Alston Medical Practice

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 last assessment, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 78 (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 ethos was always to learn and improve continuously. Systematic work was undertaken to understand the sources of risk and causes of safety events, and there was evidence of improvements in delivery of care and treatment as a result of learning. Effective approaches to learning were embedded in practice. Examples of this include improved protocols for asthma patients and communication with patients particularly those who have received a complex diagnosis.

Patients felt supported to raise concerns and felt staff treated them with compassion and understanding. Representations from the Patient Participation Group (PPG) felt the provider took concerns seriously, they felt leaders had an ‘open door’ policy and proactively made improvements to the service. An example of this was the introduction of new computer software to address issues with prescribing certain types of medications and obtaining supplies for the dispensary. This prevented a situation where certain medications needed by patients would not have been able to be ordered easily. Therefore, preventing any situations where patients couldn’t get the medications they needed in a timely manner.

During staff meetings, issues were discussed, and there was active learning which would be followed up subsequently by leaders. Examples of changes that were put in place from discussions held in these meetings included plans whereby all patients who have had a cancer diagnosis would be offered a GP appointment, changes made to flagging systems used by practice administrators, changes to secondary care letter review processes and follow up appointment requests. Leaders also set actions to discuss plans, options and signpost patients and families to other services as part of their new cancer diagnosis plan. This process was kept under review. We saw examples of feedback from the North Cumbria medical examiner and 6 patients’ families that recognised the extra efforts staff went to make patients comfortable and reduce any undue stress.

There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Feedback from staff and patients highlighted how they felt leaders were approachable if they had concerns and they felt listened to. Learning from incidents and complaints resulted in changes that improved care for others. Examples of this included the review and rewording of patient information letters to be bespoke to individual patients.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There were systems in place for processing information relating to new patients. The service worked with other providers to deliver shared care.

The practice is in a very rural location and some patients found attending hospital appointments challenging. Leaders told us they had engaged with hospital teams to try and streamline processes. Leaders told us in doing so they also considered the demographics of the patients and the local public transport links. They arranged blood tests, for example, to see if they could be done at the practice to ensure this was accessible for patients. Referrals and test results were managed in a timely way.

Two specific examples that demonstrated the work the practice took to improve pathways for patients where gaps in local provision were identified included improving access to blood transfusions for frail patients with severe anaemia. The practice was aware some patients were very frail and not well enough for further investigations. Those patients were discharged by the hospital, with ongoing monitoring of their anaemia becoming the responsibility of the practice. However, there was no adequate local pathway in Cumbria to ensure timely access if they needed a blood transfusion, which meant they had to travel a long distance to attend accident and emergency. The practice was proactive in identifying an improved pathway for their patients.Leaders balanced patient need with professional safety, sought specialist advice, escalated concerns through multiple routes and worked with wider system partners to create a sustainable solution for patients.

Patients were subsequently supported to receive community transfusions rather than relying solely on emergency attendance. The wider learning was that vulnerable patients could fall between service pathways when responsibilities are unclear. By escalating the issue and engaging with the LMC and secondary care, the practice highlighted a wider system risk and advocated for a clearer, safer pathway for future patients.

The second example improving the pathway for carcinoma of unknown primary (CUP) and malignancy of unknown origin (MUO). All patients with suspected cancer should be referred to a specialist on a 2 week wait urgent suspected cancer referral pathway – including when we are suspecting MUO/CUP. However, there was no pathway available in Cumbria for this. The absence of a clear referral pathway caused significant distress for patients and created avoidable uncertainty. Patients should have been able to access a specialist team to co-ordinate further investigations, explain the next steps and support them through their cancer journey. Instead, the practice was left trying to obtain advice from multiple specialist teams, often receiving differing views and being unable to secure the coordinated help that patients needed

The practice worked with oncology colleagues, acute care teams and commissioners to support the development of a pathway for patients in Cumbria. This involved contributing a primary care perspective, sharing the impact on patients and helping to shape how the pathway worked in practice. This helped improve care not only for patients at Alston Medical Practice, but for all patients across Cumbria.

There was a strong understanding of safeguarding across the service and staff knew how to take appropriate action. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations including social workers, maternity services and local authorities. The practice has an appropriately trained adult and children’s safeguarding lead.

There is proactive identification of hazards and risks, which are robustly assessed and managed to avoid adverse outcomes. Solutions to risks are developed collaboratively with the right people including external partners and the effectiveness of the controls are monitored and measured. Lessons were always learnt to continually identify and embed good practice.

The service provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Emergency equipment was available and well maintained. Staff could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed by the provider alongside the other services they were responsible for running.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. The practice staff worked effectively together, with administrative staff multi-skilling to ensure in all eventualities that a professional, co-ordinated service could be offered to patients.

There were a range of clinical and non-clinical roles within the practice. This included 3 General Practitioners (GPs), 1 GP assistant, 1 Advanced Nurse Practitioner (ANP), 2 Practice Nurses, 1 Healthcare assistant plus administrative and dispensary staff.

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. Safe recruitment practices were followed.

The service 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 lead and all staff had completed relevant training. The IPC lead was involved in the induction programme for all new staff members. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks. We saw evidence of internal and external IPC audits with action logs and appropriate escalation procedures in place when required.

The service 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.

The practice operated an on-site dispensary for eligible patients living in rural areas. It also took part in the Dispensing Services Quality Scheme, with a named GP holding overall responsibility for the oversight of the dispensary.

Medicines were stored securely with restricted access. Staff managed stock effectively, with clear processes for ordering, checking expiry dates, and identifying short-dated items.

Fridges were clean, well-organised, and temperatures were monitored consistently.

Controlled drugs were stored securely, with restricted access. Staff carried out monthly stock checks in line with the standard operating procedure (SOP), and the stock balances were accurate with no discrepancies. CD keys were kept securely.

CD register record-keeping and the timely destruction of expired stock required some strengthening. This was discussed with staff, who acknowledged the findings and took action to address them.

The practice had clear processes for ordering, receiving, and dispensing prescriptions and staff understood these well. Staff reviewed prescriptions awaiting collection each month and this was managed well.

When medicines were unavailable, staff checked alternative suppliers or gave patients the option to take their prescription to another pharmacy or return to the GP for an alternative medicine. The practice offered a medicines delivery service on a voluntary basis; governance arrangements to support these services needed further work. The practice has acknowledged this and provided assurance that a review would take place.

The practice received MHRA alerts by email and acted on them appropriately, with declarations submitted online. There was a process to ensure all staff read and shared relevant safety information.

Dispensary staff were appropriately qualified and experienced, with arrangements in place for SOPs to be regularly reviewed; however, some updates were needed to reflect staffing changes.

The practice had an appropriate system to record medicines errors, incidents, and near misses and disseminate any lessons learn.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely.

Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was lower than local and national averages.