Cranbrook 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 assessed all quality statements in the safe key question.

This is the first inspection for this service since its registration with CQC. At this assessment, we rated the key question as Good. The service regularly reviewed, analysed and learnt from events and incidents. The practice had clear systems and processes to keep people safe and safeguarded from abuse.The facilities and equipment met the needs of people and were visually clean and well-maintained. There were systems and processes to monitor people’s prescribed medicines which required additional monitoring. The staff had the right skills, qualifications and experience. However, not all staff were up-to-date with their mandatory training. To address this, following the inspection, the practice developed a process to monitor and ensure training compliance.

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.

Staff understood how to raise concerns and report incidents. Staff told us there was an open culture, and 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. Significant events and complaints were discussed in meetings and learning was shared to improve patient care. A PPG representative felt the service took concerns seriously and proactively made improvements.The practice discussed and shared lessons learnt with the PPG during their meetings.

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.

Staff had clear responsibilities and followed systems to ensure continuity between secondary and primary care. Referrals and clinical correspondence, including test results, were managed in a timely way. The practice had a system of clinical cover to review test results during staff absence. The practice appointed an administrative staff member to be the referral champion to ensure people were referred to other services appropriately and were prioritised for urgent actions. There was a policy for processing information relating to new patients. However, at the time of assessment, there was a backlog of over 3000 patient records waiting to be summarised. The practice had not received any complaints or identified any incidents related to a delay in summarising. We have not received any patients’ feedback related to summarising. The service was aware of this and had developed a detailed action plan with a timeframe to address the backlog.

The service 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 practice shared concerns quickly and appropriately with relevant partners.

Staff were able to tell us about the systems and processes to keep people safe and safeguarded from abuse and felt confident in raising concerns. This was supported with examples of how safeguarding concerns had been managed. Staff knew who the safeguarding leads were. Staff were made aware of people with identified safeguarding concerns together with their household members, by the use of an alert on their clinical records. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. The practice regularly discussed safeguarding concerns at weekly meetings and externally with safeguarding nurses, community matron, hospice nurse and the local Integrated Care Board (ICB) when required. A representative from the local school commented about the practice’s safeguarding awareness: “On occasions where vulnerable families or pupils have been involved, we have seen evidence of a thoughtful, sensitive, and proactive approach”. The safeguarding adults and children policy was up-to-date and accessible to all staff on the practice’s computer system. The policy listed the training requirements for each role. However, not all the staff were up-to-date with their mandatory safeguarding training. The practice has developed an action plan to maintain oversight of mandatory training, including safeguarding.

The service worked with people to understand and manage risks. They provided care to meet people’s needs that was safe and supportive.

Staff could recognise a deteriorating patient and were knowledgeable regarding the appropriate action to take. Receptionists received training on emergency symptoms. GPs were available to support the receptionists. Staff we spoke with provided examples of coordinated responses between clinical and non-clinical staff to manage medical emergencies. People received advice on risks related to their condition and actions to take if their condition deteriorated. People said they were involved as much as they wanted to be in decisions about their care and treatment.Our clinical searches identified 26 patients of childbearing age who were prescribed teratogenic drugs (medicines that can cause birth defects or developmental disorders). We sampled 5 patient records and found that 4 of them were on specific teratogenic drugs (valproate/topiramate). They were using effective contraception but did not have a pregnancy prevention plan or pregnancy risk acknowledgement form in their patient records. This was not in line with national guidance. The practice took immediate actions to identify, contact and review patients in this category. The practice discussed the issue in a team meeting to raise awareness, and an audit would be carried out to monitor compliance.

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 practice was well-maintained and free from clutter. The facilities and premises were appropriate for the services being delivered. Equipment was fit for purpose and in good working order. Fire equipment checks and fire drills were documented. Electrical equipment was tested to ensure it was safe to use and equipment was calibrated for accuracy. All staff were up-to-date with fire safety and health and safety training. Lead roles for health and safety were clearly defined. The practice had a health and safety policy and business continuity plan detailing what actions were to be taken in the event of any incident which would hamper the running of the services. There was a lone working policy and risk assessment to promote staff safety. Health and safety risk assessments had been carried out and where necessary and appropriate actions taken. However, the fire risk assessment was out of date. The practice took immediate action to arrange the fire risk assessment and it was completed during the assessment period. We saw evidence that the practice had acted on the recommendations.

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 which met people’s individual needs.

There was a range of clinical and non-clinical roles within the practice. Most staff expressed there were enough staff to provide safe and high-quality care. However, staff added they would like to have more clinical staff to cope with the rising demand from the rapidly growing patient population in Cranbrook. Safe recruitment practices were followed in line with the practice’s recruitment policy. We reviewed 5 recruitment files during the site visit and found appropriate recruitment checks had been carried out. Staff received induction appropriate for their roles and staff were working within their agreed areas of competence. They had regular appraisals and were able to discuss their development. Although staff had protected time for learning and development, over half of the staff members were not up-to-date with their mandatory training. The practice developed a process to monitor and maintain oversight of the completion of mandatory training. There was an improvement in mandatory training completion during the assessment period. However, the oversight process had yet to be embedded in the practice.

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 (IPC) lead, and all staff were aware of who the person was. The IPC policy was accessible to all staff. Staff knew how to manage clinical waste and specimens.Cleaning schedules were followed and the premises were visually clean. Up-to-date IPC risk assessments and audits were completed, and actions were taken to mitigate risks. Personal protective equipment (PPE) was available to staff and there were hand-washing facilities in clinical areas. Sharps waste bins were safely managed. External clinical waste bins were locked and stored in a secure area. Not all clinical staff were up-to-date with their IPC training. The practice implemented a process to oversee training completion, and this had yet to be embedded in the practice.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

The practice had a policy for the management of medicines including repeat prescribing. The practice had a process for authorising staff to administer medicines including Patient Group Directions (PGDs - a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition) or Patient Specific Directions (PSDs - a written instruction from a doctor or other independent prescriber for a medicine to be supplied or administered to a named patient). Blank prescription stationery was securely stored in a locked filing cabinet. Vaccines were appropriately stored and monitored in line with national guidance to ensure they remained safe and effective.Staff carried out regular checks on emergency medicines and equipment.Some emergency medicines, recommended nationally by the Resuscitation Council UK were not stocked at the practice. However, there was no evidence regarding the reason for this. The practice conducted a risk assessment to explain why certain emergency medicines were or were not kept in stock. There were no formal audits for non-medical prescribers (NMPs, healthcare professionals who can prescribe medicines but are not GPs) although they could approach GPs for advice. The practice developed a new formal process of regular audits and clinical supervision sessions for NMPs to assess their competencies and monitor their performance.

Our remote clinical searches demonstrated mixed results in the review and monitoring of patients prescribed certain medicines.For example, our clinical searches identified 21 patients who were on methotrexate (a medicine used to treat inflammatory conditions and some cancers but can have serious side effects on blood cells, liver and kidney) which required regular monitoring. We reviewed 5 of these clinical records and all had received timely and appropriate blood monitoring. However, we identified 3 out of 5 patients who were on aldosterone antagonist (a medicine that can affect body salt and water balance) with heart failure but were overdue for appropriate blood monitoring. Our clinical searches also identified 27 out of 37 patients who were on a direct oral anticoagulant (DOAC) (a medicine that prevents blood clots) but had not received appropriate monitoring. The practice identified and arranged follow-ups with these groups of patients. The practice also developed new processes to regularly monitor these specific patient groups. Clinical searches identified 291 patients who had medicine reviews in the last 3 months. We sampled 5 patient records to look at the quality of medicine reviews and found 3 of them contained insufficient details. The practice immediately conducted an audit to assess the inconsistent quality of medicine reviews and developed a detailed improvement plan to address this.

The staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes. Prescribing data reviewed as part of our assessment confirmed this. For example, the prescription of gabapentinoids (medicines prescribed for treatment of epilepsy, neuropathic pain or generalised anxiety disorder but with risk of misuse or dependence) and antimicrobials was lower than the national average. The practice had audited and reviewed its prescription data and found a high number of patients were on opioids (medicines with potential for misuse). The practice revised its prescribing process so only GPs, but not other clinicians, could prescribe opioids. This change, along with improved continuity of care and stronger rapport with patients, led to a reduction in opioid prescriptions.