Minehead 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.

This is the first inspection for this service since its registration with CQC. This key question has been rated as good. The service had a learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. Staff had the right skills, qualifications, and experience. At the time of this assessment, most GP appointments were being provided by locum GPs. The service was aware they needed to recruit to permanent roles at the practice to provide continuity of care. Managers made sure staff received training to maintain high-quality care. Staff managed medicines well and involved people in planning any changes. There were systems and processes to monitor prescribed medicines which required additional monitoring however, we noted some gaps in this monitoring during our clinical searches. The service addressed this immediately and instigated further systems and processes to reduce the risk of this reoccurring.

This service scored 69 (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 felt there was an open culture and were supported to raise concerns and felt they were treated with compassion and understanding. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Representatives from the Patient Participation Group (PPG) told us the service listened, took concerns seriously and proactively made improvements. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. The service 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. Learning from incidents and complaints resulted in changes that improved care for others.

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. People were able to request the same GP, but this request could not always be fulfilled. However, due to the high usage of locum GPs, continuity of care was a challenge. The service was aware of this and were trying to secure longer-term locum GPs until they had recruited permanent GPs. There were systems for processing information relating to new patients. At the time of this inspection, there were 274 new patient records that required summarising. The service had planned for staff to attend a training course, who once the course was completed would work on reducing this backlog. The service worked with other providers to deliver shared care and when people moved between services. We reviewed the document management process for information coming into the service which included ensuring test results were managed in a timely way. GPs were allocated daily administration time to manage these documents. This process was monitored on each day and GPs were reallocated administration duties depending on the varying number of incoming documents. There was a system to monitor 2-week-wait referrals but no systems to monitor other referrals. Staff told us people were safety-netted by being told to get back in touch if their symptoms changed.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately. Safeguarding policies were available to provide guidance to staff, who were trained in safeguarding procedures. During this inspection, there was no onsite safeguarding lead. The safeguarding administrator based onsite liaised with the remote safeguarding lead, attended meetings, maintained a list of vulnerable people, and completed referral forms with clinicians. The service recognised not having an onsite safeguarding lead was an issue and had plans to appoint someone to this role from the current workforce. There were regular discussions between the service and other health and social care professionals to support and protect adults and children at risk of significant harm. The service acted on concerns working in partnership with other organisations.

The service worked with people to understand and manage risk. They provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them. Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of the action to take. People were advised on risks related to their condition and the action to take if their condition deteriorated.

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 service made reasonable adjustments when people found it hard to access services such as having step-free access and consulting rooms on the ground floor. Staff had completed safety training including fire safety and data security.Contracts with external organisations ensured the premises were maintained. Health and safety risk assessments and audits had been completed and the risks identified had been addressed. There was a business continuity plan which was monitored and regularly reviewed.

The service made sure there were enough qualified, skilled, and experienced staff, who received effective support and development. Not all staff had received an annual appraisal. The service told us they were aware of this and had a scheduled plan to ensure all staff received an appraisal in the near future. The staff team worked together well to provide safe care that met people’s individual needs. There were a range of clinical and non-clinical roles within the service. Most staff feedback expressed that the current staffing levels provided safe care. We found training was up-to-date, learning needs and the development of staff was managed effectively, and staff were working within their agreed areas of competence. Safe recruitment practices were followed. The provider had reviewed staff skills, knowledge and experience to ensure they were working within their scope of competencies.

The service assessed and managed the risk of infection. They had processes in place to detect and control the risk of infections spreading and share concerns with appropriate agencies promptly. The service had a designated infection, prevention and control lead and all staff had had relevant training. The premises we visited were visually clean. Sharps bins inside premises were appropriately managed. Personal Protective Equipment (PPE) was available to staff.Cleaning schedules were followed and we saw evidence the service liaised with cleaning contractors to review processes. Risk assessments and audits were completed, and actions taken to mitigate risks. However, during our onsite visit, the external clinical waste storage area was not secure as the door was open and not locked. The service identified they had just had a waste collection, and the contracted service had not ensured the storage area was locked when they left. The service immediately secured the area and addressed this incident with the contracted service. There was a process to record staff vaccinations in line with national guidance. However, we found there were some gaps in the monitoring of staff vaccinations.This was highlighted to the service during our inspection, but they did not provide us with any evidence of actions following the inspection.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

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. Staff managed prescription stationery appropriately and securely. We reviewed a sample of Patient Group Directions (PGDs) (a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition by named registered health care professionals without them having to see a prescriber) and 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) and found they been completed in line with guidance. Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. However, during the onsite visit we saw expired vaccines being stored in the fridge with no labelling or plans of disposal. We also found the provider was not able to evidence the considerations given to not stocking the recommended emergency medicines in line with national guidance. The service immediately addressed our concerns in these areas. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

The provider had systems to manage and respond to safety alerts and medicine recalls however, these were not always effective. Our clinical searches identified 3 people aged 65 and over on a high dose of citalopram or escitalopram (medicines to treat low mood and panic attacks). These people had not been fully informed of the risks of taking higher doses of these medicines and they had not had a baseline ECG recorded in their patient record. The service took immediate action to review these people, reminded clinicians of this medical alert and included it in the medication review alert information pack.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. Our clinical searches identified 71 people were prescribed methotrexate (medicine to treat inflammatory conditions such as arthritis and psoriasis). We reviewed 5 patient records and found 1 person was overdue monitoring and the service contacted them immediately to address this.

Staff took steps to ensure they prescribed medicines to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials Co-amoxiclav, Cephalosporins or Quinolones issued by the provider between April 2024 and the end of March 2025 was observed as 4.75%, lower than the expected 7.8%. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

Our clinical searches identified 574 people had received a medication review in the previous 3 months. From all the patient records we reviewed, we found some lacked structure, quality and content. The clinical lead carried out audits on consultation notes and gave feedback to GPs. This was a challenge due to the high use of locums and not always being able to see improvements from feedback when the locum GP had not returned to work at the service. The service was working towards recruiting permanent staff to ensure systems and processes were consistently followed and improvements could be made or followed up with staff.