Central Clinic

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.

This is the first inspection for this service since its registration with CQC. This key question has been rated as Good.

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.

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.

Since taking over the running of the service the provider had undertaken a full review of systems and processes and made many changes to improve the safe running of the service.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong. Meetings were held monthly so that staff learnt from clinical issues, complaints or incidents. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Clear processes were in place for reporting incidents, near misses, and safety related events.

The practice conducted an annual review of all concerns, including incidents, complaints, NHS Friends and Family Test (FFT) feedback, and audit outcomes, to identify recurring themes and drive improvements in the quality of care.

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. We found clinicians made appropriate and timely referrals in line with protocols and up to date evidence-based guidance. There was a system in place to ensure all patient information including documents, laboratory test results and referrals were reviewed and actioned in a timely manner. Referrals and test results were managed in a timely way. During our review of the clinical system, we noted a high volume of outstanding tasks.A sample of these was examined, and we received assurances that they had been appropriately actioned, with no evidence that any urgent tasks had been missed. The provider assured us they would take action to address this to mitigate future risk.

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 well understood by staff, who had received appropriate training in safeguarding procedures. The practice maintained a register of vulnerable individuals and responded to concerns in collaboration with external organisations. Monthly meetings were held with the health visitor to review child safeguarding cases, and policies were in place to support care transitions and monitor children who were not brought to appointments.

Safeguarding processes were regularly reviewed, with audits conducted to ensure registers were accurate and up to date. Relevant information was shared across the team to support coordinated care. Vulnerable patients were appropriately coded, and safeguarding alerts were placed on both individual and household family members records.

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. A medical emergency policy was in place, and all staff had completed basic life support training within the past 12 months, ensuring they were prepared to respond appropriately in emergency situations.

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 premises were managed by NHS Property Services and contracts were in place to ensure the premises were maintained. Health and safety protocols, including fire safety measures, were in place across the practice. Staff had received training in health and safety topics such as fire procedures and infection control. Risk assessments for the premises had been completed, and 2 fire drills undertaken in the last 12 months. Clear signage was present throughout the building to support safe evacuation procedures in the event of an emergency.

The practice maintained a business continuity plan that provided structured guidance in the event of significant service disruptions, including IT system failures.

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 employed a range of clinical and non-clinical staff to support service delivery. At the time of inspection, there was one part time nurse in post, with a locum Advanced Nurse Practitioner utilised on an ad hoc basis to provide additional clinical capacity. The practice also had plans in place to recruit a Healthcare Assistant and a salaried GP to further strengthen the clinical team.

Staff training was up to date, and learning needs were appropriately identified and supported. Staff were working within their defined areas of competence which was supported through clinical supervision, audits and protocols.

A recruitment policy was in place, and a review of personnel files confirmed that safe recruitment was consistently followed. Records of staff immunisation status were maintained, and all staff had completed annual appraisals. New staff participated in a structured induction programme and were required to complete mandatory training within appropriate timeframes. Staff were supported to deliver safe care through access to relevant training and development opportunities.

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 provider had policies in place for infection, prevention and control which was accessible to staff. The provider had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The service had made improvements since the takeover of the practice to ensure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

We carried out remote searches of clinical records as part of our assessment to check how the practice monitored patients’ health in relation to the use of high-risk medicines. We found that staff followed established processes to ensure people prescribed medicines with specific risks such as Methotrexate (an immune system suppressant drug) received the recommended monitoring.

Our remote clinical searches found 181 patients had received a medication review in the previous 3 months. We reviewed a random sample of 4 records and found a good standard of medication reviews undertaken.

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. Medicines including controlled drugs were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Emergency medicines were in place; however, one recommended item was not available at the time of inspection, nor had been risk assessed. The practice confirmed they would take action to determine whether the medicine should be appropriately stocked. After the inspection the practice confirmed this had been actioned.

Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials, gabapentinoids and hypnotics issued by the practice were lower or in line with national averages. There were regular clinical audits of prescribing that focused on improving care and treatment.