Dr Umadevi Parameswaran Also known as Ashburton Park 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, we rated this key question as Good. At this assessment, the rating remains the same.

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. 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.

Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. We spoke with members of the group, and they confirmed that incidents and learning from them were shared with the group.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues.

The provider had processes for staff to report incidents, near misses and safety events. GPs we spoke with discussed significant events with us, and they demonstrated oversight of managing them.

There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

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. Doctors went through urgent blood and laboratory results before the start of surgery and called patients where appropriate to discuss the results. If results were not urgent but a patient needed a review, they would liaise with reception to arrange appointments.

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. One of the GP’s was the safeguarding lead.

The practice maintained a list of vulnerable people. Improvements were required to ensure that registers were up to date, and patients were coded accurately. For example, family contacts did not have alerts and information about safeguarding risk was not always up to date because some patients on the child protection register were no longer subject to this.

The practice acted on concerns working in partnership with other organisations. For example, they regularly attended the local authority safeguarding meeting. Doctors gave examples of a recent meeting they had attended which had helped them to improve the way they record information on their register.

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. Records of the weekly and monthly checks were kept noting expiry of medicines appropriately.

Staff could recognise a deteriorating patient and knew of action to take. The practice had a triaging system, and GPs reviewed the list of patients requiring an appointment every morning to determine priority of appointment need. This included having alerts for patients on the palliative care register, to ensure they were able to speak with a clinician whenever they needed to. 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.

Contracts were in place to ensure the premises were maintained. We saw copies of risk assessments for fire, electrics and legionella. Where actions had been identified the practice had completed or were working toward completing them. 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 always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

There were a range of clinical and non-clinical roles within the practice. We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence.

Safe recruitment practices were not always followed. We reviewed 6 staff files and saw that documents required under schedule 3 of the Health and Social Care Act were missing. For example, there was no summary of interview notes for 5 staff. Whilst references had been taken and indemnity insurance in place for staff, copies of references were not on 2 records and proof of indemnity was missing from 2 records. The provider also could not provide evidence of one member of staffs’ disclosure and barring services check. We discussed this with the practice, and they assured us the files would be reviewed and updated as a matter of priority. They contacted us shortly after the onsite visit with the missing documentation.

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 staff files we reviewed confirmed they had completed relevant training. Cleaning schedules were in place and followed. Clinical rooms conformed with infection control guidance including having lever operated taps, foot pedal bins and sharps bins assembled correctly. 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 happened.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. The pharmacist was responsible for monitoring reviews and ensuring patients were contacted when their review was due. This included ensuring people prescribed medicines with specific risks received recommended monitoring.

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. They told us that they usually used electronic prescriptions however paper prescriptions were kept securely. Systems were in place to identify if prescriptions were being misused.

Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

Medicines including controlled drugs were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs.

Waste medicines were recorded and disposed of appropriately including medicines returned by patients. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls.

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 slightly higher than local averages. They had completed two clinical audits of prescribing that focused on improving care and treatment to improve their performance.