Gray’s Inn Medical Group Vauxhall

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 good overall, although we found that the service was not always providing safe services.

The service was in breach of legal regulation in relation to medicines optimisation and effective staffing. This was because not all prescribed medicines were being monitored in line with national guidelines and the service did not have an effective process in place to ensure patients with asthma who were prescribed steroids received a follow-up review. We also found that there was a lack of formalised clinical supervision for physician associates.

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.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. Managers fostered a culture where staff felt safe to raise concerns when things went wrong. During staff meetings, the whole team discussed and learned from clinical issues. Staff felt there was an open culture, and that safety was a top priority. The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

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 and when patients moved between services. Referrals and test results were managed in a timely way. Staff conducted weekly checks to ensure referrals to secondary care had been processed appropriately.

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. Staff we spoke with knew the identity of safeguarding leads. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. This included close engagement with health visitors who attended clinical meetings.

The service worked with people to understand and manage risks by thinking holistically. They 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 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. Fire drills and fire alarm tests were conducted on a regular basis. There was a business continuity plan in place which was monitored and reviewed annually.

They service did not always make sure staff received effective support, supervision and development. Although physician associates worked closely with GP colleagues when making clinical decisions, we found that formalised clinical supervision was not sufficiently developed. Whilst we were told that physician associates would receive daily informal supervision from a GP at the end of their session, it was unclear whether there was designated time scheduled in on a regular basis to address overall goals and clinical performance of the physician associate. We were not provided documents which evidenced that formal supervision of physician associates was completed.With the above exception, 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.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. 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. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

We found that the provider did not have effective systems in place to monitor patients who had been prescribed high risk medicines. Data reviewed as part of our assessment showed that the provider was prescribing medicines safely in most cases. However, we noted that not all prescribed medicines were being monitored in line with national guidelines.

We reviewed clinical records for patients who had been prescribed medicines which required routine monitoring. We identified 412 patients who were prescribed an angiotensin converting enzyme (ACE) or angiotensin receptor blocker (ARB) medicine, of which 34 patients had potentially not received the required monitoring. ACE and ARB medicines are used to treat patients experiencing high blood pressure or heart failure. We reviewed 5 patient records and found that 2 patients were overdue monitoring. Overdue monitoring could place patients at risk of undetected kidney damage.

Twenty-seven patients were prescribed an aldosterone antagonist (a medicine used to treat heart failure or high blood pressure) and ACE/ARB medicine, of which 7 had potentially not received the required monitoring. We reviewed 5 patient records and 2 of these patients were overdue monitoring. Overdue monitoring could place patients at risk of kidney impairment and abnormal salt levels.

Fourteen patients had been prescribed a bisphosphonate (a medicine prescribed to treat patients with osteoporosis) for 5 years or over. We reviewed the patient records for 4 of these patients and found that 1 had not received a recent bone density scan or review of their medication. Without ascertaining a patient’s bone density and completing the required monitoring, patients could be at increased risk of fracture.

We identified 116 patients who were prescribed medicine for hypothyroidism. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones. We reviewed 5 of these patient records and found that 3 patients were overdue monitoring. This could mean that patients were left potentially over or under treated with thyroid hormones.

We also found that service’s prescribing policy did not include acute and chronic prescribing.

Provider representatives told us that they would address these omissions following the assessment.