Farrow Medical Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Overall, we found that the practice provided safe care and treatment for patients. At the inspection in April 2023, issues included the management of infection prevention and control (IPC), vaccine refrigerators and recruitment checks. A review of patient clinical records found the provider did not ensure the safe and appropriate management of patient medicines and medicines monitoring. In this assessment we found the premises to be clean and tidy and saw that regular audits were undertaken to assess the standards of cleaning carried out at the practice. There was effective management of vaccine handling and storage, and an effective system in place to ensure that recruitment checks were carried out in accordance with regulations. A review of patient clinical records found that generally patients were safely managed by the practice. We identified some areas for improvement, which included working on the historic summarising backlog, and ensuring there were always trained designated fire wardens on site.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Leaders told us that the practice had a strong learning culture and that they encouraged staff to report incidents openly. An example of this is an incident where an incorrect vaccine was administered to a patient. We saw that this incident had been reported and investigated, that the patient and relevant professionals were informed, and that this had led to the creation of a new protocol. Staff told us that they were able to raise concerns and ideas for improvement, and that this was welcomed by managers.

There were policies and processes in place to record, investigate and take action from incidents and complaints. These were discussed in monthly meetings and minutes made available to staff who were unable to attend. There was some evidence of incidents not being reported to relevant external organisations until internal investigations were complete. The practice told us they would change their processes to ensure that relevant incidents were immediately reported in future. There was a safety alerts policy and named leads who were responsible for distributing this information to relevant staff and ensuring they were actioned. A review of clinical records indicated that safety alerts were generally actioned in line with guidance. There were sufficient numbers of staff who were trained to carry out their role effectively. Clinical and non-clinical audits were carried out on regular basis, and these resulted in improvements to processes and patient care.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Leaders told us that they worked with others to establish and maintain safe systems of care for patients. They also told us that continuity of care for patients was important and that they achieved this through collaboration with others. For example, staff used a clinical decision support tool to log and monitor urgent referrals and this included input from external professionals involved in the patient's care. Cancer diagnosis data was reviewed to identify good and poor practice with referrals and to make improvements. We saw that the number of new cancer cases treated resulting from an urgent cancer referral, using latest data from March 2022, was in line with the national average. Staff we spoke with understood the referrals processes and how to manage correspondence.

We spoke with the NHS West Yorkshire Integrated Care Board ahead of this assessment. From the feedback we received from them there was no indication of concern in this area.

Policies and guidance were in place to support workflow and pathways for appointments, referrals, records summarising and correspondence. There were processes to monitor and manage care when patients were moved between services such as after referral to secondary care, or admission to hospital. A review of the practice clinical system, which formed part of this assessment, indicated that patient test results were being managed in a timely manner. There was however a summarising backlog of 982 records and the practice told us that a new member of staff was due to start working on these in August.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Leaders told us they used the clinical system to record and alert staff to safeguarding concerns. Staff told us they had received training in safeguarding and chaperoning and were able to explain their role in these processes, including how to recognise and escalate any concerns. At the time of the assessment most staff were up to date with training in these areas as well as in the Mental Capacity Act and the Deprivation of Liberty Safeguards, where required. Leaders told us about an audit they had recently carried out regarding children not being brought for appointments or immunisations and this highlighted the importance of ensuring correct coding being applied in such cases.

We spoke with the NHS West Yorkshire Integrated Care Board ahead of this assessment. From the feedback we received from them there was no indication of concern in this area.

There were designated safeguarding children and adult leads at the practice. There were monthly multi-disciplinary meetings where safeguarding issues were discussed and these were attended by GPs and a nurse. External stakeholders were invited to safeguarding meetings, however their attendance was limited. We were told that relevant information was discussed with these organisations where needed. Policies for chaperoning and safeguarding were in place and accessible to staff.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Staff we spoke with knew where to locate emergency drugs and equipment and were able to explain how to act safely in an emergency, including alerting clinical staff and emergency services.

There was a resuscitation policy, and an emergency drugs policy which detailed the procedure for the checking of emergency drugs including staff responsible for these tasks. We saw that checks on emergency drugs and equipment were carried out and recorded regularly, and that risk assessments had been carried out for recommended medicines that were not stored at the practice. Staff received training in basic life support, sepsis and anaphylaxis.

Staff told us they had undertaken required mandatory training in respect of health and safety, such as fire safety training, and that they had no concerns related to health and safety in the practice. Staff confirmed that fire alarm tests and emergency evacuation drills had been undertaken and this was supported by records we examined.

We saw that the premises was clean, modern and accessible and that equipment was stored safely. There was a lift available for staff and patients to access the first floor. There was appropriate signage in place, such as for fire doors and escape routes.

The provider had established processes to assure that health and safety requirements were met. Equipment was tested and maintained regularly, and risk assessments were carried out with identified actions and recommendations followed up or monitored. There was a fire evacuation plan and policy, however there were no plans in place to ensure that a designated fire warden was always available on site. Immediately after the assessment we saw that the practice had arranged fire warden training for additional members of staff.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Leaders told us about the ways in which they ensured staff were qualified and skilled to carry out their roles, and the support that they offered them. This included carrying out security checks during recruitment and providing staff with mandatory and role-specific training. Leaders told us they monitored staffing levels and that although they used locums where necessary, there had been no recent requirements for locums as staffing levels were sufficient. There was however a need for another nurse, for which the recruitment process had been started. Staff told us they received appropriate support and supervision and that they received protected time to undertake training.

Policies on recruitment, induction and staff appraisals were in place. Staff also had access to a handbook which provided key information such as absence and grievance processes. A folder was available to locums to provide them with the necessary information to carry out their role safely. Trainees and non-medical prescribers received appropriate supervision. We reviewed some staff personnel files as part of this assessment and found that documentation was generally in line with guidance. This included Disclosure and Barring Service (DBS) checks, immunisation records and appraisal records.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Feedback from staff informed us that they had a good understanding of infection prevention and control (IPC). Staff knew who the IPC lead was and how to raise IPC concerns. Staff who handled clinical specimens told us that they had received guidance on how to do this safely.

On the day of the assessment, we found the premises and equipment to be tidy and clean. Cleaning schedules and records were in place for various areas such as clinical rooms and refrigerators where vaccines and drugs were stored. The cleaner’s cupboard was tidy and contained appropriate equipment and cleaning materials. Appropriate personal protective equipment was available to staff. There was some expired equipment found in a clinical room which was immediately discarded.

There was an infection prevention and control (IPC) lead for the practice who carried out weekly spot checks of cleanliness and reported any issues to staff and to the external cleaning company that were contracted to clean the practice. Staff received IPC training and this formed part of their mandatory training requirements. There was an IPC policy in place which had been reviewed in November 2022 however this had not been updated to correctly reflect the current IPC lead and date of the last IPC audit. An IPC audit had been carried out in November 2023 and identified issues had been actioned. In response to the previous inspection the practice had introduced daily dedicated slots for clinical staff to document that they had cleaned clinical equipment within their rooms at the end of each day. Clinical waste was appropriately managed by an external company.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Leaders told us that performance in relation to medicines outcomes were closely monitored through discussions in clinical meetings and through medicines audits. For example, a gout audit was carried out in April 2023 which was based on NICE guidance from June 2022, and this resulted in additional checks being carried out for patients taking a specific medication to treat gout. To ensure continued safe prescribing for patients who had not attended for required medicines monitoring, these patients were subject to repeated contacts to encourage attendance and when necessary, prescribed lower amounts of medicines. Staff told us they received appropriate training and supervision in medicines management, including the management of vaccines.

As part of our assessment a CQC GP specialist advisor (SpA) undertook searches of patient records on the practice’s clinical system. Overall, the searches showed that medicines had generally been effectively managed by the practice. Findings included: Azathioprine (an immunosuppressant): all 14 patients had received the required monitoring in the last 6 months, or relevant tests had been requested for them. Direct oral anticoagulants (DOACs - help to prevent blood clots from forming): Of 84 patients prescribed a DOAC it appeared that 35 had not had their Creatinine Clearance calculated in the past year. We reviewed 3 patient records and found 1 had an appointment booked for relevant testing. After the assessment the practice reviewed and actioned all 35 patients. Acting on drug safety alerts: 4 patients had been prescribed an aldosterone antagonist (a diuretic) along with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers which are used to treat raised blood pressure, and did not appear to have had the required monitoring in the last 6 months. All 4 patients either had an appointment booked or had received relevant safety netting. Potential missed diagnosis of diabetes: Of 27 patients identified in this category, 5 were reviewed and 1 was found to be incorrectly coded as pre-diabetic. This was reviewed and corrected after the assessment. Medication reviews: There had been 800 medicines reviews in the last 3 months. Of the 5 we reviewed, there were no concerns identified. Medicines usage: Benzodiazepines and Z drugs (sedative-hypnotic medications). There were 37 patients who had received more than 10 prescriptions. We reviewed 5 patients and found that they had all had a structured medicines review in the past 12 months. It was not always clear whether patients had been informed of the risks of addiction or that there had been an attempt to wean these patients off the drug. This was actioned by the practice after the assessment.

There were policies in place covering repeat prescribing, management of prescription forms, and vaccine management. Medicines within the practice were effectively ordered, stocked and monitored. There were Patient Group Directions and Patient Specific Directions in place which relevant staff worked to. There was a process in place to ensure prescription stationery was logged and stored securely. Refrigerators used to store vaccines and medicines were regularly cleaned, temperatures were monitored and logged, and products were appropriately stored within them. The practice participated in the Lowering Antimicrobial Prescribing (LAMP) audit and Campaign to Help Improve Respiratory Prescribing (CHIRP), and as a result had a good overview of their overall prescribing performance.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this as the practice performance was in line with or better than national averages for all indicators. For example, data for March 2024 showed that the percentage of Co-amoxiclav, Cephalosporins and Quinolones prescribed was at 3.7%, compared to the national average of 7.8%.