Bewdley Medical 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 looked for evidence that people were protected from abuse and avoidable harm.

We rated this key question as Good.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had a good learning culture, and processes were in place to support staff to report incidents, near misses and safety events. Managers investigated incidents thoroughly. Learning from incidents and complaints was discussed in meetings and resulted in changes that improved the service.

Leaders were committed to learning, and we discussed some examples of significant events and the actions the practice had taken in response to the learning identified. One incident involved the incorrect processing of a death certificate for a patient which resulted in distress for the patient’s family. In response to this, the practice developed a new process and pathway; and a team of staff members to lead on this area of work.

The practice worked with patients and healthcare partners to establish and maintain safe systems of care. Staff worked to facilitate continuity of care, including when patients moved between services. There were protocols in place for managing incoming correspondence into the patient’s medical records. Patient referrals to specialist services were documented in the referrals systems and patient record. We found referrals were managed in a timely manner.

Safeguarding policies and procedures were in place to keep people safe and safeguarded from abuse. The practice had a nominated GP safeguarding lead and a Safeguarding Administrator. Staff had completed the relevant safeguarding training for their role and shared concerns quickly and appropriately. The practice maintained a list of vulnerable adults and children. They acted on concerns working in partnership with other organisations. Clinical system alerts were used to identify people who were at risk of harm or abuse including household contacts. There were systems in place to respond to concerns and act on correspondence. For example, they followed up children who failed to attend their appointments or were frequent attenders to the accident and emergency department.

Safeguarding was discussed regularly as part of monthly clinical meetings. In addition, safeguarding cases were discussed at Wyre Forest Health Partnership meetings where safeguarding risks and patient care was reviewed.

Staff could recognise a deteriorating patient and knew what action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. There were processes in place to ensure care was prioritised for the most clinically vulnerable patients.

As part of our assessment, we checked the emergency equipment and medicines available and the reviewed the processes to maintain these. We found adrenaline medicine (used in emergencies to treat severe allergic reactions, cardiac arrest, and severe asthma attacks) was not located within all of the consultation rooms where vaccines were administered to patients. This was not in line with the Resuscitation Council UK recommendations. Emergency medicines were located in a locked room within the practice. Emergency medicines should be readily accessible in an emergency.

Emergency medicines, except for those subject to additional storage requirements, should notbe stored within locked cupboards or rooms as this can cause an unacceptable delay in the event of an emergency.

The practice facilities were fully accessible to patients. Consultation rooms were available on the ground floor and lifts provided access to other floors.

The practice detected and controlled potential risks. They made sure equipment, facilities and technology supported the delivery of safe care. Contracts were in place to ensure the premises were maintained. Systems were in place for the checks of fire alarms, fire extinguishers and fire evacuation procedures. Portable appliance testing was completed annually to ensure equipment was safe to use. The practice provided us with evidence of health and safety risk assessments which showed that risks were properly managed.

There was a business continuity plan in place which was monitored and reviewed. As part of the Wyre Forest Health Partnership, Bewdley Medical Centre had access to the various practice sites and could receive assistance from colleagues from across these sites, which enhanced their business continuity preparedness.

The practice made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

There were a range of clinical and non-clinical roles within the practice. GPs had also been nominated to lead on clinical areas such as dementia, learning disabilities, drugs and alcohol, palliative care, bone health, dermatology and gastroenterology.

We found learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Leaders explained they had a mentoring system in place for clinical staff. For example, when GPs joined the practice, they were assigned a GP mentor whom they had regular meetings with. The GP partners at the practice also had a ‘buddy’ GP from across the GP practices within the Wyre Forest Heath Partnership. The Advanced Nurse Practitioners had similar mentoring meetings. In addition, there were regular prescribing audits and meetings undertaken to provide assurance of appropriate clinical care.

We discussed clinical supervision of the Physicians’ Assistant and leaders explained a nominated GP reviewed and discussed all the patient cases with them.

As part of our assessment, we reviewed staff personnel files and training records. At the time of our onsite visit, we identified gaps in the records of some staff members, however following our visit we were provided with evidence of the missing documentation.

The practice 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 an infection control policy in place and a designated infection, prevention and control (IPC) lead. Staff had completed relevant infection control training. Risk assessments and audits were completed, and actions taken to mitigate risks. Clinical waste procedures were in place. The practice had effective oversight of the external cleaning company to ensure cleaning schedules were followed and cleanliness met the required standard.

The practice strived to make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved patients in planning, including when changes happened.

Staff involved patients in reviews of their medicines and helped them understand how to manage their medicines safely. Patients knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

Medicines were stored securely and at appropriate temperatures. Refrigerators used to store vaccines and medicines were monitored to ensure temperatures were maintained and products were appropriately stored within them. Staff regularly checked stock levels and expiry dates for all medicines, including emergency medicines. There were Patient Group Directions (written instructions to help specific healthcare professionals supply or administer medicines to patients)in place which relevant staff worked to.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. We discussed with staff an audit which had been undertaken on hormone replacement therapy (drugs used to treat the menopause), where the audit assessed the prescribing of both oestrogen and progestogen medicines for patients.

Prescribing data was reviewed as part of our assessment found practice performance was in line with national averages for Pregabalin and Gabapentin medicines (primarily anticonvulsant drugs, also prescribed for pain); psychotropic medicines (used to treat various mental health conditions); and antibiotics.

As part of our assessment a Care Quality Commission GP Specialist Advisor undertook searches of patient records on the practice’s clinical system. Our clinical records review identified the following:

Leflunomide (a drug used to treat rheumatoid arthritis): We identified 3 patients prescribed this medicine and found all 3 patients were receiving appropriate treatment and monitoring.

Direct oral anticoagulants(DOACs) (blood-thinning medications): We identified 735 patients were prescribed these medicines of which 25 had potentially not received the required monitoring. We reviewed in detail the care records of 5 of these patients and found 4 patients were overdue monitoring. Of these 4 patients, 2 patients were already booked in for an appointment with the practice. Following our site visit, the practice updated us that all patients identified had been contacted and received the necessary blood tests and weight checks.

Bisphosphonate (medicines that strengthen bones): National guidance recommends that after a patient has been taking this oral medicine for 5 years, the need for continuing treatment should be reassessed and consideration should be given to providing a Dual‑Energy X‑ray Absorptiometry (DEXA) scan. DEXA scanning offers a non‑invasive and highly accurate method for evaluating body composition, including bone mineral density. We identified 88 patients who had been prescribed this medicine for over 5 years and reviewed the records of 5 patients. We found no issues with the monitoring of these patients prescribed this medicine.

Safety Alerts: There was a process in place for recording and sharing medicine safety alerts. Safety alerts were discussed in clinical meetings. We reviewed patients who were prescribed both an Aldosterone antagonist (a diuretic medicine which prevents potassium loss) and an Angiotensin-converting-enzyme (ACE) Inhibitor (a drug used primarily for the treatment of high blood pressure and heart failure). We identified a total of 130 patients prescribed these medicines and found 6 patients who were overdue monitoring. We looked in detail at these patient records and found all patients had already been booked in for appointments to receive these tests.

Medication reviews: We reviewed a random sample of 5 medication reviews out of a total of 3722 reviews that had been completed for patients in the previous 3 months. We found 3 of these 5 medication reviews had been coded but lacked information, such as monitoring arrangements or details about what had been reviewed or changed as a result of the review. Staff took on board our feedback on this issue and recognised the importance of documentation for medication reviews. Following our visit, the practice provided us with an update on actions they had taken to improve medication review documentation which included reminding clinicians that every medication review must include a brief summary of what was reviewed; confirmation of patient discussion, where applicable; and clear documentation of any changes made.

As part of our assessment, we reviewed the processes in place for controlled drugs. Controlled drugs are medicines that are regulated by the government. This is usually because they are at a higher risk of causing harm (such as dependence or misuse). Clinicians explained their systems and processes which included prescriptions not being issued on repeat; no more than 28 days of medicine prescribing; regular patient reviews; dedicated text messages to patients with information about the risks and monitoring required; a proactive approach to offering patients the opportunity to reduce their medication and support from the clinical pharmacist to do this.