Fir Tree 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment in January 2023, we rated this key question as requires improvement. At this assessment the rating has changed to good.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Safe processes were in place for monitoring and reviewing safe care and treatment in a positive learning culture. These included managing incidents and significant events. Protocols and flow charts were in place to support staff in raising an incident. Staff were encouraged to raise concerns and report incidents which were later discussed at clinical staff meetings. There was a log of all significant events and incidents however, we found that not all events had been fully investigated, and records written for learning. Missing information included investigation records and action plans showing the steps taken by the provider to prevent recurrence.

The provider had a complaints policy and procedures, and these were in line with recognised guidance. The service learned lessons from individual concerns and complaints and from analysis of trends. The service had processes and systems to ensure compliance with the requirements of the duty of candour.

The provider worked with people and healthcare partners to establish and maintain safe systems of care. There were protocols in place for managing incoming correspondence into the patient’s medical records. The clinical team reviewed all patient correspondence and our review of patient records showed that all tasks had been acted upon. There was a system for processing information relating to new patients, including the summarising of new patient notes. Patient referrals to specialist services were documented in the referral systems and patient record. Urgent referrals were monitored to ensure patients attended appointments. Triage systems and protocols were in place for staff to follow.

Meetings took place with partners to ensure effective monitoring of care continued as people moved between services. For example, monthly meetings with community partners took place to monitor the needs of patients on the end-of-life pathway.

Systems, processes and procedures were in place relating to safeguarding matters and concerns. The provider had a centralised team who provided advice and support to staff so that they shared concerns quickly and appropriately. Policies and procedures were reviewed and up to date and were aligned with other local safeguarding teams. Staff we spoke with were aware of how to identify, report and take action for safeguarding matters or concerns. The service had a designated lead for safeguarding adults at risk and children and staff were aware of this. The service had a register for vulnerable adults and children, and this was reviewed with the central safeguarding team on a monthly basis. Minutes of meetings showed at risk patients on the register had been reviewed. Partners and staff were trained to appropriate levels for their role.

The service had a chaperone policy in place to maintain patient privacy during intimate examinations. Posters were displayed in all consultation rooms and waiting areas.

The provider worked with people to understand and manage risks through a holistic approach. For example, recalling patients who were at risk of developing diabetes or referring patients for dietary advice or smoking cessation. There were 16 chronic disease registers identified for call and recall, and these patients were annually reviewed. Health reviews included reviewing their current conditions and providing advice, care and treatment to improve or maintain this and prevent a deterioration.

The service encouraged patients to attend for health screening. Parents of children who had not attended for childhood immunisations and people who had not attended for cancer screening, were followed up and encouraged to attend. Patients who were prescribed high risk medicines were called for regular checks.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider had health and safety and fire risk assessments in place to evaluate, address, and monitor any safety concerns related to the premises. The provider had systems in place to test electrical equipment to ensure it was safe to use. There was a business continuity plan in place which was monitored and reviewed.

The provider made sure there were enough qualified, skilled and experienced staff, who received support, supervision and development opportunities. They worked together well to provide safe care that met people’s individual needs. There were safe recruitment practices to make sure that all staff, including agency staff, were suitably experienced, competent and able to carry out their role. Processes were in place to ensure staff were fit to work at the service, for example when undertaking Disclosure and Barring Service (DBS) checks. However, we identified that documented evidence and records to support decisions made at the time of recruitment, required improvements.

Systems were in place to ensure staff received good support, supervision and appraisals for their professional development. Staff confirmed they received training appropriate and relevant to their role. They told us they felt supported with their personal development and were given opportunity to learn. Interviews with staff confirmed that meetings took place with non-medical prescribers to review their prescribing practice, such as advanced nurse prescribers.

Infection prevention and control audits were carried out and reviewed, and actions taken where necessary. People were protected as much as possible from the risk of infection because the premises and equipment were kept clean and hygienic. Some nurses had responsibilities around infection prevention and control, and they linked in with other infection control leads in the area. The arrangements for managing waste, sharps and clinical specimens kept people safe. Staff vaccination was maintained in line with current UK Health and Security Agency (UKHSA) guidance, if relevant to their role. There was a system for the service to report infection-related concerns to the relevant agencies (e.g. notifiable diseases).

There were systems in place for medicine optimisation to meet people’s needs, capacities and preferences. We saw that medicines including vaccines were stored safely and staff were aware of what to do if a fridge temperature was out of range. Staff had access to emergency medicines and equipment including oxygen and a defibrillator.

We noted that Patient Group Directions (PGDs) (written instructions to supply or administer medicines to patients in planned circumstances for example, vaccinations) were in good order. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. Reviews of non-medical prescribing practice had taken place.

Regular medicines reviews were carried out to ensure patient medicines were appropriate to their needs and safe. We sampled a small number of these and found that some did not have sufficient details of the discussion that had taken place with patients. Our clinical searches identified that a small number of people had not attended a review appointment to discuss their conditions and reassess their medicines, despite being invited. Following the assessment the provider implemented a plan to improve all patient medicines reviews.

There was a system for recording and acting on safety alerts, however, the service was unable to demonstrate that all relevant safety alerts had been acted upon. For example, we looked at The Medicines and Healthcare products Regulatory Agency (MHRA) alert for women of childbearing age on teratogenic drugs (a substance or agent, that can interfere with the normal development of an embryo or fetus, potentially leading to birth defects or other abnormalities). We found these patients had received only a generic text message warning them of the risks of this medicine. A face-to-face appointment to discuss risks would have been more appropriate. We reported this to the provider at the time of assessment. Our clinical searches identified that for patients who were prescribed high risk medicines, the service had good monitoring systems in place.