West Common Lane Teaching 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

The service had a positive learning culture where people could raise concerns, and managers investigated incidents thoroughly. People were protected and kept safe. Appropriate safeguarding policies and procedures were in place, and all staff had received safeguarding training, although training frequency for non-clinical staff was not aligned with national guidance. Staff understood and managed most risks. Facilities and equipment met people's needs, were clean and well maintained, and risks were generally mitigated, although arrangements for accessing and monitoring emergency equipment required review. Staff had the appropriate skills, qualifications and experience, and received regular appraisals to support high-quality care. However, monitoring of non-medical prescriber competency checks and the rationale for some decisions required better documentation. Staff managed medicines well and involved people in planning any changes.

This service scored 69 (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. Managers encouraged staff to raise concerns when things went wrong, and lessons were learnt to continually identify and embed good practice. During clinical meetings, staff 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. For example, following a self-reported high blood pressure reading not being highlighted to a GP, a new procedure was implemented and shared with all staff.

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 hospital letters were managed in a timely way. There was a system in place for checking urgently flagged pathology results daily to assess urgency and determine any necessary action by the on-call GP.

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 and the practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. All staff had received safeguarding adults and safeguarding children training, however, for non-clinical staff, the frequency of this training was not in line with national guidance. The provider took immediate action to review this and updated their training policy to reflect best practice guidance and arranged for staff to receive updated training.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was supportive and enabled people to do the things that mattered to them although this was not always safe with regard to emergency equipment availability and monitoring.

Staff could recognise a deteriorating patient and knew what action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Emergency equipment was available and staff had received basic life support training. At the branch site however, the defibrillator was part of a shared arrangement, and the provider did not carry out any checks of this equipment to ensure it was in good working order. In addition, access to the shared defibrillator at the branch site was restricted on the day of the site visit due to issues with the door fobs. Monitoring checks of emergency equipment across both sites was being undertaken monthly rather than weekly in line with recommended guidance. The provider responded promptly by relocating the defibrillator on the day of the site visit to an accessible location, immediately purchasing a dedicated device for the branch site, and implemented weekly equipment checks.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care with the exception of the defibrillator at the branch site (see ‘Involving people to manage risks’ for further details). 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. We identified that some window blinds in 3 patient-accessible clinical rooms did not have cleats fitted to secure the blind cords, however, these blinds were not easily accessible. The provider addressed this immediately following the site visit. There was a business continuity plan in place which was monitored and reviewed.

The service ensured staff were qualified, skilled and experienced. The provider had identified pressures within the reception and administrative teams when staff were on leave or sick absence, and we observed that actions were being taken to address this. Staff worked effectively together to provide safe care and support that met people’s individual needs. There were a range of clinical and non-clinical roles within the practice. We found training was mostly up to date, learning needs and development of staff was managed appropriately, with the exception of safeguarding training and staff were working within their agreed areas of competence. From discussions with leaders, we found that oversight of non-medical prescribers was informally being undertaken. However, formal records were not maintained to demonstrate this monitoring activity. Safe recruitment practices were followed. However, formal risk assessments were required where national guidance was not followed. For example, although a rationale existed for not obtaining employment references to confirm conduct in previous employment for a staff member who had previously worked at the practice as a registrar for a significant period, this rationale was not documented and there was no formal risk assessment on file.

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 (IPC) lead and all staff had had relevant training. 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.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. We saw that 322 people, including 63 aged over 75 years, had received a medicines review in the previous three months. We reviewed five patient records and found that all reviews had been completed appropriately and in line with national guidance. 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 securely although they did not have a system to track them throughout the practice. The provider immediately put a system in place to address this. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Clinical searches we carried out confirmed effective monitoring processes were in place for patients on high-risk medicines or those requiring review with a low number of people not receiving their monitoring tests at the appropriate time. For example, our clinical searches identified 3 out of 39 patients with stage 4 or 5 chronic kidney disease and 1 out of 268 patients with hypothyroidism who had not completed the required blood tests. Review of their records showed that all had been proactively offered appointments and sent reminders to support timely 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, vaccines, and controlled drugs. 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 and hypnotic medicines. Prescribing data reviewed as part of our assessment confirmed this with the number of antimicrobials and hypnotic medicines issued by the provider being lower than local and national averages. The provider carried out clinical audits of prescribing that focused on improving care and treatment.