Earls Barton 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 reviewed the practice’s policies, spoke with staff via video calls, and carried out on-site observations to assess the safety and quality of care. This was the first inspection of the service since its registration with the CQC. During the inspection, we identified concerns relating to the monitoring and oversight of people prescribed high-risk medicines, as well as gaps in record keeping and risk management systems. This key question has been rated as Requires Improvement.

This service scored 56 (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 clear processes for reporting incidents, near misses, and other safety events. However, the service did not always have a proactive and positive culture of safety based on openness and honesty. Staff did review significant events and complaints during meetings. Some staff told us they did not always feel listened to and did not receive meeting minutes if they failed to attend multi-disciplinary meetings limiting their ability to fully contribute to shared learning. While learning from incidents and complaints was evident, staff mentioned that managers could improve on their involvement with staff to improve their shared learning. Managers encouraged staff to speak up, but not all staff felt their feedback was consistently acted upon.

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. Some partners reported that access to the practice had been challenging and that the service had not always been as responsive as they would have liked in meeting individuals’ needs. Staff demonstrated a clear understanding of their responsibilities to ensure referrals were made promptly and in line with relevant policies and procedures. They provided examples of effective collaboration with other healthcare services to meet people’s needs. Appropriate referral pathways were in place, and systems for processing and summarising new patient information were being followed. At the time of the inspection, there was a backlog of 120 new patient records awaiting summarisation and the service was aware of this and had implemented actions to address it. Referrals to specialist services were well documented and contained all necessary information, with systems in place to monitor and follow up on any delays. Patient feedback reflected that patients felt their referrals were dealt with in a timely manner.

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 practice had implemented clear safeguarding policies and procedures that promoted effective partnership working with other healthcare professionals. Electronic systems were in place to alert clinical staff to potential safeguarding concerns when accessing patient records. Staff were trained to the appropriate levels for their roles and were able to identify vulnerable people. Safeguarding concerns were discussed at monthly multi-disciplinary team meetings. The practice had a chaperone policy in place to maintain patient privacy during intimate examinations and posters were displayed in consultation rooms and waiting areas. Staff understood the systems and processes in place to keep people safe and safeguarded from abuse and felt confident in raising concerns when needed. Staff knew who the safeguarding lead was and how to access them for advice or support.

We found that the service did not always work effectively with people to understand and manage risks. We carried out remote searches of clinical records as part of our assessment and conducted a search on patients that needed follow up bloods. We identified a total of 9 patients and reviewed a random sample of 5 patient records. We found that 5 out of 5 patients had not had their follow appointment. However, the practice took immediate action in response to this finding and ran additional searches across all patient records to identify any further potential outliers. Results from the latest GP Patient Survey showed that 89.2% of respondents stated they were involved in decisions about their care and treatment during their last appointment. This was below the national average of 91.2%. We found that emergency equipment was available, regularly checked, and maintained. Staff we spoke with were able to recognise a deteriorating patient and demonstrated a clear understanding of the actions to take in an emergency.

Staff were aware of their responsibilities to maintain a safe environment and understood their role in responding to emergencies. All staff had completed appropriate safety training relevant to their roles. The practice had policies and procedures in place to ensure that equipment, facilities, and technology supported the delivery of safe care. Health and safety risk assessments had been completed, and appropriate actions were taken to mitigate identified risks. During our onsite visit, clear signage throughout the premises supported staff and patients in the event of an emergency evacuation. The premises were visibly clean and well maintained. Portable appliance testing (PAT) and equipment calibrations were up to date. Systems were in place to check and maintain fire safety equipment, including alarms and extinguishers, to ensure they remained in good working order.

The practice made sure there was enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked well together to provide safe care that met people’s individual needs. There were a range of clinical and non-clinical roles within the practice. Staff were working within their agreed areas of competence. However, some staff told us that the recent restructure had placed additional pressure on clinicians. Leaders were aware of safe staffing requirements and responded appropriately to changes in demand by using agency staff. We found that staff rotas were managed effectively to ensure adequate cover across the service. During our onsite review of personnel files, we identified that some recruitment records were incomplete, with missing documentation such as copies of references and evidence of immunisation status for some staff members. Not all staff had completed their mandatory training, and the practice manager did not have full training records available at the time of the inspection. However, the practice actioned these areas in a timely manner and provided evidence of the missing records following our visit. We reviewed patient feedback and noted that while some concerns had been raised about staffing levels, patients consistently reported positive experiences regarding how they were treated by staff.

Staff were aware of their infection prevention and control (IPC) responsibilities and who the IPC lead was should they need additional support. Staff raised IPC concerns in team meetings. Staff knew how to manage clinical waste and specimens. Cleaning schedules were in place, and the premises were visually clean. However, we found there were gaps in the auditing and there were carpets in some clinical rooms. The practice assured us that there were non-surgical procedures that were carried out in these rooms and were awaiting on the removal of the carpets. Clinical rooms had adequate provision of personal protective equipment (PPE) and handwashing facilities. Systems were in place to safely manage clinical waste and sharps, with correct storage and disposal observed during the inspection.

As part of our assessment, remote clinical searches were conducted by one of our GP Specialist Advisors. During the clinical searches, we found that not all systems and processes worked effectively as not all medication reviews and monitoring were completed in line with best practice. We reviewed a selection of patient clinical records and saw instances whereby staff had prescribed medicines to patients without the required monitoring tests and reviews being undertaken. For example, high risk medication such as leflunomide (a drug used to treat active rheumatoid arthritis). We reviewed a random sample of 4 patients and found that 3 out of 4 patients did not have their blood pressure and weight recorded before being prescribed leflunomide.
We also identified a total of 70 patients who were elderly and on oral NSAID (non-steroidal anti-inflammatory drugs - a medicine used for relieving pain, reducing inflammation, and bringing down a high temperature) for over 65 years or antiplatelet over 75 years and no PPI (proton pump inhibitors - medicines that decrease stomach acid production). We reviewed a random sample of 5 patients and 5 out of 5 patients were not prescribed a PPI.
Staff received regular training, were competency assessed in medicines optimisation, and felt confident managing the storage, administration, and recording of medicines. People knew what to do and who to contact if their condition did not improve or if they experienced any unexpected symptoms. Prescription stationery was managed appropriately and stored securely.