Stirling Road 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this under our new ways of reporting. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. Shortfalls were identified in health and safety processes. Not all staff had received safeguarding training relevant to their role. Improvements were needed to demonstrate significant events were used to improve service provision and actions taken to mitigate risk. There was a risk of delays in providing care and treatment to people due to information in documents not being processed in a timely manner. Areas of the environment needed refurbishment to make sure they could be effectively cleaned and reduce the risk of infection. Staff were not allocated adequate time to fulfil their role, and not all had received appropriate training. Staff told us more staff were needed to make sure the service was safe and effective, in order to meet patients’ needs. Consistency in the monitoring of people’s medicines was needed to make sure blood tests and physical checks were carried out prior to a review or prescription being issued. The service was in breach of legal regulation in relation to people’s safe care and treatment; the ways people’s medicines were managed safely; infection control; and safe and effective staffing.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. The provider did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. There were mixed views from staff about reporting incidents, with some staff saying they were discouraged from doing so. Clinical meetings were planned where significant events were discussed, but these did not always happen. Our review of significant events showed some changes were made as a result of an event. However, records were not clear on who should be taking action to reduce the risk from reoccurring and how this was monitored. Staff had been provided with information on how to report incidents, but it was unclear from the incident log how feedback to staff had been given. We saw delays in reporting incidents, one incident was reported 2 months after it had occurred.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services. Delays in managing documents meant the provider could not fully demonstrate safe systems of care were effective and minimised the risk of harm. Pathology results had been colour coded to identify the highest risk. All outstanding results had been allocated to a clinician to action, with the oldest dating from 6 December 2024. There were 2878 non-urgent documents waiting to be scanned onto patient records. Some of these had already been sent electronically, so were already on the patients’ records. The oldest document waiting to be scanned was dated 3 December 2024 . The provider planned to train more staff to deal with documents to make sure people’s records contained relevant information. The provider was also changing the way GPs worked in the practice to promote continuity of care and have a named GP responsible for managing results. The practice received 400 to 500 documents daily. Documents awaiting scanning were sampled, we did not identify any potential risk of harm to patients. The provider planned to implement spot checks of documents waiting to be scanned in January 2025 when relevant staff were in place. There was a standard operating procedure to check summarisation of patient records was up to date and accurate, when a patient requested an appointment. New patients were asked to complete a pack, this was sent to the hub to be checked and uploaded onto their patient records.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Some staff were not aware who the safeguarding lead was until this assessment was announced. Some staff were confident about knowing what to do when there was a safeguarding concern, but others were unsure of what the process should entail.

Training records showed not all clinical staff had received safeguarding training to the appropriate level.

An advanced nurse practitioner worked with the GP safeguarding lead and had allocated time to maintain the safeguarding register.

Staff said there were occasions when getting external support for patients experiencing severe poor mental health was challenging, due to limited resources in the community. Staff would still refer people and provide them with relevant telephone numbers for further support and inform them of likely delays. The practice had access to a qualified mental health practitioner who was able to support with lower risk mental health concerns, such as mild depression .

The provider usually worked with people to understand and manage risks enabling them to make informed decisions. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Staff understood the procedure for acting on safety alerts and the checks they would make to ensure action was taken, we saw this was followed. Published information from the National GP survey related to the time prior to the provider taking over the service and we did not receive direct feedback on patient involvement in managing their care and treatment.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Fire risk assessments and emergency lighting checks were carried out and were up to date, with no risks identified. Regular fire drills were carried out with the time to evacuate the building recorded. However, there was no designated fire warden for one site. A fire exit was blocked by a table at another site.

Equipment used by clinicians was calibrated and serviced to make sure it measured accurately. However, staff reported buying their own equipment, such as headsets for telephone calls and ophthalmoscope (used to examine the eyes), as none were made available.

Storage areas were not always secured, some cleaning cupboards were not locked. A boiler room which was accessible to people was unlocked as there was no key available, even though there were hazard warning signs on the door. Keys for rooms, cupboards and vaccine fridges were not stored securely.

A site leader oversaw the running and maintenance of premises used to provide the service. They told us they planned to meet with the landlords of the buildings to discuss management of keys in January 2025.

Windows at Stirling Road were not restricted and there was no risk assessment in place to demonstrate why this had not been done.

Areas of peeling and chipped paint were found in clinic rooms at one site which posed a health and safety risk. The provider said they had received funding to replace flooring and repainting some areas. The basement at this site had a musty smell and there was water damage on the walls due to a leak. Staff worked in this area and medical records were stored there. During our assessment the medical records stored in a cellar with outside access were removed to a secure location, due to the security risks and the records creating a fire hazard.

A baby changing room and patient toilets at one site were cold, due to no heating being on. It needed refurbishing as paintwork was chipped and peeling in places.

A meeting room at one site was used to store redundant equipment such as microwaves and fans. The site lead said they had not had sufficient time to dispose of the items.

Lone worker risk assessments were not completed for staff who opened and closed buildings, but a policy was in place for lone working.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Staff said staffing levels were not consistently adequate. There was limited resilience in staffing numbers if there was absence. At 1 site there was only 1 GP, 1 health care assistant and 1 practice nurse working each day, which was considered to be adequate. However, the practice nurse was not available every day which meant patients had to attend another site for their appointment.

Care navigators at the same site told us there were usually 3 of them working Monday to Wednesdays which was adequate as long as absences at other sites did not have to be covered. They said the workload on Thursdays and Friday was usually managed by 2 members of staff, but at lunchtime this was reduced to 1 to accommodate breaks. Mixed comments were received from staff on getting hold of managers to discuss concerns. One site only opened 3 days a week and patients were asked to attend other sites, which would be problematic if a patient was unable to drive due to limited public transport links.

Some sites did not always have a duty GP on site when they were open, which potentially caused delays in patients receiving appropriate care and treatment.

Some staff said they did not have clear direction on their role as a result of changes being made by the provider to the service. They had been given protocols to follow and some guidance on what to do, but there was no face to face training to further support their understanding.

Data analysis of telephone calls, including abandoned calls and wait times was carried out and the provider planned to use this to assist with staffing numbers.

Training records showed not all staff had been able to complete training required by the provider. Staff said protected time was not available during their working hours and they would often complete training in their personal time, for which they would be paid or get time back.

Care navigators had mixed views on specific training provided to undertake their role. Some were satisfied with the training, but others considered it did not prepare them well enough. The provider said trainers had sat alongside care navigators to train them. However, no written guidance or information was provided. We requested details of training materials used for care navigators, but this was not provided. Staff with specific roles had not always received appropriate training, for example site leads.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly. Premises used for delivering the service were visibly clean and tidy, but cleaning records were not always completed fully. Monthly audits of cleaning were carried out and regular meetings were held with the external contractors to discuss any issues. Staff at 1 site said the cleaners only attended for 2 hours a day, which they did not think was enough, as the building was old and all rooms were used daily. This had been raised with the estates officer, but no feedback had been received. At 3 sites there were issues with ensuring the environment could be adequately cleaned due to peeling paint and plaster crumbling around sink areas in clinical rooms. Some seat covers on chairs were torn and coverings were cracked and posed an infection risk, as they could not be effectively cleaned. Some desks had personal belongings on them which hindered effective cleaning. This was addressed by the provider on the day. One site had a wooden table in a clinical room, which could not be cleaned effectively, however there was also a metal trolley available for use. We noted at this site there was peeling paint on walls, doors and skirting boards in all areas. Legionella checks were carried out, but the provider could not demonstrate fully that little used water outlets, such as showers, were flushed through to minimise the risk of bacteria growing.

Sharps bins for used needles were not consistently available in all clinic rooms or stored safely when full; and clinical waste was not stored securely at two of the sites.

At one site there were out of date specimen bottles, pregnancy tests and dressings not in their original boxes and no date of expiry visible. These were removed at the time of assessment. We noted the infection control audits had identified issues with areas that needed refurbishment but had not identified out of date supplies and the clear desk policy had not been followed. There were no action plans in place to show how these shortfalls would be rectified.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning. Improvements were needed in the monitoring of some high risk medicines. For example, 760 patients were on painkillers that could be addictive and 44 patients had not had a review. We sampled 5 records and found 2 patients had started the medicine in the past year; 1 patient was new to the practice; 1 patient had an appointment booked for monitoring; and the other patient had been reviewed, but this was not coded on their records. Medication reviews were carried out but on the 5 records we sampled there was limited details of what was discussed in the review. There was a system to manage and respond to safety alerts and medicine recalls. 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 national averages. Protocols were followed to ensure medicines were prescribed safely. Audits of prescribing practice were carried out and training and supervision was provided when needed. Vaccines audits were carried out to ensure they were in date and safe to use. The practice pharmacy team worked on medicines queries and optimising prescribing practices, to make sure they were in line with current guidance. The team also managed safety alerts and had oversight of long term condition medication reviews and undertook medicine reconciliation. (Medicines reconciliation is the process of identifying an accurate list of a patient's current medicines, including over the counter and complementary medicines, and carrying out a comparison of these with the current list in use, recognising any discrepancies, and documenting any changes).

All prescriptions were checked by a pharmacist prior to being sent to a pharmacy to be dispensed. Staff usually managed prescription stationery appropriately and securely. However, we found prescription stationery in 1 printer, this was removed at the time of the site visit.

Emergency medicines were held at all sites, and the provider sent us evidence of a risk assessment with mitigation for not storing all emergency medicines at the practices..

Medicines were not always stored securely at all sites. For example, vaccination fridges had keys left in them, with one being easily accessible to members of the public. There were no risk assessments in place to demonstrate how this risk was minimised. Vaccine fridge temperatures were routinely recorded and we saw they were within recommended ranges.

Staff used patient specific directives for vaccines and clinics, for example those for flu. These were appropriately authorised. (A Patient Specific Direction is an instruction from a doctor or non-medical prescriber for medicines to be supplied and/or administered to a named patient after the prescriber has assessed the patient on an individual basis.)

Patient group directives were in place but had been signed by clinicians after they were authorised. The practice sent us confirmation this issue had been rectified after our site visit. (Patient Group Directions (PGDs) provide a legal framework that allows some registered health professionals to supply and/or administer specified medicines to a pre-defined group of patients, without them having to see a prescriber (such as a doctor or nurse prescriber.)