Middleton Health 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

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 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 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. During discussions with representatives of the PPG, members reported that the practice takes their views and concerns seriously and is responsive to feedback. They advised that the practice actively involved them, where appropriate, in decision-making processes, ensuring that they felt informed, included, and able to contribute. Representatives described the practice as having a positive and supportive atmosphere and stated that staff work to ensure patients are satisfied, feel valued, and have confidence that their voices were listened to and acted upon. The practice held regular staff meetings at which employees were encouraged to provide feedback, make suggestions for improvement, and raise concerns when things went wrong. Clinical issues were discussed comprehensively, with lessons identified, shared, and embedded into practice to support continuous learning and improvement. The practice ensured that staff members who were unable to attend meetings received appropriate updates on relevant discussions, decisions, and outcomes. Staff reported that communication was effective throughout the practice, and that important information was shared consistently ensuring that all team members remained informed and engaged. Staff felt there was an open culture, and that safety was a top priority. The provider had robust 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 and improved outcomes for people and changes to the way in which services were delivered, improving care for others, such as the identified need to increase the support offered to the LGBTQ+ community and responding to people in mental health crisis.
 

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. On review, we found safeguarding alerts were not managed consistently. However, following the assessment, the practice undertook a comprehensive review of its processes and successfully implemented and rolled out an action plan to strengthen the management and oversight of safeguarding concerns.
 

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.
All staff had received annual basic life support training and were aware of the procedures to follow in the event of a medical emergency. Staff could recognise a deteriorating patient and knew of action to take. Appropriate emergency medicines were available within the treatment room and were readily accessible to staff when required. The practice was equipped with a defibrillator and oxygen, including both adult and paediatric masks, to support the management of medical emergencies. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Emergency medicines were stored securely in a designated area and were easily accessible to authorised staff. Staff were familiar with their location and use, and we found that all medicines checked were within their expiry dates and stored in accordance with recommended guidance.
 

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. 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 made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. 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, providing patients with access to a multidisciplinary team. This included GPs, nurses, healthcare assistants, administrative and reception staff, as well as a focused care worker, employed by Hope Citadel, who supported patients with wider social, welfare, and wellbeing needs. The practice had introduced a GP Assistant role to support clinicians by undertaking appropriate administrative and clinical support tasks, helping to reduce administrative tasks and free up valuable clinician time to focus on direct patient care. We found that staff training was up to date and that systems were in place to identify, monitor, and support the learning and development needs of staff. Staff were appropriately skilled, experienced, and working within their agreed scope of practice and areas of competence. Safe recruitment practices were followed, with appropriate checks completed before staff commenced employment, this helped ensure the practice had a competent and well-supported workforce capable of meeting the needs of its patient population, such as the need for the additional support of a focussed care worker, to supported to the patients who needed more advanced support than what is available by social 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 had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions were 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. 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. 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 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. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.