Abbey Field 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

We assessed 1 quality statement, medicines optimisation, to see whether improvements had been made. We have combined the scores for this area with scores based on the rating from the last assessment, which was good. Our rating for this key question remains good.

We found the service had made improvements to medicines safety. Now, people were provided with appropriate advice about associated risks with their medicines. There were safe and secure systems to manage medicines.

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.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Practice leaders had reviewed their processes and policies, had acted and made improvements to medicines safety. Updated guidance for staff, recall systems and running regular searches for monitoring people on a range of medicines were in place. The practice also used a system to identify and prioritise people, who may be at risk from their medicines, for review. From April 2025, they had started to use a ‘medicine monitoring alert tool’ in their clinical system, which was regularly updated with evidence-based practice guidelines. They were working with the developers of the tool to review this throughout June and July 2025 and follow up any outstanding work. We acknowledged their systems continued to be reviewed and improved, and work continued to embed these processes.

Staff we spoke with gave examples of how systems had improved and advised processes were in place for information to be shared with a Clinical Pharmacist and GP, as applicable, who advised or undertook action in response. Examples of this were demonstrated on the clinical system during the onsite visit.

We carried out remote searches of clinical records, and reviewed clinical records on site, to check how the practice monitored people’s health in relation to the use of medicines which required additional monitoring. We found improved systems and processes were in place. For example, 1 clinical search identified 69 people prescribed an immunosuppressant medicine which required additional monitoring, and all people had received monitoring. Another search identified 1971 people prescribed a cardiovascular medicine, of which 11 people had not had the required monitoring. We reviewed the records of 5 people and undertook a further review of 2 people’s records on site and found that people were no longer taking the medicine or had been appropriately followed up by the practice. A further search for another immunosuppressant identified 29 people, of which 2 people had not had the required monitoring. We reviewed the records of 5 people and undertook a further review of 3 people’s records on site and found no concerns. The number of people with outstanding blood monitoring tests was low based on the number of people prescribed the medicines and the practice were continually improving their processes to identify any outstanding people.

We carried out remote searches of clinical records, and reviewed clinical records on site to check if safety alerts had been actioned appropriately, such as informing people prescribed certain diabetes medicines about important signs and symptoms of side effects and when it would be necessary to seek medical advice. We reviewed the records of 5 people and undertook a further review of 2 people’s records on site. In 2 cases it was unclear in the record how people had been informed about these risks. Following the site visit, the provider advised they had sent information to all people by text message with a letter attached, and also by posted letter.

Another search of a medicine which can cause birth defects if taken during pregnancy, identified 5 women who must have counselling and a pregnancy prevention plan (PPP) in place. We undertook a further review of their records on site. Only 1 of these people was at risk of pregnancy and the provider had plans in place to follow them up. Following the site visit, the provider submitted evidence which demonstrated this person had been followed up, and was not at risk of pregnancy. They also evidenced a recall system for people prescribed a contraceptive injection. The provider did not have copies in the records of the annual risk assessment forms provided by the specialist for the 5 people we reviewed; these had been requested. Practice leaders advised annual reviews using the ‘medicine monitoring alert tool’ were being set up.

We saw improvements had been made to the security of medicines at 1 location, with key fob access now in place.

Medicines that required cold storage within the practice were being appropriately kept within temperature monitored fridges, and monthly checks of expiry dates of medicines which included vaccines, injections and emergency medicines were documented. We checked a sample of medicines that required cold storage, including vaccines, and found they were all in date and appropriately stored.

The practice had updated their emergency medicines and an injection to treat low blood sugar, should a person not be able to take medicine orally, was now available.