Dr Neeta Ghosh-Chowdhury Also known as Hilltop 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 April 2016, we rated this key question as Good. At this assessment, the rating remains the same because we found no issues with patient safety and clinical care.

This service scored 66 (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 felt supported to raise concerns and felt staff treated them with compassion and understanding. Staff were encouraged to raise concerns when things went wrong. Lessons learnt from complaints and significant events were discussed during staff meetings and recorded in the minutes to ensure an improved care for all patients.

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. 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.

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 service maintained a safeguarding register and acted on concerns working in partnership with other organisations. However, records of patients on the safeguarding register we reviewed, showed that not all household members of such patients were coded. Following the site visit, the service informed us that the process to rectify the issue had been initiated to code all household members correctly.

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 and maintained. Additional suggested emergency equipment which was not available during our visit was ordered for by the service after the visit ended. Staff could recognise a deteriorating patient and know of action to take. 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. The premises were managed by NHS Property services and all maintenance checks carried out appropriately. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. Fire risk assessment was current and recommended action plans completed by the building owner. There was a business continuity plan in place which was monitored and reviewed. The premises were visibly clean during the site visit. However, the emergency cord in the accessible toilet was out of reach posing a risk to any patient who would require using it while sitting on the toilet on collapsed on the floor.The service, following the site visit had escalated this issue to the building owner after feedback was provided.

The service made sure there were enough qualified, skilled and experienced staff. They worked together well to provide safe care that met people’s individual needs. Safe recruitment practices were followed and staff worked within their agreed areas of competence. However, they did not always make sure staff received effective support, supervision and development. Our review of staff training record showed that not all staff had completed their mandatory training and the appraisals were not completed regularly. The service had created an action plan prior to CQC visit to address the staff training completion.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The practice had a designated infection, prevention and control lead and most staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, including Legionella risk assessment 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 happened. Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely. Prescription forms not collected by patients were recorded, secured and destroyed monthly. Patient group directions were current and authorised by appropriate clinicians. There were no patient specific directions used by the service as all vaccinations were completed by a nursing professional and not a health care assistant.

Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. For example, emergency medicines that were not carried by the service such as naloxone, atropine and midazolam, we saw completed risk assessments with the rationale for not carrying them (no coil is fitted at the practice for instance, and the area is subjected to people who may be addicted to opioids). The provider had effective systems to manage and respond to safety alerts and medicine recalls. In addition, the service had a cold chain policy that is current and used by all staff. Data logger was used as a back up to manual readings of vaccines fridges and staff understood the protocol to follow if the temperatures were out of recommended range.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring and followed up on patients that did not engage with the service to complete with required blood tests. 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 regular clinical audits of prescribing that focused on improving care and treatment.