Longtown Medical 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

The service had processes in place so people could raise concerns, however there was a lack of initiative by leaders to ensure a safe learning culture. Managers investigated incidents within practice policy guidelines. Staff understood risks and managed them. People were protected and kept safe. The facilities and equipment met the needs of people and were clean and well-maintained. There were enough staff with the right skills, qualifications, and experience to provide services at current level of need. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and usually involved people in planning any changes to ongoing treatment.

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.

There were some shortfalls in how the practice shared learning around significant events and complaints with all staff. Learning was not always shared effectively and there was limited evidence of how the practice monitored the embedding of improvement actions. Leaders told us they would address this, by ensuring there was clear documentation signed by staff which outlined they understood any changes to practice. This will be reviewed at our next assessment.

There was a significant events and complaints register which was maintained in line with policy. A ‘decisions and actions’ log was used to record issues, discussions and actions decided by leadership. At the time of our assessment, the action log did not clearly show which actions were completed or in progress.

We saw some evidence that learning from incidents and complaints resulted in changes that improved care for others, for example updates made to the Change of Details policy including homelessness following a complaint. Leaders told us where a change needed to be implemented following an event or complaint, they would circulate an email to staff. However, leaders did not follow up on this email to ensure staff had implemented changes into practice. Furthermore, there was no evidence of any changes to practice being revisited to evaluate how patient outcomes had been affected.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong. We provided staff with an opportunity to complete a questionnaire as part of the assessment process, of those who completed it we found there was an open culture, and that safety was a top priority. The provider had processes for all 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.

The practice collaborated well with people and healthcare partners to establish and maintain safe systems of care. Staff managed and monitored people’s safety. 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.

We spoke with care home managers as part of our assessment. They told us that they had good access to GPs using a bespoke contact number. They had been consulted on the process and had been asked for their ongoing feedback. The told us they had good access to the practice and felt residents received a quality service.

The practice 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.

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. Most of the patients we reviewed were appropriately coded.

The practice 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 what action to take. Staff were up to date on basic life support (BLS) and training in how to recognise a deteriorating patient. Patients were advised on risks related to their condition for example smoking cessation for patients with Chronic Obstructive Pulmonary Disease (COPD), 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.

Health and safety risk assessments were undertaken and risks identified had been addressed. Daily safety checks were completed as part of a walkaround before the surgery opened.

Fire risk assessments had been carried out and appropriate actions were taken where issues were raised.

We observed the premises to be clean and tidy. Fridge checks were carried out and daily cleaning logs completed by appropriately trained staff.

There was a business continuity plan in place which was reviewed by leaders periodically.

The practice made sure there were enough experienced staff with a range of skill sets, who received relevant support, supervision, and some development opportunities. Staff told us they worked together in a friendly atmosphere to provide safe care that met people’s individual needs.

We found training was up to date, the learning needs and development of staff were recorded on an online database, which notified staff when training was due. Staff were working within their agreed areas of competence. Safe recruitment practices were followed.

The practice 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 had relevant training.

Medicines were stored appropriately. Risk assessments were in place to determine the range of medicines held. The IPC lead was proactive in managing this since coming into the role. They reviewed practice policies and procedures and took an active part in the induction process for new staff.

Cleaning schedules were in place and followed. Risk assessments and audits had not been carried out for a period prior to the assessment due to staff absence, but this had been addressed by the practice.

The practice had systems, processes and policies in place to support medicines management.

People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

Staff received training, were competency assessed on medicines optimisation, and were confident managing the storage, administration and recording of medicines. 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. 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.

Staff stored medical gases, such as oxygen safely. The provider had systems to manage and respond to safety alerts and medicine recalls.

There was a defibrillator on site that was regularly checked and fit for use. But it was not clear that the pads with the defibrillator could be used for both adults and paediatrics. We asked staff during the on-site inspection, but they were unsure. Leaders assured us this would be rectified immediately.

As part of our assessment, a CQC GP specialist advisor (SpA) conducted a series of remote clinical searches of patient records to assess the practice’s procedures around prescribing and medicines management. The clinical searches identified a small number of cases where patients’ medicines had not been prescribed in line with current best practice. Leaders told us they had begun contacting those patients who could be affected.