24 November 2022
Manor Farm Medical Centre is located in Swaffham at:
The practice has branch surgeries at:
Oak Farm Surgery
North Pickenham Road
PE37 8EF and
We did not inspect either branch.
There is a dispensary at Manor Farm Medical Centre which was inspected and also one at Oak Farm Surgery which was not inspected.
The provider is registered with CQC to deliver the Regulated Activities
- Treatment of disease, disorder or injury
- Surgical procedures
- Diagnostic and screening procedures
- Maternity and midwifery services
- Family planning services.
These are delivered from all sites.
The practice is situated within the Norfolk and Waveney Integrated Care Board (ICB) and delivers General Medical Services (GMS) to a patient population of about 7,600. This is part of a contract held with NHS England.
The practice is part of a wider network of GP practices which make up the Primary Care Network (PCN) Swaffham and Downham.
Information published by Public Health England shows that deprivation within the practice population group is in the fifth lowest decile (5 of 10). The lower the decile, the more deprived the practice population is relative to others.
According to the latest available data, the ethnic make-up of the practice area is 98% White, 1% Asian and 1% Mixed.
There is a higher proportion of older people registered at the practice than both local and national averages.
There is a team of three GP partners at Manor Farm Medical Centre. The practice has a team of nurses and Health Care Assistants. The GPs are supported at the practice by a team of reception/administration staff. The practice manager and assistant practice manager are based at the main location to provide managerial oversight.
The practice is open between 8.30am to 7.15pm on Mondays and 8.30am to 6.30pm on Tuesdays, Wednesdays, Thursdays and Fridays. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments.
Extended access is provided locally, where late evening and weekend appointments are available. Out of hours services are provided by Integrated Care 24 and accessed via the NHS 111 service.
24 November 2022
We carried out an announced comprehensive inspection at Manor Farm Medical Centre on 8 November 2022. Overall, the practice is rated as good.
Safe - Good
Effective - Good
Caring - Good
Responsive - Good
Well-led - Good
Following our previous inspection on 31 March 2022, the practice was rated inadequate overall and for providing safe and well-led services, requires improvement for providing effective services and good for providing caring and responsive services. The practice was placed into special measures and issued with a warning notice relating to a breach of regulations.
A subsequent focused review was carried out on 11 July 2022 where we found that the practice was compliant with the warning notice and improvements had been made. This inspection on 8 November 2022 was a comprehensive inspection to follow up on the concerns identified during the inspection in March 2022.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Manor Farm Medical Centre on our website at www.cqc.org.uk
Why we carried out this inspection
We carried out an announced comprehensive inspection as the practice was in special measures. This inspection was to review in detail the actions taken by the provider to improve the quality of care and to confirm whether legal requirements were now being met. The focus of this inspection included:
- The key questions of safe, effective, caring, responsive and well led.
- The follow up of areas where the provider ‘should’ improve identified in our previous inspection.
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.
- 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.
- Staff questionnaires.
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 had, with the support of the Integrated Care Board (ICB) and with additional external support from a GP and practice manager made significant improvements to provide care in a way that kept patients safe and protected them from avoidable harm.
- Patients received effective care and treatment that met their needs.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- Patients could access care and treatment in a timely way.
- The way the practice was led and managed promoted the delivery of high-quality, person-centred care.
The practice had fully engaged with the findings of our last report and had worked with the ICB and an external team to make changes, monitor and ensure those improvements were sustainable. Leadership had been strengthened and feedback from staff was positive about the changes and the future.
Whilst we found no breaches of regulations, the provider should:
- Continue to encourage uptake of cervical screening.
- Continue to assess and monitor antibiotic prescribing in the practice.
- Continue to embed and sustain the newly implemented systems and processes to provide safe and effective safe.
- Continue to encourage the uptake of NHS health checks.
I am taking this service out of special measures. This recognises the improvements that have been made to the quality of care provided by this service.
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