The Everglade Medical 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 our last assessment in November 2022 using our previous inspection methodology, we rated this key question as requires improvement as there were concerns relating to infection prevention and control, administration of the rotavirus vaccine, out of date and/or missing emergency medicines and equipment. We were also not assured that the practice had appropriate systems and processes in place to ensure all policies, checklists and procedures were being regularly reviewed and updated. At this assessment, the rating has changed to good because the previously reported issues have been resolved and improvements put in place.

This service scored 72 (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. The staff and leadership listened to concerns about safety, investigated and reported safety events. Lessons were learnt to consistently identify and embed good practice. Learning outcomes were discussed at both clinical and administrative meetings with actions for improvement made. However, the practice did not keep formal minutes for clinical meetings. Notes were placed directly onto the patient record which could lead to patients being overlooked at a later date. Staff informed us that they were encouraged to raise concerns. Lessons learned from complaints and significant events were shared with staff during meetings and minutes were held electronically for staff to have access.

The service 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. Systems were in place for processing information relating to new patients. The service worked with their car providers, including health visitors, community nurses and secondary services to deliver shared care when patients moved between services. Referrals and test results were managed in a timely way.

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. The practice 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 that fully met people’s needs and 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 actions to take. Patients were advised on risks related to their conditions and actions to take if their condition deteriorated.

The service detected and controlled patient risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The building was maintained by NHS property services who ensured an overall safe and clean environment. The practice had carried out its own health and safety risk assessments and audits. Risks identified had been either addressed by the practice or referred on to the landlord for follow up. The practice was planning to move to a new purpose-built facility in the future as the current premised was in an area of regeneration. The practice was preparing for this while ensuring the current premised remains fit for purpose. Security was placed at the front of the premises fo the safety of both staff and patients. There was a business continuity plan in place which was monitored and reviewed.

The service made sure that there were enough qualified, skilled and experienced staff, who received thorough support, supervision and development opportunities. They worked together to provide safe care that met people’s individual needs. The practice had a range of clinical and non-clinical roles. Staff undertaking chaperone duties had been fully trained. Learning and development needs of staff were managed well with staff working within their competencies. Staff were recruited safely with staff records seen during the site visit.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with the appropriate agencies promptly. The practice had a designated infection, prevention and control lead and all staff had received relevant training. Cleaning was carried out centrally by the building landlord. Schedules were in place and there were communication channels to discuss areas of concern. Risk assessments and audits were completed and actions taken to mitigate risks.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning including when changes happen. Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training. Staff managed prescription stationery appropriately and securely. Protocols were followed to ensure staff prescribed all medicines safely and recommended reviews and monitoring was done with patients. Staff regularly checked the stock levels and expiry dates for vaccines and controlled drugs. Emergency medicines were placed in an area accessible to all at the practice. A risk assessment was in place for all emergency medicines that the practice did not hold. Systems were in place to ensure that these were appropriately monitored. At the time of the visit, all emergency medicines that the practice documented that they held were present and in date.

Staff stored medical gases such as oxygen, safely and completed the required risk assessments. Systems were in place to manage safety alerts. Staff followed processes to ensure people prescribed medicines with higher risks received recommended monitoring. Steps were taken to ensure staff prescribed medicines appropriately to optimise care outcomes, including antibiotics.

The prescribing data reviewed as part of our assessment showed that the practice prescribed antimicrobials at a level in line with local and national averages, and the prescribing of pregabalin and gabapentin (used for treating long term conditions such as epilepsy and neuropathic pain) was significantly lower than the local and national averages.

Clinical audits of prescribing were conducted which showed the drive to improve care and treatment for the patients. Monitoring systems had been put in place since the last inspection for the nurse prescriber. This was appropriate and up to date.