The Harefield 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 this first assessment of the service since its registration with CQC, this key question has been rated as good because safe care and treatment were delivered to the patients. Staff recruitment and induction were safely completed, infection prevention and control (IPC) audits were conducted. Patient medicines were managed safely with regular reviews and monitoring conducted. We were assured of patient safety and clinical care.

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.

The service had a proactive and positive culture of safety with transparency and honesty. The leadership and staff at this service ensured complaints and concerns were investigated and lessons learnt to identify and good practice continually. The service discussed and shared lessons at clinical and administrative meetings. Concerns were encouraged to be shared by staff with the management for a proactive resolution; for example, the practice reviewed its controlled drugs prescribing policy following an incident with a patient at a care home who was registered with another practice and had overdosed on opiates. Following the experience of the other service, this service initiated a non-fatal dose policy to reduce the potential of their patients stockpiling. Another example of being proactive was the use of Pre-emptive Significant event analyses (PSEA) which was a way to consider the potential of harm before it occurs and thereby shield the patients from the potential harm. Another example of learning from significant events was when a relative of a patient brought to the practice’s attention that the patient had non-fatally overdosed on a prescription medicine. The practice reviewed its prescription policy and how medications that required monitoring were reviewed to ensure patient safety. They also began a patient education process for those receiving regular medication. There had no recorded overdose since the policy was changed, and staff were made aware of new procedures.

The practice shared its learning through a network of local GPs, pharmacists, nurses and consultants called “Ux- Bridges”. A messaging application was utilised to share information with around 80 members who were involved with the care of the patient population in Uxbridge and can quickly brainstorm and resolve any issues involving primary care in the area.

This service worked with people and healthcare partners to ensure and maintain safe systems of care that were monitored and managed. Referrals were promptly monitored for the patients who needed them. There was a system to ensure new patients accessed the right information. Test results were managed in a timely manner. The service ensured collaboration with other care providers when patients moved between services and information about the patients was updated and accessed easily. The service had a team of care navigators who were trained to ensure the patients got the right services they needed. The practice had a “Safety Matrix” used as a dashboard to confirm monthly that all systems used by the service were checked and any issues were addressed promptly. At the end of each day, each team completed a report detailing how the day went and tasks that needed to be completed the next day. For example, the administrative team completed “Admin Department Stats Details” which included tasks that were yet to be completed and needed to be picked up the next day. These allowed the practice to ensure no task was omitted.

The service worked with people and other relevant stakeholders to keep people safe. The practice demonstrated effective systems and processes were in place to protect people from harm and abuse. Safeguarding policies were in place and staff were aware of how to access them. Staff knew who the safeguarding leads for adult and children were. The staff had training on safeguarding procedures including making referrals and there was a safeguarding register for both adults, children who were at risk and the practice worked in partnership with the local safeguarding board. Our clinical searches of patient records showed there were appropriate safeguarding alerts on some of the patient records reviewed. Safeguarding was a standing item on the meeting agenda and there were monthly meetings to discuss patients identified as vulnerable.

The service worked with people to manage risks and provided health care that supported and enabled the patients to do the things that mattered to them. People were informed of risks which were responded to in a proportionate approach by staff and people. Staff took information from patients over the telephone and could direct them to the most appropriate person or service; for example, the duty doctor for an urgent appointment, the roving care home team or the emergency services.

The service delivered at this location was conducted in a property owned by NHS Property Services. All cleaning and maintenance services were completed by the building owner. The environment was clean and well-maintained. The practice conducted risk assessments and ensured equipment used to deliver care and treatment were suitable and used properly. However, there were safety concerns identified during the site visit which we brought to the attention of the management of this location. For example, the fire extinguisher screws connecting them to the wall were loose posing a risk to the patients and staff. The timed motion sensor light fixtures in the female toilet and the disabled toilet were not fit for purpose. The door to the clinical waste area was unlocked posing a risk to the patients and staff. The leadership and management of this location informed us that they had made NHS Property Services aware of the situation. Following the site visit, the practice shared a copy of the email sent to NHS Property Services reiterating the concerns and risks to patient safety if undealt with quickly. However, it was not clear that the practice had undertaken a risk assessment and taken any other mitigating actions while awaiting resolution.

The practice ensured enough qualified and skilled staff with the right experience were employed. The practice completed supervision and appraisals for all the employed staff to ensure safe care was provided to the patient population effectively. Staff told us they were well-supported by the management and the staffing level was sufficient. The practice ensured staff training was relevant and current to their roles and responsibilities. Recruitment and induction processes were safe and effective from our checks of the records held by the practice.

We found no issues with the Infection prevention and control (IPC) at this practice. The practice assessed and managed the risk of infection in line with relevant national guidance. Concerns were shared with appropriate agencies promptly. There was a lead for IPC who carried out IPC audits working together with the practice staff to ensure equipment and premises were clean, hygienic and concerns flagged to NHS property Services. The IPC policy was specific to the practice. The IPC lead monitored the immunisation status of all the practice staff to ensure everyone was up-to-date with their immunisation. Relevant risks assessments were completed and recorded. All staff were trained in infection prevention and control.

The practice ensured that medicines and treatments were safe and met the needs of the people, preferences and their capacities involving them in planning and reviews when changes occurred. Staff involved people in reviews of their medicines and helped them to understand how to manage their medicines safely. For example, patients on controlled drugs were educated and encouraged not to stockpile to mitigate the risk of overdose. Staff were trained regularly, and prescription stationery was managed securely and appropriately. Resuscitation equipment and emergency medicines were kept and maintained in line with the guidance from Resuscitation Council UK.

Medical gases were stored safely and required safety risk assessments were completed by the practice. There were effective systems to manage and respond to safety alerts and medicine recalls. Established processes for the optimisation of care outcomes by ensuring medicines were prescribed appropriately and monitored were followed by the practice. Recommended medicines reviews and monitoring were done by the practice and the patients were involved. The prescribing data reviewed as part of our assessment showed the practice prescribed antimicrobials at a level (0.93) that did not vary statistically with the national average (0.84) including data for multiple psychotropics prescribing (8.6%, while the national average was 6.8%). The practice supported patients who did not have technological abilities to order their prescription over the phone by using the “Medication by phone” service under strict security measures.

However, our clinical searches showed issues with the medication review coding and a lack of documenting response (side effects) for medication reviews for gabapentinoid (an antiepileptic medicine commonly used to treat neuropathic pain). Following our site visit, the practice updated the gabapentinoid policy and gave feedback to the clinical pharmacist at the practice and the team of pharmacists at the Primary care network as part of good practice. The practice’s process for the medication review of long-term conditions such as diabetes and hypothyroidism where the coding was not done have been reviewed following our clinical searches.