Dr AM Deshpande & Dr P Gurjar Practice Also known as Dr A Deshpande & Partners

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

At our last assessment, we rated this key question as Good. At this assessment, the rating remains the same. We looked for evidence that people were protected from abuse and avoidable harm.

There was a culture of learning from safety events and when things went wrong, managers investigated incidents thoroughly, although there was not always evidence to demonstrate that the actions agreed had been fully implemented. Recruitment checks were generally carried out in accordance with regulations and new staff received an informal induction to their work. There were enough staff with the right skills, qualifications and experience and staff received continuous, ongoing feedback. Staff managed medicines well and involved people in planning any changes. Our review of the clinical system found that patient’s medication and conditions were generally well managed.

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 treated them with compassion and understanding. 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. Staff felt there was an open culture, and that safety was a top priority. 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. 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. Staff demonstrated safeguarding icons on the practice system and the family was appropriately linked to safeguarding patients that may be affected.

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. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

Not all staff had completed sepsis or sepsis awareness training, relevant to their role, but most staff had completed basic lifesaving training. During the site visit, leaders told us staff had been advised of training which needed to be completed, and they would be supported to complete it.

The service did not always detect and controlled potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

There were no contracts in place to ensure that the premises were maintained. Health and safety risk assessments and audits had been undertaken by practice staff who were not suitably qualified to identify potential risks. There was a business continuity plan in place which was monitored and reviewed.

The service made sure there were enough qualified, skilled and experienced staff who told us that they received effective support, supervision and development. They worked together 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 some gaps in training demonstrating that there was a lack of oversight from the management team. On the whole learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Upon reviewing staff files, we found a new member of staff without a Disclosure and Barring Service (DBS) certificate, but the provider told us that it had been received and had not been recorded on the file.

The service assessed and managed the risk of infection. Cleaning schedules were in place and followed. Risk assessments and audits were completed.

The practice had a lead nurse for infection prevention and control (IPC), but they were not present at the practice each day. Whilst policies and guidance were available for staff, not all staff had attended relevant training, which meant that there was a potential risk to patients.

We reviewed staff immunisation records. We found the practice did not hold the relevant information relating to the immunisation status for all staff but were in the process of gathering this.

Cleaning schedules were in place and followed. 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.

Patient Group Directions (PGDs) were in place to allow the nurse to give vaccinations without a prescription, and these had been appropriately authorised for use. Prescription stationery was managed appropriately. Medicines that required cold storage were being appropriately kept within temperature monitored fridges. However, it is ideal to use a second thermometer independent to the integral thermometer in the vaccine fridge. This second reading cross-checks the accuracy of the temperature. It monitors the temperature if the electricity supply to the vaccine fridge is interrupted.

Emergency medicines were available for use within the practice, stored appropriately and checked regularly.

Medicines records were comprehensive and included those medicines that were prescribed and supplied elsewhere. Changes made to medicines following appointments elsewhere such as the hospital, were actioned in a timely manner.

Prescription stationery was handled appropriately and securely, and staff followed protocols to ensure medicines were prescribed safely. Medical gases, such as oxygen, were stored safely, with the required safety risk assessments completed.

The provider had effective systems in place to manage and respond to safety alerts and medicine recalls. Staff generally followed established processes to ensure people who were prescribed medicines with specific risks received the recommended monitoring. However, during our clinical searches, we found a small number of patients who were overdue medication reviews or who had a missed diagnosis of a long-term condition. Practice staff provided evidence during the assessment, that all of these patients had been reviewed, contacted and the correct monitoring arranged.

There was evidence that safety alerts had been actioned, and people received the correct information about any risks associated with their medicines. We identified a small number of patients who required further action, and these were contacted during the assessment.

We reviewed a range of prescribing indicators, which included for example, antimicrobials, antipsychotics, hypnotics and antibiotics. The practice was within the expected range for prescribing these medicines.