Bartholomew Medical Group

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 good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience, however, we found that more oversight of staff consultations and gathering patients’ medical history was required. Managers made sure staff received training and regular appraisals. There were clear safeguarding policies and procedures in place that staff understood. Searches on the practice’s clinical system highlighted that there was a mixed quality of medicine reviews which resulted in delays for some patients receiving the most appropriate monitoring. This was immediately addressed by the provider.

This service scored 66 (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.

Staff we spoke with, told us they were confident in a raising significant event and could describe the process for doing this. Staff felt there was an open culture, however some staff told us that communication between different teams could still be improved further. The practice had introduced daily huddles within the reception team and weekly clinical meetings to try and improve communication across teams.

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, the process for filing blood results of pregnant patients with hypothyroidism had been changed following an incident that was reported.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored, however we found that this could be improved further. Through searches we ran on the practice’s clinical system, we identified that medicine reviews were not always completed effectively. We identified that reviews were often completed without evidence of contact with the patient. We saw how it was documented that monitoring was overdue, however, action was not always taken to address this, and, in some cases, prescriptions were being reauthorised until the patient’s birthday month when they would receive their next recall. The practice was aware of this issue and had put in measures to resolve it. Through their Primary Care Network (PCN), the practice utilised a remote pharmacy company which completed the majority of their medicine reviews. We saw evidence of how the practice had been engaging with the remote pharmacy service to improve the quality of reviews that were being undertaken and improve the medicines optimisation that was in place.

Through our searches we also identified that some Medicines and Healthcare products Regulatory Agency (MHRA alerts) were not being followed when medicine reviews were being completed. Searches identified 7 patients taking either clopidogrel (medicine to prevent blood clots) and either omeprazole or esomeprazole (medicine to treat heartburn or digestion). When both these medicines are taken together it reduces the effectiveness of clopidogrel. We looked in detail at 5 patient records and saw that 4 patients had received a recent medicines review where this interaction had not been identified. When this was fed back to the practice it was immediately resolved.

There were systems in place for processing information relating to new patients. Referrals and test results were managed in a timely way. The service worked with other providers to deliver shared care and when patients moved between services.

Staff understood their roles and had systems in place to manage tasks and test results. This included having a duty doctor in place who reviewed any urgent test results.

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. All staff were appropriately trained in safeguarding procedures. There was a safeguarding lead for adults and children.

Safeguarding concerns were discussed at weekly clinical meetings. The practice operated a “blue list” for their most vulnerable patients. These patients were allocated to senior GPs within the practice to ensure continuity of care.

Chaperones were easily available for patients. Staff had received training in this area. The practice had posters on notice boards and in clinical rooms making patients aware they could request a chaperone should they wish.

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

Administration staff had received training in care navigation and basic life support. They were able to explain how to act safely in an emergency, including alerting clinical staff and the emergency services. We saw that the practice had a duty doctor who sat in reception with administration staff so that immediate support was available if required.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The practice had a health and safety officer who carried out regular checks of the building.

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 enough qualified, skilled and experienced staff, however, searches on the practice’s clinical system identified that further support and supervision was required for some staff. Records we reviewed identified that some consultations notes by members of staff were not always adequate as they did not effectively cover patients past medical history or provide a robust enough examination.

There was a stable partnership made up of 5 GPs (4 female, 1 male), who were responsible for running the practice. The practice also employed salaried GPs. There was a diverse mix of clinical roles which included acute clinical practitioners, acute nurse practitioners, musculoskeletal practitioner and social prescribers. There was also a range of non-clinical roles at the practice.

The practice was a training practice for GP registrars with a teaching partnership with the Hull York Medical School (HYMS).

Staff 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 followed. As part of this assessment, we looked at recruitment files of 4 members of staff, this included 2 administrative roles and 2 in a clinical role. All files had appropriate checks carried out, however, following our assessment the provider updated their process and carried out risk assessments for administrative staff that were chaperone trained but had not had a disclosure and baring service (DBS) check.

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 received relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks. As part of our visit, we reviewed treatment rooms, consultation rooms and stockrooms at both sites.

The service endeavoured to make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. However, we identified areas were this needed improving.

Searches also identified 34 patients with heart failure prescribed an Aldosterone Antagonist (medicine used to treat high blood pressure and heart failure) who had not received the required monitoring. We looked in detail at 5 patient records, all 5 patients had not received the required monitoring. This was immediately actioned by the practice. A new process was put in place that highlighted patients that were overdue this monitoring.

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

Searches we ran on the practice’s clinical system identified 39 patients prescribed disease-modifying anti-rheumatic drugs (DMARDs) of which 2 had not received the required monitoring within the last 6 months. We looked in detail at both patients and found that the required monitoring was being undertaken by secondary care.

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.

Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. There was a programme of regular clinical audits, examples of these included paracetamol dosage, bariatric surgery, dual antiplatelet prescribing and a psoriasis audit.