Berrycroft Community Health 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 all the quality statements in the safe key question. We found that services were delivered safely and in line with national guidance. However, there was a significant backlog of patient records requiring summarising and some authorisations for non-prescribers were not appropriate.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patient feedback was used by the provider to identify improvements to the service. There was consistent feedback about difficulty in accessing appointments from patients. The practice had reviewed this and engaged with their patient participation group and undertaken a campaign to inform patients of learning from this feedback. Changes to clinical resources were implemented in an attempt to improve access for patients. The impact of these changes was conclusive at the time of the inspection.

Staff informed us they understood how to report learning or significant events. They told us these were discussed in meetings and relevant learning was shared with them.

There was a system for recording and acting on significant events. There was evidence of learning and dissemination of information following significant event reviews.

Patient feedback did not indicate any concerns regarding patient pathways or transitions such as referral management or sharing and receiving of information with external services.

Staff assured us they were aware of actions to take if they encountered a deteriorating or acutely unwell patient and had been given guidance on identifying such patients.

A local care home provided feedback that the GP practice shared information with care home residents’, the care home staff and communicated with families during the planning and delivery of care. Feedback from commissioners did not indicate any concerns regarding patient pathways or transitions such as referral management or sharing and receiving of information with external services.

The practice was equipped and had protocols to respond to medical emergencies (including suspected sepsis) and staff were suitably trained in emergency procedures. There were systems for managing patients’ care across different services such as hospitals and care homes.

Reviews of patient feedback did not indicate any concerns with safeguarding processes or sharing of information.

Partners and staff informed us they were trained to appropriate levels for their role. They understood where to find information on safeguarding and showed the inspection team quick reference guidance including safeguarding referral information.

We did not have any concerns on record or directly from stakeholders such as commissioners or the local authority regarding safeguarding at this GP practice.

Safeguarding systems, processes and practices were developed, implemented and communicated to staff. Clinical and support staff were trained to appropriate levels for their role in safeguarding adults and children. There were systems to identify vulnerable patients on record.

Patient feedback indicated that accessing services for care and treatment was sometimes difficult for them. However, feedback did not indicate any concerns with involving patients to manage risks to keep themselves safe.

The nursing team informed us of the processes they used to ensure long term condition reviews were undertaken safely and prioritised risk appropriately. Support staff explained there was a process to prioritise and forward patient correspondence from external providers, such as hospitals, to clinicians where needed and ensuring for actions to be completed.

There were systems to manage referrals, prompts for patients to attend for routine tests and reviews of their conditions and to ensure correspondence was prioritised appropriately. However, there was a significant backlog of patients’ clinical notes from their previous GP practices’ which required summarising. This amounted to approximately 2,500 sets of notes which required summarising dating back to 2022. The practice had assessed the associated risk as low as there was a system for digitised clinical notes to be summarised when patients transitioned between GP practices. There was a risk that information in paper clinical notes which had not been digitised would not be included on some patients’ records, meaning clinicians would be able to obtain a full medical history prior to planning and delivering care.

Staff informed us that they had training and qualifications in using equipment including diagnostic tools such as spirometry. They told us that the premises were fit for purpose and provided a conducive environment for providing clinical care.

We saw the premises were purpose built and modern. They included a variety of clinical rooms and facilities such as sluices, medicine storage cupboards and patient waiting areas.

There were risk assessments related to the facilities including for fire and premises and related actions were completed. Service contracts were in place for clinical apparatus, fire-fighting equipment. Electrical goods received portable appliance testing and medical equipment was calibrated.

Patient feedback indicated there was not sufficient clinical resources to meet the demands of the patient population. The practice had worked with local commissioners, their patient participation group and recruited a diverse range of clinical resources in an attempt to meet the demands of the local population. There was significant building development in the local areas around Aylesbury which was leading to significant increased in GP practices’ patient list sizes and therefore causes capacity issues in primary care services. Feedback from patients in the GP national survey indicated people felt involved in decisions about their care and treatment.

Staff believed they had the opportunity to undertake training related to their role. They told us they were provided with guidance documents such as prioritisation tools for reception staff to appropriately allocate patients to the correct appointments. Staff reported not always feeling fully supported by senior leaders in the delivery of services but did not report this resulted in any compromising of safety in the delivery of care.

Staff were provided with protected time for learning and training resources. There was supervision process for non-medical prescribers and an appraisal process for all staff. There were systems to decide what staff resources needed to be deployed.

Feedback from patients did not indicate any concerns regarding infection control.

We spoke with the infection control lead during the assessment and they felt supported by the lead nurse to undertake their role. They informed us they had protected time to undertake the infection control audits and interim checks on clinical waste disposal, cleanliness and other infection control measures. Staff informed us they had training in infection control relevant to their role.

The premises were clean, modern and well maintained. Clinical treatment rooms had appropriate flooring and surfaces to enable cleaning. There were paper hand towels, hand wash basins with elbow taps and disposable privacy curtains were dated to ensure they were disposed of when required.

There was a comprehensive audit process in place for infection control. There were no significant actions from the most recent audit. Clinical waste was managed in line with the infection control policy. There was a sharps injury protocol made available to staff for such an event where quick action may be required.

Patient feedback from complaints and on NHS reviews did not indicate any significant concerns regarding the management of their repeat prescriptions or medicines management.

Interviews with lead clinicians indicated there were effective processes for the management and monitoring of patients on repeat prescriptions including high risk medicines which required patients to attend for regular blood tests. Leaders were aware of the performance of these monitoring systems.

We observed medicines were stored appropriately and securely. There were monitoring processes to ensure medicines were stored at appropriate temperatures. Fridge temperatures were monitored in line with national guidance. There was a second thermometer in each of the medicine fridges but this was not used to verify the primary thermometer regularly, it was only checked when needed to verify the length of time any temperature breach occurred and ensure the efficacy of the medicines. We looked at the log used to monitor emergency medicines and equipment. This was a comprehensive checklist that contained expiry dates for all the contents of each medical emergency bag. We saw an automated external defibrillator’s battery expiry was not accurately recorded. This was rectified during the course of the assessment. We found the authorisations for non-prescribers to administer medicines such as vaccines were not always signed appropriately or not signed at all by the authorising prescriber. Paper prescriptions were stored in a locked cupboard and a log was used to monitor which batch numbers were removed and by whom. The log did not indicate which printers the scripts had been taken to in order to ensure full audit trail.

There were robust monitoring processes for patients who needed medicine reviews to ensure prescribing was safe. This included input from GPs, clinical pharmacists, nurses and support staff. There were prompts sent to patients when they needed tests related to the medicines they took. These were followed up when patients did not attend for their tests. Coding on the clinical record system was maintained for nearly all patients to ensure staff would be notified if a patient needed interventions related to of their medicines.

We undertook extensive clinical searches on the patient record system to check whether patients received their medicines through repeat prescriptions safely. Overall we found systems and processes in place which minimised the risks associated with high risk medicines. There were a very small number of patients who did not have all the interventions required by evidence based research but these were not as a result of system failures and the practice was working to ensure the interventions needed took place.