Harewood 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 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

In feedback to CQC, all staff who responded confirmed that they knew how to report a significant event and most stated that they were invited to discuss significant events and that learning was shared with them.

Managers encouraged staff to raise concerns when things went wrong and, during staff meetings, the team discussed and learnt from clinical issues. Staff felt there was an open culture, and that safety was a top priority.

The practice had processes for staff to report incidents, near misses and safety events. There was also a system to record and investigate complaints, and when things went wrong, staff apologised and offered people support.

Learning from incidents and complaints resulted in changes that improved care for others.

Harewood Medical Practice worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. It 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 practice worked with other providers when patients moved between services and to deliver shared care.

As part of our assessment, we looked at the practice’s clinical system to view the number of patient referrals and test results that required action. We saw that referrals and test results were managed in a timely way and there were arrangements to distribute tasks when staff were absent or on leave.

We also saw that there were systems and processes in place to deal with Medicines and Healthcare products Regulatory Agency (MHRA) alerts. These alerts were followed to ensure that medicines and medical devices were safe.

Harewood Medical Practice worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. It concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect.

Safeguarding policies were in place and were known to staff who had received training in safeguarding children and adults at a level relevant to their role. One of the GPs was the safeguarding lead for the practice and safeguarding was a standard agenda item for all clinical meetings.

In feedback to CQC, staff stated that they were confident in identifying safeguarding issues and that they knew who to report safeguarding concerns to.

Chaperones were available at the practice and both clinical and non-clinical staff had received training in this area. The practice website contained clear information on their chaperone policy and there were posters in some consultation rooms advising patients that they could request a chaperone should they wish to do so.

‘Learning disabilities and Autism’ training was mandatory for all staff and most had completed it. The one member of staff that had not, had been enrolled on the course and completion was being monitored.

Harewood Medical Practice worked with people to understand and manage risks by thinking holistically. It provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them.

Emergency equipment (such as emergency medicines and a defibrillator) was available on-site and was routinely checked and maintained. It was stored in a central location and in feedback to CQC, staff told us that they could easily access it.

All staff had completed Sepsis training so that they could recognise a deteriorating patient plus training in basic life support and anaphylaxis training.

Patients were advised on risks related to their condition and actions to take if their health deteriorated.

Harewood Medical Practice detected and controlled potential risks in the care environment. It made sure equipment, facilities and technology supported the delivery of safe care.

Contracts were in place to ensure the premises were well maintained and a health and safety risk assessment, legionella risk assessment, Control of Substances Hazardous to Health (COSHH) risk assessment and asbestos report had all been undertaken within the last year to identify potential risks to staff or the public.

Portable appliance testing and calibration of equipment were both up to date and regular fire safety checks were conducted at the surgery. All staff had completed fire awareness safety training.

There was a business continuity plan in place which was regularly monitored and reviewed. This included contingency plans in the event of an incident such as loss of utilities, loss of the internet/internal systems, adverse weather or building lockdown.

The practice also had a clear policy to ensure the safety of staff members supporting patients registered via the NHS Special Allocation Scheme (SAS). These patients have usually been removed from other GP practices due to violent or threatening behaviour and Harewood is one of 4 practices in North Yorkshire who are part of the scheme.

In feedback to CQC, staff told us that they were happy with the health and safety arrangements at the practice.

Harewood Medical Practice made sure there were enough qualified, skilled, and experienced staff, who received effective support, supervision, and development. It worked together well to provide safe care that met people’s individual needs.

We found that most training was up to date; that learning needs and the development of staff was managed appropriately; and that staff were working within their agreed areas of competence.

There was a policy for the clinical supervision and competency of clinical staff and in feedback to CQC, clinical staff confirmed that they had received regular supervision between their annual appraisals.

Although some staff stated that they would benefit from more protected time to complete administrative duties and training, one staff member explained that “if I requested this, I'm confident I'd be given time, no problem.”

Safe recruitment practices were followed. These included appropriate levels of Disclosure and Barred (DBS) List checks made pre-employment. Where DBS checks had not been received, the practice had appropriate risk assessments in place for those staff members.

Harewood Medical Practice assessed and managed the risk of infection. It detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was a designated infection, prevention and control (IPC) lead who completed regular audits of the premises and staff procedures, such as handwashing and use of personal protective equipment.

IPC training was mandatory for all staff and only one member of staff had not completed it. A plan was in place to address this and completion was being monitored.

In feedback to CQC, staff stated that they were aware who the IPC lead was and that they felt that IPC arrangements were sufficient to protect staff and patients.

Cleaning schedules were in place and followed. During our visit, we observed the practice to be clean and tidy throughout.

Harewood Medical Practice generally ensured that medicines and treatments were safe and met people’s needs, capacities, and preferences. It also involved people in planning, including when changes happened.

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.

The practice had effective systems to manage and respond to safety alerts and medicine recalls.

Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for medicines, including emergency medicines and vaccines.

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

Patient Group Directions (written instructions allowing non-prescribing health professionals to administer specified medicines to a specific group of patients without a specific prescription) were in place and up to date. Patient Specific Directions (a formal written instruction provided by a prescriber, detailing the medicines to be supplied and/or administered to a specific patient) were also in place and had been completed as per best practice.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

Staff followed established processes to ensure that people prescribed medicines with specific risks received recommended monitoring. Findings from clinical searches generally showed good oversight and monitoring of patients prescribed high-risk medicines, such as those on anti-rheumatic medicines and those prescribed medicines to treat high blood pressure. We did however identify 25 patients on a medicine to treat pain and inflammation who had potentially not received the appropriate monitoring and when we reviewed 5 of their records in more detail, 4 of them required action. The practice immediately carried out a review of all these patients following the assessment and took appropriate action where required.

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 issued by the provider was in line with the national average.

Processes were in place to manage blank prescription stationery and track it throughout the practice.