Mitcham Family Practice

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• 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, we rated this key question as Good. At this assessment, the rating has changed.

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 service did not always have a proactive and positive culture of safety.

Not all safety events were discussed or noted in meeting minutes. There was no recorded follow up of actions to ensure that changes had been made and were effective. We saw evidence of disagreement between service leaders as to which events should be managed through the service process, which led to differences in engagement with investigation and difficult discussions in meetings.

There was a system to record and investigate complaints. Where there were themes action was taken to make improvements.When things went wrong, staff apologised and gave people support, but we saw one example when this communication had not been managed well.

The service worked with people and healthcare partners 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 generally 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.

The service did not always work well with people to understand and manage risks.

We looked at the records of 3 patients experiencing an exacerbation of one long-term condition. Documentation of follow-up arrangements to re-review patients was inconsistent. The provider could not consistently demonstrate through the records that patients had been managed and monitored in line with national guidance. Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take.

The service 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 did not have clear, documented processes to make sure all staff had the knowledge, skills and experience for all parts of their role. Staff worked together well to provide safe care that met people’s individual needs. Staff received effective support, supervision and development.

There were a range of clinical and non-clinical roles within the practice. Some clinical staff were working in advanced roles, seeing patients triaged by non-clinical staff.

Non-clinical staff allocated patients to staff in advanced clinical roles based on a list of conditions. The list differentiated some conditions by severity and underlying cause, which would require clinical knowledge. This could lead to patients being inappropriately triaged to staff in advanced clinical roles rather to than GPs.

The practice policy stated that guidance from the Royal College of GPs (RCGP) was followed. The practice list of conditions included some that the RCGP said should not be allocated to these staff.

The list of conditions that could be seen by staff in advanced clinical roles had been increased.

Staff in advanced clinical roles received supervision after each consultation. We found that general training completed by all staff in the practice was up to date.

A review of staff records undertaken during the inspection identified that appropriate Disclosure and Barring Service (DBS) checks were not consistently completed for all staff members, in accordance with safer recruitment practices.

The practice had a designated infection, prevention and control lead and all staff had had relevant training. The service had assessed the risk of infection, and had taken actions to manage it, however staff who completed the assessment were unable to explain why one risk identified had not been acted upon. The service collected information about staff immunity on recruitment. We looked at the records of 3 staff members. Two of these had information that showed immunity in line with national guidance. The third staff record had some information, but the process was not sufficiently well-documented to demonstrate that national guidance was followed. Cleaning schedules were in place and followed.

The service had systems to make sure that medicines and treatments were safe and met people’s needs, capacities and preferences, but these were not all consistently effective. The service involved people in planning, including when changes happened.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was lower than local and national averages. There was a programme of clinical audits of prescribing that focused on improving care and treatment. Staff managed prescription stationery appropriately and securely.

Medicines (including controlled drugs were stored securely and at appropriate temperatures, but the provider’s system to verify the correct storage temperature of vaccines was not consistently effective.

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, and medicines for use in an emergency, safely. The provider had completed a risk assessment and identified the need to store the Automated External Defibrillator where it could be accessed rapidly. The risk assessment did not consider the risk of potential delays in access to other emergency equipment and medicines, in line with the most recent guidance.

The provider had small numbers of patients on prescribed medicines that required specific monitoring. We reviewed 5 people on one r high-risk medicine, 2 on another medicine and 1 on a third medicine. Most people had received the monitoring required. In patients that had not, we did not see evidence of a consistent documented approach to follow up to ensure these patients received the monitoring required.