• Doctor
  • GP practice

Farrow Medical Centre

Overall: Inadequate read more about inspection ratings

177 Otley Road, Bradford, West Yorkshire, BD3 0HX (01274) 637031

Provided and run by:
Farrow Medical Centre

All Inspections

19 September 2023

During an inspection looking at part of the service

We carried out an announced focused inspection at Farrow Medical Centre on 18 and 19 September 2023. This inspection was not rated.

Following our previous inspection on 18 and 20 April 2023, the practice was rated as inadequate overall. The key questions of safe, responsive, effective and well-led were rated as inadequate. The rating for the provision of caring services was good.

As a result of the April 2023 inspection, we issued the provider with warning notices for breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for Regulation 12: Safe care and treatment, Regulation 16: Complaints and Regulation 17 Good governance.

During this inspection, undertaken on 18 and 19 September 2023, we saw improvements had been made to the practice’s management of recruitment processes, antibiotic prescribing, consent processes, cold chain management, and how the practice dealt with complaints. However, risks to control the spread of infections at the practice had not been managed appropriately, and our searches of clinical records identified some issues regarding the safe and appropriate management of patient medicine and care and treatment.

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

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection. This was a focused, unrated inspection to review the warning notices for Regulation 12: Safe care and treatment and Regulation 16: Complaints.

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 short 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 premises was well maintained, clean and tidy, however the provider could not demonstrate that all risks to control the spread of infections at the practice had been managed appropriately.
  • There was an effective system in place to ensure that recruitment checks were carried out in accordance with regulations.
  • There were some issues identified with the safe and appropriate management of patient medicines, care and treatment.
  • Consent to care and treatment was obtained in line with legislation and guidance.
  • The practice had significantly reduced their rate of antibiotic prescribing from January to May 2023.
  • There was effective management of vaccine handling and storage.
  • There was a functioning system in place to effectively manage the receiving, recording, handling of and responding to complaints.

The areas where the provider must make improvements as they are in breach of regulations are:

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

Please see the specific details on action required at the end of this report.

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 Health Care

20 April 2023

During a routine inspection

We carried out an announced comprehensive inspection at Farrow Medical Centre on 18 and 20 April 2023. Overall, the practice is rated as inadequate.

Safe - inadequate

Effective - inadequate

Caring - good

Responsive - inadequate

Well-led – inadequate

At a comprehensive inspection on 5 December 2018, we rated the practice as inadequate overall, and placed the practice in special measures. A further focused inspection was undertaken on 28 May 2019 to review compliance with the warning notices which had been issued for a breach in regulations. The practice was re-inspected on 7 August 2019, rated as requires improvement overall, and remained in special measures. At this inspection conditions were placed on the provider’s registration, as the practice had begun to improve their management of significant events and complaints, but a comprehensive and embedded management system was not in place. We also found issues with the management of vaccines.

At the last inspection, on 20 February 2020, we found the provider had continued to improve their systems and processes in respect of significant events and complaints, but had not implemented a fully workable and effective system which were auditable. At this inspection on 18 and 20 April 2023 we found additional concerns regarding the management of complaints and significant events. Further issues with the management of vaccine refrigerators and infection, prevention and control and issues were identified, alongside the safe management of medicines. The provider did not ensure that governance structures were effective.

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

Why we carried out this inspection

We carried out this inspection to follow up concerns from a previous inspection and in response to concerns reported to us.

The focus of the inspection included:

  • A review of the key questions; is the service safe, effective, caring , responsive and well led.
  • A review of the ‘shoulds’ identified in previous inspection.
  • A review of concerns highlighted to us by stakeholders.

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 telephone and video conferencing.
  • Completing remote 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.
  • Receiving written feedback from 8 members of the team.
  • A shorter 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 provider did not consistently demonstrate the delivery of safe, responsive, effective and well-led care to all their patients.
  • The practice did not have effective systems for the appropriate and safe use of medicines, including medicines optimisation.
  • The provider did not have a functioning system in place to effectively manage the receiving, recording, handling or responding to complaints.
  • The provider had failed to establish policies, systems and processes which operated effectively to assess, monitor and improve the quality and safety of care provided in the carrying on of the regulated activities.
  • The management of significant events at the practice did not keep staff or service users safe.
  • Staff fedback that senior leaders and the team were approachable, caring and supportive.
  • Results from the National GP Patient Survey, July 2022 showed the practice was consistently above local and national averages for patient satisfaction regarding access.

We found 3 breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Ensure that any complaint received is investigated and necessary and proportionate action taken in response to any failures identified in accordance with the fundamental standards of care.

In addition the provider should:

  • Take action to improve the uptake of childhood vaccinations and cancer screening at the practice.

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

20/02/2020

During a routine inspection

Farrow Medical Centre was inspected on 5 December 2018; we rated the practice as inadequate overall and the practice was placed in special measures. Three warning notices were issued by the Care Quality Commission for breaches of Regulation 12, safe care and treatment, Regulation 17, good governance and Regulation 18, staffing of the Health and Social Care Act 2008, regulated activities) Regulations 2014.

Further inspections were undertaken in May 2019 to review the warning notices for regulation 12 and 17, this inspection was not rated but a report was produced. The practice was last re-inspected on 7 August 2019 and rated as Requires Improvement overall, but as inadequate for providing well led services. The practice remained in special measures.

Following the August 2019 inspection conditions were placed on the provider’s registration. The practice had begun to improve their management of significant events and complaints, but a comprehensive and embedded system was not in place. We also found issues with the management of vaccines. The full reports and evidence tables from the previous inspections can be found by selecting the ‘all reports’ link for Farrow Medical Centre on our website at www.farrowmc.co.uk.

We carried out this announced comprehensive inspection at Farrow Medical Centre on 20 February 2020.

At this inspection we found the provider had continued to improve their systems and processes in respect of significant events and complaints but had not yet managed to implement fully workable and effective systems which were auditable. We found that effective systems and processes were in place for the management of temperature sensitive medicines and vaccines.

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 have rated this practice as good overall. However, we have rated the practice as requires improvement for providing effective services and for the population groups of families, children and young people and for working age people, which means the overall rating for effective is requires improvement.

We found that:

  • At this inspection the provider had further reviewed, improved and embedded effective systems and processes to support the good management of the practice. We found that a further review of significant events and complaints would enhance systems and learning and ensure that patients were kept safe at each contact.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • A comprehensive, colour coded matrix was in place for all operational health and safety checks. This computer matrix indicated when checks were due and included fire safety checks, infection prevention and control and all other necessary assessments required to ensure the smooth running of a GP practice.
  • On the day of inspection, we saw that locums’ checks, revalidation dates, indemnity insurance, disclosure and barring checks and the staff training matrix were all closely monitored and up to date
  • We saw effective management of safety alerts, appropriate audits of patient care and the review and improvement of recall systems to ensure that patients attended necessary appointments.
  • Patient feedback on the day of inspection and patient comment cards, reflected that patients received kind, friendly and effective care and treatment which met their needs. Patients said they felt listened to.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way, seven days per week.

Whilst we found no breaches of regulations, the provider should:

  • Continue to improve the system which has been implemented for the management of significant events, to include the timely discussion of actions and learning points with the entire staff team, which are clear and auditable.
  • Continue to improve and clarify the system which has been implemented for the management of complaints, to include the timely discussion of actions and learning points with the entire staff team.
  • Provide a clear document management protocol to support the management of patient results and correspondence.
  • Develop a process whereby, when children are consistently not brought to appointments that this is reviewed as appropriate.
  • Continue to improve the uptake of childhood immunisations at the practice and ensure that the World Health Organisation minimum target of 90% is met; to support herd immunity.
  • Continue to improve the uptake of cancer screening at the practice including breast, bowel and cervical screening.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service. The previous conditions on the registration of the provider will be removed.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

07/08/2019

During a routine inspection

We carried out an announced comprehensive inspection at Farrow Medical Practice on 5 December 2018. The overall rating for the practice was inadequate.

Three warning notices were issued by the Care Quality Commission after the December 2018 inspection for breaches of Regulations 12, safe care and treatment, Regulation 18, staffing and Regulation 17, good governance of the Health and Social Care Act 2008, Staffing (regulated activities) Regulations 2014.

A further focused inspection was undertaken on 28 May to review compliance with the warning notices issued for the breaches of Regulations 12 and 17 and any actions taken by the provider. We found that some improvements had been made. However, following the inspection we issued a requirement notice for Regulation 17, good governance for continuing non-compliance regarding the management of complaints, significant events and safety alerts.

This inspection carried out on 7 August 2019, was an announced comprehensive inspection of the service which also reviewed in detail the breach of Regulation 18 (staffing) from the December 2018 inspection.

We have rated this practice at this inspection as requires improvement overall.

The report for the 28 May 2019 inspection and previous inspection reports can be found by selecting the ‘all reports’ link for Farrow Medical Practice on our website at www.farrowmc.co.uk .

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 rated the practice as requires improvement for providing safe services because:

  • The provider did not have appropriate systems in place for the safe management of vaccines and the cold chain.
  • The provider had not taken steps to ensure that all actions related to the management of infection prevention and control were completed.
  • The provider did not always learn and make improvements when things went wrong.

We rated the practice as requires improvement for providing responsive services because:

  • The provider had not sufficiently improved their response to patient complaints. The response and management of complaints did not follow NHS guidance or the provider’s own policy. On the day of inspection, we found that it was difficult to track and follow a complaint through to completion or see how learning was shared.

We rated the practice as requires improvement for providing effective services because:

  • We found an overall reduction in the number of children being brought for vaccinations in 2018/2019.
  • Data showed that outcomes for some patients with long term conditions were below CCG and national averages with high exception reporting, for example respiratory issues.

We rated the practice as inadequate for providing well-led services because:

  • While the practice had made some improvements since our inspections on 5 December 2018 and 28 May 2019 it had not adequately addressed the Warning Notice and subsequent Requirement Notice in relation to Regulation 17, good governance of the Health and Social Care Act 2008, Staffing (regulated activities) Regulations 2014.
  • The provider could not demonstrate that all the systems and processes in place at the practice kept people safe. The provider had reviewed the system for the documentation, discussion, review and management of complaints and significant events. However, we found that overall governance at the practice remained ineffective.

We rated the practice as good for providing caring because:

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care. Patient feedback was positive and the results of the National GP patient survey 2019 showed that the practice had scored higher than their CCG average in every question. Results were also better than or comparable to national averages.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Complete all of the required improvements and actions identified relating to the management of infection prevention and control.
  • Improve meeting notes to reflect the discussions held and allow all members of the team the opportunity to be involved in the continual evaluation and improvement of services for patients.

This service was placed in special measures on 27 February 2019. Insufficient improvements have been made such that there remains a rating of inadequate for at least one population group, key question or overall. Therefore, we are taking action in line with our enforcement procedures to vary the terms of their registration with CQC. The service will remain in special measures for a further period of six months, be kept under review and if needed could be escalated to urgent enforcement action. Another inspection will be conducted within six months, and if there is not enough improvement we may take action to begin the process of preventing the provider from operating the service.

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 Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated care

28/05/2019

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Farrow Medical Centre on 5 December 2018. The overall rating for the practice was inadequate. The full comprehensive report on the December 2018 inspection can be found by selecting the ‘all reports’ link for Farrow Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection, carried out on 28 May 2019. The purpose of this inspection was to review actions taken by the provider in response to warning notices for non-compliance with Regulations 12, safe care and treatment and Regulation 17, good governance issued by the Care Quality Commission in January 2019.

At the inspection on 5 December 2018 the provider was rated as inadequate and told they must improve. This inspection on 28 May 2019 was not rated.

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 provider had complied with the warning notice for regulation 12 of the Health and Social care Act 2008, safe care and treatment. Improvements had been made in the management and oversight of infection prevention and control (IPC), health and safety, fire and the appropriate and safe storage of vaccines and prescriptions.

  • The practice had not fully complied with the warning notice for regulation 17,of the Health and Social Care Act 2008, good governance and there were issues remaining with the systems and processes that were in place to manage complaints, significant events and safety alerts.

  • We saw that a Disclosure and Barring Service Check (DBS check) or a risk assessment was in place for all staff members.

  • The practice had improved their identification of carers to 1.2% of the practice population.

  • The practice could not assure themselves that everyone who had direct contact with patients, including reception staff, was up to date with routine immunisations.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Continue to review the outcomes of the environmental audits that have been undertaken and ensure that they continue to implement the actions required from the fire risk assessment, the health and safety risk assessment and the infection prevention and control audit.

  • Continue with the work to review the immunisation status of the staff team in line with the requirements of Immunisation against infectious disease (The Green Book).

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care


05/12/2018

During a routine inspection

We carried out an announced comprehensive inspection at Farrow Medical Centre on 5 December 2018 as part of our inspection programme.

Farrow Medical Centre was last inspected on 4 November 2014 and was rated as good.

Our judgement of the quality of care at this service is based 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 have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

  • The provider could not demonstrate that suitable arrangements were in place to prevent the spread of infection at the practice.
  • The provider had failed to assess the risks to the health and safety of staff and patients at the practice.
  • Systems and processes were not in place to keep patients safe and protected from abuse.

We rated the practice as inadequate for providing effective services because:

  • The practice was unable to demonstrate that staff were suitably trained or had the skills, knowledge and experience necessary to carry out their roles.

This issue affected all areas of the service. Therefore, we rated all population groups as inadequate.

We rated the practice as inadequate for providing well-led services because:

  • The overall governance arrangements were ineffective.
  • The practice did not have clear and effective processes for managing risks, issues and performance. For example; we saw that the processes in place to manage complaints, significant events, safety alerts and patient group directions were ineffective.
  • The practice could not demonstrate that the relevant policies and procedures were in place to support the good governance of a GP practice. A small number of policies were available but the majority did not contain up to date or relevant information and the practice could not assure themselves that they would direct staff to the best course of action.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure that persons employed by the service are suitably trained as is necessary to enable them to carry out the duties they are required to perform.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Review and improve the identification of carers to ensure that they are able to meet the needs of this vulnerable group.
  • Continue to review the immunisation status of the staff team in line with the requirements of Immunisation against infectious disease (The Green Book).
  • Ensure that DBS checks are undertaken in line with practice policy.

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.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

04/11/2014

During a routine inspection

Letter from the Chief Inspector of General Practice:

We carried out an announced inspection visit on 4 November 2014 and the overall rating for the practice was good.

Our key findings were as follows:

  • The practice provided good, safe, responsive and effective care for all population groups in the area it serves.
  • Where incidents had been identified relating to safety, staff had been made aware of the outcome and action taken where appropriate, to keep people safe.
  • All areas of the practice were visibly clean.
  • Patients received care according to professional best practice clinical guidelines. The practice had regular information updates, which informed staff about new guidance to ensure they were up to date with best practice.
  • The service was responsive and ensured patients received accessible, individual care, whilst respecting their needs and wishes.
  • We found there were positive working relationships between staff and other healthcare professionals involved in the delivery of service.

We saw areas of outstanding practice including:

  • An additional Saturday morning surgery is taking place during the winter months; November 2014 to March 2015, to help reduce weekend pressure on the local Accidents and Emergency department. The practice is working with GPs from eight other practices in meeting this initiative.
  • Each patient aged 75 years and over and those patient who were at risk of hospital re-admission, has a named GP who they mostly see at an appointment. They also contact their patients personally with any follow up information about their treatment or care.
  • The practice is providing a service to local hostels; including the homeless, and mother and child. The mother and child hostel was a short term facility which meant they should have been registered as temporary patients with the practice. To improve the care provision, availability and access to services, the practice registered them as permanent patients.
  • The practice is working with The National Institute of Clinical research to screen patients for Hepatitis B & C.
  • When patients experiencing poor mental health turn up at the practice for a repeat prescription, they are accommodated instead of them having to give the standard 48 hours’ notice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice