Park Royal 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

Safe -We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment in October 2021, we rated this key question as requires improvement. The provider was in breach of Regulation 12 (Safe care and treatment) because we identified shortfalls with medicines management.

At this assessment, we found improvements in this area. However, we found issues relating to safe and effective staffing resulting in a breach of Regulation 19 (Fit and proper persons employed). This was because the provider did not have robust recruitment procedures for locum staff or systems to ensure locum staff had the required skills, knowledge and experience. We have asked the provider for an action plan in response to the concerns found at this assessment. The practice remains rated requires improvement for providing safe services.

This service scored 62 (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 were professional and acted with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. 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. 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. There were systems in place to ensure urgent and routine referrals were processed without delay and followed up to ensure people received a diagnosis. 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 practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

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. Staff could recognise a deteriorating patient and knew 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 did this in conjunction with the facilities team at the hospital where the practice was located. The practice made sure equipment, facilities and technology supported the delivery of safe care.

Recruitment checks were carried out in accordance with regulations for permanent staff. However, the provider was unable to demonstrate that locum staff had undergone recruitment checks prior to employment. There was a system to monitor training for permanent staff, however the provider could not demonstrate that locum staff had the required skills, knowledge and experience. Following our assessment, the provider sent us a spreadsheet to monitor recruitment and training requirements for locum staff and informed us this was in progress.

The provider had an induction checklist to be completed during induction, however we reviewed two staff files where there was no evidence of the induction checklist. Staff more recently employed confirmed they had received an induction on commencement of employment.

Leaders told us they had sufficient staffing to meet current patient demand. This view was also shared by other staff members. The provider was making use of staff funded by the primary care network in ‘associated’ roles, for example clinical pharmacists, social prescribing link workers, a first contact physiotherapist and a dietician. Clinical pharmacists received informal supervision when requested, however there was no structured supervision or formal oversight to demonstrate the prescribing competence of non-medical prescribers.

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 all staff had received relevant training. Staff had access to relevant policies and guidelines and sufficient supplies of personal protective equipment. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks. Patient feedback did not highlight any concerns regarding cleanliness at the practice.

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 and felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely. 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. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. 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 national averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.