Hythe 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 practice since its registration with CQC. This key question has been rated as good.

This service scored 81 (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 strong proactive and positive culture of safety, based on openness and complete honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong and had introduced short daily meetings called ‘huddles’, to ensure that emerging issues could be explored and addressed quickly. Leaders had worked to foster a positive, blame-free culture in which learning and improvement were vital in maintaining a high standard of care.

There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. All logged concerns were discussed in clinical meetings, role-specific team meetings and in dedicated ‘incidents and complaints’ meetings. Learning was often formalised in training sessions for a specific staff group and resulted in changes that improved care for others. We saw that actions taken were shared with staff, and changes were reviewed and audited to ensure that improvements were sustained and embedded. For example, when concerns were raised about the process for coding from clinical correspondence, systems and processes were adapted and safety measures strengthened. This involved a training session for all staff involved in coding, and extra steps being implemented in the checking of codes entered by digital systems. Ongoing auditing of coding processes ensured that high standards of accuracy were maintained, to keep records correct and care appropriate.

The practice had also raised concerns about systems not working as intended in the referral process to a secondary care service. Following investigation of a significant event, GPs at the practice identified an ineffective referral pathway which had resulted in an episode of unnecessary delay to receiving appropriate care. By working with management at the onward service to highlight the problems, changes were made to improve access for others referred using this pathway, both in the practice population and in the wider community.

The practice worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They 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 had introduced a digital registration system to reduce the administrative burden of processing applications, minimising staff time needed for this task. Work had been undertaken to ensure that this system was able to accurately identify and flag items of concern, with checks built into the process for additional assurance of its safety.

The practice worked with other providers to deliver shared care and when patients moved between services. Extended hours appointments were provided by the community healthcare service which had direct access to patients’ digital records, for continuity of care. Arrangements were in place for information sharing with this service, to ensure the safe processing of information of concern, such as safeguarding issues. For example, children not brought to appointments and coding of the needs of vulnerable adults.

There was a process for ensuring the safe and timely management of tasks within the clinical system, and figures for referrals, pathology results and other tasks were transferred onto a board in reception to make all staff aware of progress. The practice team aimed to process most tasks within that working day, to maintain empty inboxes where possible, and we found a shared commitment to this process across staff teams. Staff had a clear understanding of their roles and responsibilities in the referrals process, with urgent tasks and results being processed first.

The practice 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 practice shared concerns quickly and appropriately.

The practice maintained a list of vulnerable people and acted on concerns, working in partnership with other organisations. Staff we spoke with showed good knowledge of safeguarding children and adults and knew how to escalate concerns appropriately. Records demonstrated that staff had completed safeguarding training for vulnerable adults and children, to the appropriate level.

Safeguarding policies were in place and known to staff who were able to identify their nominated safeguarding leads for both children and vulnerable adults. Staff told us they felt confident in approaching the safeguarding leads for advice. A process of flagging was in use in the clinical system to identify patients considered vulnerable, which included close family and household links for enhanced oversight of risk.

We observed safeguarding was an agenda item in all clinical meetings and were told about collaboration and information sharing with relevant agencies such as Health Visitors. All safeguarding notifications received by the practice were processed on the same day to avoid delays in intervention, and staff we spoke with were aware of their roles and responsibilities in flagging and escalating information within this process.

The practice worked with people to understand and manage risks by thinking holistically. 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 at both sites which was checked regularly and maintained, with clear roles and responsibilities defined for this. During our onsite visit, we checked the defibrillator, oxygen supply and emergency medicines, and found the practice had the equipment and medicines required to manage medical emergencies effectively.

Duty doctors were available to provide advice and support when required, and the practice had an alert function within their clinical system to request urgent assistance during an emergency. Body-worn alert devices were also in use at 1 site due to the isolated working conditions and associated risks. Receptionists received training on emergency symptoms, such as sepsis, and clinical staff were available to support the receptionists with clinical advice where required. Digital triage systems had functions built in to identify and advise escalation of symptoms which indicate clinical emergencies.

The practice detected and controlled potential risks in the care environment across both practice sites. They made sure equipment, facilities and technology supported the delivery of safe care.

Contracts were in place to ensure the premises were maintained. The business manager was the designated lead for managing the premises and estates. They held comprehensive records of environmental safety checks and associated risk assessments.

Equipment calibration had been completed and was subject to routine monitoring. Planned annual safety checks were undertaken for the fire alarm system, emergency lighting and firefighting equipment which we reviewed on site. The practice had appointed fire wardens with appropriate training and had a fire evacuation plan displayed at both sites. Regular fire alarm tests were completed and documented, and fire drills were undertaken to allow the evacuation process to be tested and learning shared with all staff.

The practice worked to deliver services from a limited space in the current main site building at Hythe Medical Centre. They maximised their provision by constantly reviewing their demand and tailoring services within their physical capacity. They also made us aware of plans to minimise disruption and ensure continued safe service provision during their build phase and move to their new premises, on the same site.

There was a business continuity plan in place which was monitored and regularly reviewed by leaders. Staff were aware of the contents of this policy and understood how to access it when needed.

The practice 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 that met people’s individual needs.

There was a range of clinical and non-clinical roles within the practice. We found training was up to date and an effective programme of appraisal and clinical supervision was established. Staff told us how they were supported in their roles with regular oversight of skills and competence. For example, time was included within clinic templates to allow non-medical prescribers and physicians assistants to seek advice and discuss complex cases with a GP.

Learning needs and development of staff was managed appropriately, and we saw examples of role progression. Clinical staff were given opportunities to enhance their knowledge and skills through completing appropriate courses and training, empowering them to constantly improve care provision.

Recruitment practices were reviewed during our inspection, and whilst generally safe and in line with current guidance, we discovered that 1 criminal records check (DBS) had not been received for a new member of non-clinical staff. Following our site visit, the practice promptly provided a risk assessment to manage this risk and details of how they plan to strengthen their process further. Within staff files, we saw evidence of induction checklists to support staff as they commenced their clinical or non-clinical roles.

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 a designated infection, prevention and control (IPC) lead and all staff had completed relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks. Records showed that staff were appropriately immunised for their roles, and risk assessments had been completed where necessary.

We observed the premises and equipment were visibly clean and well-maintained, and contracts were in place for the safe disposal of clinical waste and sharps. Personal protective equipment (PPE) was available in all relevant areas. Spillage kits were available and staff knew their location, and how to access support if required. An IPC policy was in place, in line with national guidance and appropriate to the premises and services provided.

The practice had considered IPC when furnishing rooms in their temporary building to enable effective cleaning and had an established process of restocking rooms daily, rather than over-filling and causing clutter.

The practice always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They always 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. A pharmacy technician was employed at the practice and part of their role was provision of information and addressing medication queries from patients and non-clinical staff. This meant queries could be addressed promptly by an appropriately skilled person without impacting GP capacity.

Staff received regular training and were competency assessed on medicines optimisation. Staff followed protocols to ensure they prescribed all medicines safely, and that people received all recommended medicines reviews and monitoring. Non-medical prescribing, where medicines are prescribed by professionals other than doctors, was effectively supervised, reviewed and audited to maintain high standards of compliance, in line with local and national recommendations for safe care.

Staff followed established processes to ensure people prescribed medicines with specific risks, received recommended monitoring. As part of this inspection, a GP Specialist Advisor (SpA) conducted a series of remote clinical searches of patients’ records, to assess the practice procedures around prescribing and medicines management. We found the practice achieved a very high level of compliance in medication monitoring and prescribing, as set out in national standards. This showed processes were in place to ensure that the vast majority of those on medications, including high-risk medications were effectively reviewed and monitored, to maintain safe and effective prescribing.

As part of this inspection, we also reviewed 6 additional national prescribing data sets and saw no variation when comparing the practice’s achievement to local and national averages for 4 of the 6 data sets. The remaining 2 prescribing data sets showed positive variation.

There was also a programme of regular clinical audits of prescribing that focused on improving care and treatment. Many of these audits had been repeated through multiple cycles to evidence sustained improvements. For example, we reviewed a 2-cycle audit of prescribing of controlled medications (medication requiring a higher-level assessment of risk versus benefit.) It showed that correct prescribing of a limited-time supply in each prescription, had improved from 84% to 96% compliance. This meant that prescribers were able to review patients more frequently to ensure that medications remained appropriate and to check for over-reliance, risk of addiction and misuse.

Medicines including controlled drugs 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, and we saw roles and responsibilities clearly defined within these established processes.

Staff managed prescription stationery appropriately and securely by following a process where all paper prescriptions were signed out and counter signed. The provider had effective systems to manage and respond to safety alerts and medicine recalls and had created searches within the clinical system to identify medicines subject to prescribing restrictions or supply issues.