Station 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

The service had a good learning culture and people could raise concerns. Managers thoroughly investigated incidents to ensure comprehensive understanding and resolution. 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. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care.

During our inspection, we found the prescribing of medicines was not always aligned with best practices. Specifically, we observed gaps in monitoring patients on medications, including the lack of regular reviews and blood tests. Additionally, medications were not always prescribed according to the latest guidelines.

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. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People we spoke to felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service.

Managers encouraged staff to raise concerns when things went wrong. The provider 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 provider 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.

There were systems in place for processing information relating to new patients. The service worked with other providers to deliver shared care and when patients moved between services. Referrals and test results were managed in a timely way.

During the inspection, we found that there was no oversight of smear test results for patients awaiting them. Once this issue was raised, the service implemented a system to ensure that all pending test results were received from the laboratory.
 

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 in place and known to staff, who were appropriately trained in safeguarding procedures. There was a dedicated safeguarding team comprising of two GPs and two non-clinical leads. This gave capacity for safeguarding, which allowed the leads to attend meetings and engage with social services face to face as well as having the support of the GPs. The team maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

The service 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 in multiple locations in the main site, regularly checked and maintained. Staff could recognise a deteriorating patient and knew of action to take. On reviewing patients’ notes, we found patients were advised on risks related to their condition and actions 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.

Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed.

The service 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 were a range of clinical and non-clinical roles within the practice. We found in most cases training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Safe recruitment practices were followed, and a dedicated team had been established to recruit and support new members of staff and ensure current staff had all required adjustments and mentorship.

The service did not always assess or manage the risk of infection. During the inspection it became apparent the branch site had not had an infection prevention and control audit within the last year and there was not a dedicated lead who had oversight of all the sites.

Cleaning schedules were in place and followed. For the main site risk assessments and audits were completed, and actions taken to mitigate risks.

The service did not always make sure medicines and treatments were safe and met people’s needs, capacities and preferences this was reflected in the clinical searches.

For example, we found out of 684 patients taking a medicine used to treat both epilepsy and nerve pain, 370 had not had a review to ensure they were taking the correct dose and not suffering from any side effects.

When these concerns were raised with the practice, the lead GP and clinical team made significant changes and updates to ensure corrective action was taken and future prescribing was in line with the guidelines.

Staff managed prescription stationery appropriately and securely.

Medicines including vaccinations and immunisations 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.

Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls.