Cossington Park Surgery

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 looked for evidence that people were protected from abuse and avoidable harm.At our previous comprehensive assessment we rated this key question as Requires Improvement. At this assessment, we rated this key question as Good.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had processes for staff to report incidents, near misses and safety events. The practice had a positive culture of safety and leaders encouraged staff to raise concerns when things went wrong. Staff felt there was an open culture, and that safety was a top priority.

Lessons were learnt to continually identify and embed good practice. Learning from incidents and complaints was discussed in meetings and resulted in changes that improved the service.

Leaders were committed to learning, and we discussed an example of a significant event and the actions the practice had taken in response to the learning identified. This involved the over issuing of prescriptions for a patient who was travelling abroad for a few months. The error was picked up by one of the reception team. Learning from this incident included adding information to the patients’ homepage on the clinical system that they are travelling and the dates of their travel. Staff will then issue three months’ worth of medication and inform the patient that any additional medication required will have to be obtained from the country they are visiting. Staff then task the pharmacy to remove the patient’s repeat medicines until they return. As a result, when the patient returns from travel, staff are able to ensure any monitoring required such as blood tests, are arranged promptly.

The practice worked with patients and healthcare partners to establish and maintain safe systems of care. Staff worked to facilitate continuity of care, including when patients moved between services. There were protocols in place for managing incoming correspondence into the patient’s medical records. Patient referrals to specialist services were documented in the referrals systems and patient record. We found referrals were managed in a timely manner.

Safeguarding policies and procedures were in place to keep people safe and safeguarded from abuse. The practice had a GP safeguarding lead, and staff had completed the relevant safeguarding training for their role and shared concerns quickly and appropriately. The practice maintained a list of vulnerable adults and children and acted on concerns working in partnership with other organisations. Clinical system alerts were used to identify people who were at risk of harm or abuse including household contacts. There were systems in place to respond to concerns and act on correspondence. For example, they followed up children who failed to attend their appointments or were frequent attenders to the accident and emergency department.

Regular safeguarding meetings with the practice safeguarding lead and multidisciplinary healthcare professionals took place where safeguarding risks and patient care was discussed. Safeguarding was discussed with all staff in practice meetings to keep staff informed as appropriate.

Staff could recognise a deteriorating patient and knew what action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. There were processes in place to ensure care was prioritised for the most clinically vulnerable patients.

As part of our assessment, we checked the emergency equipment and medicines available and the reviewed the processes to maintain these. Staff regularly checked stock levels and expiry dates for all emergency medicines. However, we found emergency medicines were located in a locked room in the practice. Emergency medicines should be readily accessible in an emergency.

Emergency medicines, except for those subject to additional storage requirements, should not be stored within locked cupboards or rooms as this can cause an unacceptable delay in the event of an emergency. We raised this concern with leaders who took immediate action to address this issue.

The practice facilities were fully accessible to patients. The building was step-free for patients, with full access for wheelchair users. Consultation rooms were located on the ground floor.

The practice detected and controlled potential risks. They made sure equipment, facilities and technology supported the delivery of safe care. Contracts were in place to ensure the premises were maintained. Systems were in place for the checks of fire alarms, fire extinguishers and fire evacuation procedures. Portable appliance testing was completed annually to ensure equipment was safe to use. The practice provided us with evidence of health and safety risk assessments which showed that risks were properly managed. There was a business continuity plan in place which was monitored and reviewed.

The practice made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

There were a range of clinical and non-clinical roles within the practice. We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence.

We discussed clinical supervision of Non-medical Prescribers in the practice of which there were two Pharmacists and one Advanced Nurse Practitioner. Leaders explained meetings and de-brief sessions were arranged with the lead GP and staff were able to contact one of the GPs as and when needed if they had any patient queries. In addition, the lead GP undertook audits of patient consultation notes and prescriptions to provide assurance of appropriate clinical care. The results of these audits was fed back to the Non-Medical Prescribers.

Clinicians told us as well as supervision sessions, they had access to a clinical communication forum telephone group where learning, updates and news was shared and queries could be posted.

The practice assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The practice had a designated infection, prevention and control (IPC) lead and staff had completed relevant training. Risk assessments and audits were completed, and actions taken to mitigate risks. Clinical waste procedures were in place. The practice had effective oversight of the external cleaning company to ensure cleaning schedules were followed and cleanliness met the required standard.

The practice strived to make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved patients in planning, including when changes happened.

Staff involved patients in reviews of their medicines and helped them understand how to manage their medicines safely. Patients knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

Medicines were stored securely and at appropriate temperatures. Refrigerators used to store vaccines and medicines were monitored to ensure temperatures were maintained and products were appropriately stored within them. Staff regularly checked stock levels and expiry dates for all medicines, including emergency medicines. There were Patient Group Directions (written instructions to help specific healthcare professionals supply or administer medicines to patients) in place which relevant staff worked to.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. This included audits on intrauterine contraception, and opioid prescribing.

Prescribing data was reviewed as part of our assessment found practice performance was in line with national averages for Pregabalin and Gabapentin medicines (primarily anticonvulsant drugs, also prescribed for pain); psychotropic medicines (used to treat various mental health conditions); hypnotic drugs (used for the management of severe insomnia); and antibiotics.

As part of our assessment a Care Quality Commission GP Specialist Advisor undertook searches of patient records on the practice’s clinical system. Our clinical records review identified the following:

Methotrexate (an immune system suppressant drug): We identified 32 patients prescribed this medicine in the last 6 months and reviewed a sample of 5 patient records. We found all 5 patients had received the required monitoring and were appropriately coded on the clinical system.

Angiotensin-converting-enzyme (ACE) Inhibitors (a drug used primarily for the treatment of high blood pressure and heart failure): We identified 977 patients prescribed this medicine of which 4 patients had not received the appropriate clinical monitoring. We reviewed in detail these 4 patients’ records and found all 4 patients already had been booked in for appointments with the practice.

Bisphosphonate (medicines that strengthen bones): National guidance recommends that after a patient has been taking this oral medicine for 5 years, the need for continuing treatment should be reassessed and consideration should be given to providing a Dual Energy X ray Absorptiometry (DEXA) scan. DEXA scanning offers a non-invasive and highly accurate method for evaluating body composition, including bone mineral density. We identified 48 patients who had been prescribed this medicine for over 5 years and reviewed the records of 5 patients. We found 1 patient who was overdue a DEXA scan. We discussed this patient’s record with clinicians who made arrangements to follow up this patient.

Safety Alerts: There was a process in place for recording and sharing medicine safety alerts. Safety alerts were discussed in clinical meetings. We reviewed patients who were prescribed both an Aldosterone antagonist (a diuretic medicine which prevents potassium loss) and an Angiotensin-converting-enzyme (ACE) Inhibitor (a drug used primarily for the treatment of high blood pressure and heart failure). We identified a total of 32 patients prescribed these medicines and found 1 patient who was overdue monitoring. We looked in detail at this patient’s record and found the patient was overdue monitoring by just 3 days. We discussed this patient with staff to arrange a blood test appointment.

Medication reviews: We reviewed a random sample of 5 medication reviews out of a total of 491 reviews that had been completed for patients in the previous 3 months. We found no issues with any of these medication reviews and found they had been appropriately coded and contained necessary information.

As part of our assessment, we reviewed the processes in place for medicines liable to abuse including controlled drugs. Controlled drugs are medicines that are regulated by the government. This is usually because they are at higher risk of causing harm (such as dependence or misuse). Systems and processes included prescriptions not being issued on repeat; no more than 28 days of medicine prescribing; regular patient reviews; and a proactive approach to offering patients the opportunity to reduce their medication.