Amherst 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 2017, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 75 (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 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. Managers encouraged staff to raise concerns when things went wrong. During clinical meetings, the GPs, clinicians and practice manager discussed and learnt from clinical issues. Minutes of these meetings were shared with all staff.

Staff felt there was an open culture, and that safety was a priority. The provider had processes for staff to report incidents, near misses and safety events.

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.

There were systems for processing information relating to new patients. The service worked with other providers to deliver shared care and when patients moved between services.

Referrals were managed in a timely way. There was a system and process for monitoring and managing two week wait referrals, which all staff knew and understood. However, there was no policy to underpin this process. Following the site visit, the provider sent us evidence of a standard operating procedure that had been implemented.

The practice provided minor procedure services and was maintaining appropriate records of procedures undertaken.

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.

There were safeguarding policies that were 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. A review of safeguarding records showed that alerts were appropriately placed on patients records and those of household family members.

We were told that safeguarding audits were completed. However, there was no evidence provided to support this at the time of our site visit. Following the site visit, the provider sent us evidence of an audit that had been undertaken two weeks prior to our visit.

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. We reviewed staff training records for sepsis awareness and were unable to determine whether all reception staff had received this training. Following the site visit, the provider sent us evidence of all reception staff having completed this training and it currently being in date. There were dates set in the future for staff to complete this training when the three-year expiration period had passed.

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.

There were contracts to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had either been addressed or had an action plan with timescales for these to be completed. There was a business continuity plan which was monitored and reviewed.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked 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 found that although two references were requested for new staff, no risk assessments were conducted to determine whether receiving only one reference was sufficient. Additionally, while there was a policy outlining which staff did not require a disclosure and barring service (DBS) check, individual risk assessments were not carried out to ensure that this was appropriate for each relevant staff member. Following the site visit, the provider sent us evidence of all risk assessments having been completed, where required.

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 had relevant training. There were cleaning schedules which were followed. Risk assessments and audits were completed. The overall infection prevention and control (IPC) audit was good. However, this needed to be minorly updated to ensure it aligned with the NHS IPC toolkit, to ensure it contained all relevant areas. Following the site visit, the provider sent us evidence to show they had obtained the NHS IPC toolkit and had updated their current audit to include missing elements. The provider had a plan for the next annual audit to be completed using the NHS toolkit.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. This was accurately recorded in people’s consultation records. 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.

As part of our assessment a number of set clinical record searches were undertaken by a CQC GP specialist advisor. These searches were visible to the practice. We found that patients who were prescribed high-risk medicines were monitored appropriately in most cases.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

Staff involved people in reviews of their medicines and helped them to 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. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

The practice had a dispensary located at the branch surgery. There were suitable processes for staff to follow when dispensing medicines. 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. The practice stored medical gases, such as oxygen, safely and completed required safety risk assessments. However, we found that risk assessments had not been completed for the storage of emergency medicines in patient accessible areas. Following the site visit, the provider sent us evidence to show these had been completed and that security tagged storage had been put into place.

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 local and national averages.