Farmhouse Surgery

Updated 21 June 2023

The Farmhouse Surgery is in Christchurch, Dorset at:

Christchurch Medical Centre

1 Purewell Cross Road

Christchurch

Dorset

BH23 3AF

The practice is one of two GP providers based at Christchurch Medical Centre.

The practice provides general medical services in Christchurch, Dorset. The area covered incorporates the coastal town, attracting temporary residents on holiday during the summer months. Information published by Office for Health Improvement and Disparities shows that deprivation within the practice population group is in the seventh decile (seven of 10). The lower the decile, the more deprived the practice population is relative to others.

At the time of the inspection, there were 6160 patients on the practice list and most patients are of white British background. The Farmhouse Surgery has almost double the number of patients over 75 years (14.3% of the practice list) compared with the national average of 7.7%. All the patients have a named GP.

The practice has 3 GP partners and 2 salaried GP’s. The practice uses the same GP locums for continuity wherever possible.

The nursing team consists of 2 nurse practitioners and 1 health care assistants. All the practice nurses are employed part time and specialise in certain areas of chronic disease and long-term conditions management.

Farmhouse surgery is managed by a Practice Manager, plus administrative and reception staff.

The practice has an Action Management Before Emergency Risk team (AMBER), which is co-ordinated on behalf of Farmhouse Surgery by a GP from another practice based at the medical centre. The practice had access to the AMBER team who work across all two practices based at Christchurch Medical Centre. The purpose is to support vulnerable patients, provide home visits and proactive monitoring to avoid unplanned hospital admissions wherever possible. The Farmhouse Surgery did not employ this team and they were not included in the practice staffing numbers.

The provider is registered with CQC to deliver the Regulated Activities, diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury and surgical procedures.

The practice is situated within the Dorset Integrated Care System (ICS) and delivers General Medical Services (GMS). This is part of a contract held with NHS England.

The practice is part of a wider network of 4 GP practices called the Christchurch Primary Care Network.

The practice is open 8.30am to 6.30pm Monday to Friday. Phone lines are open from 8am to 6:00pm, with the out of hours service picking up phone calls after this time. GP appointment times are from 8.30am to 6:00pm every weekday. Extended opening hours are provided with evening appointments available by arrangement, every Monday.

Telephone appointments are available Monday to Friday by arrangement. Information about opening times and appointments is listed on the practice website and patient information leaflet. Opening hours of the practice are in line with local agreements with the clinical commissioning groups.

Patients requiring a GP outside of normal working hours are advised to contact the out of hours service provided by 111 services in Dorset.

The practice has a General Medical Service (GMS) contract.

Updated 21 June 2023

We carried out an announced focused inspection at the Farmhouse Surgery on 20 – 22 March 2023. Overall, the practice is rated as inadequate.

Safe - inadequate

Effective - requires improvement

Caring – Not inspected

Responsive - good

Well-led - inadequate

Following our previous focussed inspection on 15 December 2016 the practice was rated good overall and for all key questions. At this inspection, we found that those areas previously regarded as good had not been continued. While the provider had maintained some good practise, the threshold to achieve a good rating had not been reached. The practice is therefore now rated inadequate.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for the Farmhouse Surgery on our website at www.cqc.org.uk

Why we carried out this inspection.

We carried out this inspection to follow up concerns reported to us.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A staff questionnaire.
• A site visit.

Our findings

We based our judgement of the quality of care at this service 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 found that:

• The practice did not have clear systems and processes to keep people safe and safeguarded from abuse. There were gaps in systems to assess, monitor and manage risks to patient safety and staff did not have the information they needed to deliver safe care and treatment. The practice did not always share learning or improvements when things went wrong.
• Appropriate standards of cleanliness and hygiene were not met.
• Some aspects of medicine management did not ensure patient safety.
• Patients’ needs were assessed but care and treatment was not consistently delivered in line with current legislation, standards and evidence-based guidance. The staff were not always supported by clear pathways and tools.
• There was limited monitoring of the outcomes of care and treatment. The practice did not have a comprehensive programme of quality improvement activity and did not routinely review the effectiveness and appropriateness of the care provided.
• The practice could not demonstrate that all staff had the skills, knowledge and experience to carry out their roles.
• People were able to access care and treatment in a timely way and the practice organised and delivered services to meet patients’ needs. The practice always obtained consent to care and treatment in line with legislation and guidance. Complaints were listened and responded to. However. it was not clear how learning from complaints was shared to improve the service.
• Leadership was not effective at all levels. The practice did not have a clear vision and credible strategy to provide high quality sustainable care. The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were ineffective. The practice did not always act on appropriate and accurate information and there were no clear and effective processes for managing risks, issues and performance. The practice involved the public and staff to a limited extent. There was little evidence of systems and processes for learning, continuous improvement and innovation.

We found 4 breaches of regulations. The provider must:

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences,
• Ensure care and treatment is provided in a safe way to patients. The registered persons had not done all that was reasonably practicable to mitigate risks to the health and safety of patients receiving care and treatment.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure enough suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

The provider should:

• Take action to inform patients of the use of CCTVs outside the building.
• Take steps to ensure that the records requiring summarising are prioritised to support vulnerable patients.

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.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services