Dr Lalit Gurnani Also known as Nantwich Health 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 assessed all quality statements under this key question. At our last inspection we rated this key question as good. At this assessment the rating remains the same.

The provider demonstrated a positive approach to patient safety, had effective processes to manage safety alerts and acted on these appropriately. There were effective systems for monitoring people’s health and reviewing medicines, and staff responded appropriately when issues were identified. The practice was performing in line or above local and national averages for most required indicators, specifically those relating to medicines. Staff understood how to identify and report incidents, and there was evidence that safety concerns and incidents relating to patient care were investigated appropriately, with learning used to reduce the risk of recurrence. Safeguarding arrangements were particularly strong. Staff understood their responsibilities, had received appropriate training, and demonstrated a good understanding of how to recognise and respond to concerns. Recruitment processes and ongoing checks helped ensure staff were suitable for their roles. However, systems to share wider organisational learning were not always effective. Staff who raised concerns about aspects of the organisational culture and the way the service was run did not always feel listened to.

This service scored 63 (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 demonstrated and provided evidence of a positive culture of safety, based on openness and honesty. Processes were in place for staff to report incidents, near misses and safety events. The provider listened to concerns about safety and investigated and reported safety events. Staff said there was an open culture, and that safety was a priority. However, actions and outcomes were not consistently documented which made it difficult to identify themes and trends for review. In addition, learning was only shared where it was deemed appropriate rather than across the whole team.

Incidents and complaints were investigated and responded to and used to identify areas for improvement. However, verbal complaints were not documented or consistently reported to identify themes and trends. We discussed opportunities to improve how learning from complaints and incidents was captured and embedded across the service. The provider responded promptly and implemented changes immediately.

The provider worked with people who used the service and healthcare partners to establish and maintain safe systems of care. The provider had systems and processes in place to share information with staff and other agencies to enable them to deliver safe care and treatment. The service worked with other providers to deliver shared care when patients moved between services. Of the people who used the service, 90% indicated they felt involved in decisions about treatment pathways, and they reported prompt follow up care compared with the local result of 92% and the national result of 91%.

Members of the staff team were aware of local services and support networks that they could refer patients to for support with their needs and to prevent ill health. Reception staff had been trained in care navigation to direct patients to the most appropriate service or services to meet their presenting needs. Regular multi-disciplinary meetings were held where the needs of patients with more complex conditions or those approaching the end of life could be discussed.

Clinicians followed care and treatment pathways for treating and referring people to other services. Referrals to secondary or specialist care were made promptly, and patients referred under the 2-week wait rule for suspected cancer were followed up with appropriate safety netting processes in place. Correspondence from secondary care such as discharge letters and summaries were processed quickly and effectively. People could request a chaperone for intimate examinations if they wished and there was information to alert them to this in the waiting room and in clinical rooms.

The service worked to safeguard people from the risk of abuse. This included working with partner agencies. The provider had systems and processes in place to respond when it was suspected that people may be subject to abuse or neglect. We discussed safeguard training, and the provider took steps to ensure that staff had been provided with safeguarding training at a level that was appropriate to their roles and responsibilities. Staff had a clear understanding of safeguarding and knew who the designated safeguarding lead was. They knew the action to take if they had concerns about a patient’s safety and they told us they would feel confident to report concerns. Alerts were added to the patient record system when a patient was subject to a safeguarding concern so that all relevant members of the staff team could easily identify this. Feedback from people who used the service did not include any concerns with regards to safeguarding.

The service worked with people to understand and manage risks by thinking holistically. Initial assessments included recording people’s physical, psychological and personal circumstances and people had care plans in place. Information was also available online to help people understand their long-term conditions and how to manage them. The care and treatment provided was safe, supportive and encouraged people to remain healthy and do the things that mattered to them. People were advised on risks related to their condition and actions to take if their condition deteriorated.

The service was located in a purpose-built building that provided the required facilities such as safe access for people with physical disabilities. The premises were clean and contained the appropriate facilities to support a safe environment. The provider detected and controlled potential risks in the environment. Leaders made sure equipment, facilities and technology supported the delivery of safe care. Regular checks were carried out on the premises, facilities and equipment provided. Contracts were in place to ensure the premises were clean and well maintained. Health and safety related assessments and procedures to manage health and safety were in place. This included fire safety. Staff had been provided with training in health and safety related topics such as fire safety, infection control and manual handling. There was a business continuity plan in place to provide guidance for dealing with any major disruption to the service, for example an IT failure.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and opportunities to develop. Protected learning time took place regularly and meetings with staff were relevant to practice business such as incidents, safety alerts, safeguarding, complaints and actions for improvement. However, we discussed ways where relevant information about incidents, complaints and safeguarding could be improved for whole team learning. Most staff had completed training appropriate and relevant to their role, but not all clinical and non-clinical staff had completed sepsis and mental capacity awareness training, and we discussed other areas with the practice manager where staff may benefit from additional training. Staff did not always think there was enough of them to provide safe, high-quality care but they worked effectively in teams. There were appropriate arrangements in place for covering staff sickness, absence and vacancies and the use of temporary staff was minimal. We looked at the recruitment records for a sample of staff. These showed recruitment practices were mostly carried out in line with requirements but lacked consistency. For example, in 2 files we did not see a DBS certificate or related risk assessment and staff immunisations were not fully recorded.

The facilities and premises were appropriate to support cleaning and reduce the spread of infection. Personal protective equipment was in good supply and located appropriately around the premises. The provider assessed and managed the risk of infection. There were clear roles and responsibilities around infection prevention and control with a dedicated lead person and staff had undergone training appropriate to their role.

Cleaning schedules were in place and infection prevention control and cleaning audits were carried out on a regular basis. Cleaning equipment was stored securely and in line with best practice. The arrangements for managing waste, sharps and clinical specimens kept people safe.Staff vaccination was mostly maintained in line with current UK Health and Security Agency (UKHSA) guidance. At the time of the assessment updates were required for some non-clinical staff. There was a system for the service to report infection-related concerns to the relevant agencies (e.g. notifiable diseases).

The provider had effective systems in place for the management of medicines. Staff made sure that medicines and treatments for patients were safe and met people’s needs. We reviewed clinical records for patients who had been prescribed medicines which required routine monitoring. Our review showed that the provider managed medicines safely for patients and their approach to prescribing reflected current and relevant best practice and professional guidance. The provider was advised of the necessity to include the day of the week on prescriptions of patients taking methotrexate (a medicine used to treat severe autoimmune conditions).

Medicines reviews, prescribing and monitoring were managed well by GPs, and prescribing indicators relating to antibiotics, analgesics and hypnotic medicines were positive when compared with local and national data. The provider had also recently introduced a pharmacy technician role to support medicines audits and oversight. Although the process for medicines reviews was not always documented in the format typically seen, staff were able to demonstrate that reviews were completed appropriately, and we saw that patients received ongoing monitoring and support.

However, we identified concerns relating to the procurement and storage of emergency medicines held within the practice. Emergency medicines had been obtained in the names of individual patients rather than through appropriate practice systems and governance arrangements. While there was no evidence of immediate patient harm, this represented a governance and medicines management concern.

The provider responded promptly and appropriately once this was identified. Leaders demonstrated openness and transparency, took immediate action to destroy and replace the medicines appropriately, and implemented new systems to reduce the risk of recurrence. The provider also completed a significant event analysis to support learning and agreed to inform affected patients.