.

Updated 30 August 2018

Updated 11 August 2017

The practice is rated as good for the care of patients experiencing poor mental health (including patients with dementia).

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• People at risk of dementia were identified and offered an assessment to detect for possible signs of dementia. Where dementia was suspected, there was a referral process for diagnosis. This enabled them to access a variety of treatments (including listening and advice and counselling).
• Advanced care planning and annual health checks were carried out for patients with dementia and poor mental health.
• Carers were offered health checks and monitored for their wellbeing. They were signposted to support services such as Alzheimer’s Society or Dementia UK, and the local Dementia Café.
• There was a system to follow up patients who had attended accident and emergency (A&E) departments where they may have been experiencing poor mental health.
• Clinical staff had a good understanding of how to support patients with mental health needs. They were trained to recognise patients presenting with mental health conditions and carried out comprehensive assessments.

Data showed the practice performed mainly in line with or above local and national levels:

• Patients with mental health concerns such as schizophrenia, bipolar affective disorder and other psychoses with agreed care plans were 100% which was above the CCG average of 93% and above the national average of 89%. The practice exception rate was 37% which was higher than the CCG and national averages of 13%.
• No data had been recorded for the proportion of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months. The local and national averages were 85% and 84% respectively. The practice had diagnosed three patients with dementia during 2016/2017 and unpublished data showed they had achieved 100% of care reviews for all patients with dementia.

Updated 11 August 2017

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

• Services were provided for all vulnerable patient groups presenting to the practice. For example, the practice provided services to homeless people and patients who were affected by substance misuse.
• Outreach services for homeless people within the city of Worcester had been initiated by the practice. They had established regular clinics at a local day centre in order to promote health and wellbeing, providing appropriate healthcare and treatment where required.
• The practice worked in partnership to understand the needs of the most vulnerable in the practice population. This included working with the CCG, third sector organisations and the local health authority public health department.
• Vulnerable patients were informed how to access various support groups and voluntary organisations.
• Clinical staff regularly worked with multidisciplinary teams in the case management of vulnerable patients. Alerts were added to patients records for staff awareness so that longer appointments could be allocated.
• The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability. Longer appointments were available for patients with a learning disability. The practice had carried out annual health checks for 92% of the 25 patients on their register for 2016/2017.
• The practice pharmacist carried out medicine reviews for housebound patients. All concerns were reported and where necessary, arrangements were made for a GP to visit.