Clifton Court 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 the last assessment this key question was rated as Good. At this assessment the rating remains the same.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had processes for staff to report incidents, near misses and safety events. The provider had a proactive and positive culture of safety, based on openness and honesty. Incidents were seen as opportunities for learning. Staff and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to identify and embed good practice and comprehensively recorded. Staff felt that they were involved in learning that took place and reported feeling comfortable raising concerns. Incidents were discussed regularly in clinical or whole team meetings, and the service was proactive in how they identified and recorded incidents. We saw examples of where learning had taken place as a result.

Staff were able to describe incidents they had been involved in, and the learning, training events or changes to process that took place as a result. The provider checked that changes had been implemented and whether safety had improved as a result. Themes and trends were analysed.

The provider 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. The practice sought to take an active coordinating role in supporting patients as they moved between primary care, community services, secondary care and social care.

Regular multi-disciplinary team (MDT) meetings were held to review the care of patients with complex conditions or those nearing end-of-life, ensuring holistic, well-coordinated care. Referrals and test results were managed in a timely way. Clinicians followed established care pathways for diagnosis, treatment, and referral to specialist services. Referrals to secondary care, including urgent 2-week wait referrals for suspected cancer, were managed promptly on a risk basis, appropriately followed up, and frequently audited. Patients were given additional ‘safety netting’ advice, to call the practice within a certain timescale if they hadn’t heard, or their condition deteriorated. Communications from secondary care, such as discharge summaries, were processed efficiently to ensure continuity of care.

Reception staff were trained in care navigation, which supported them to direct patients effectively, based on their needs, and promote preventative healthcare through social prescribing.

Systems and processes were in place to respond promptly when concerns arose about abuse or neglect, and the practice aimed to work closely with partner agencies to ensure a coordinated approach. All staff had received safeguarding training appropriate to their roles and responsibilities and demonstrated a good understanding and awareness of safeguarding procedures.

Staff were aware of who the designated safeguarding leads were for both adults and children and felt confident in escalating any concerns. Safeguarding alerts were added to the clinical record system. Modern slavery training had been carried out to increase staff awareness.

Patients were informed of their right to request a chaperone, with visible notices in waiting and clinical areas to support this. Staff had received appropriate chaperone training where necessary. There were clear chaperone policies and procedures, and a patient easy read leaflet.

The service collaborated with individuals to understand and manage risks effectively. Care and treatment was delivered safely and appropriately. Patients were given advice on the risks related to their conditions with clear guidance on what actions to take if their health deteriorated.

Staff were provided with guidance and appropriate supervision to help them to support people living with long-term health conditions.

Emergency equipment including a defibrillator and oxygen was available and maintained.

Staff showed awareness of recognising signs of a deteriorating patient including ‘red flag’ symptoms, and knew what action to take, such as escalating to the duty GP. Staff described good communication between clinical and non-clinical teams and an open door policy enabling efficient sharing of information. The practice aimed to provide additional education to parents of young children on recognising signs of serious illness in children and when to seek urgent care.

The provider detected and controlled potential risks in the care environment. They made sure care equipment, facilities and technology supported the delivery of safe care. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed, although more frequent checks needed to be initiated for the emergency lighting system. The practice told us they would change their procedures with immediate effect and all required tests have since been carried out.

There was a business continuity plan in place which was monitored and reviewed.Measures included printing the next days clinic lists at the end of each day in case of overnight power failure. Staff showed a high awareness of this plan.

The service operated from a building that provided appropriate facilities, including safe access for individuals with physical disabilities. The premises were clean and equipped with appropriate resources to support effective infection prevention and control.

Staff received training in all relevant health and safety areas, including fire safety, infection control, and environmental risks.

The provider had processes in place to make sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff received a comprehensive role specific induction, with annual appraisals and ongoing informal check-ins. There were a variety of handbooks and induction policies to support safe and effective staffing.

Staff worked together well to provide safe care that met people’s individual needs. Staff described a supportive environment where they were able and encouraged to access a variety of training and development opportunities, including daily clinical and prescribing supervision where necessary. The practice was a training practice and supported GP registrars appropriately. Staff told us of a strong culture of supportive learning where support was easy to access. While some staff described short term staffing pressures due to annual leave or sickness, it was recognised that this was mitigated as much as possible by cross cover arrangements and task prioritisation.

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.

Appropriate Disclosure and Barring Service (DBS) checks were carried out on recruitment and reviewed thereafter. The immunisation status for staff was recorded.

The provider 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 staff knew how to escalate any IPC related concerns. All staff had received relevant training. IPC risk assessments had been conducted and audits were completed, with actions taken to mitigate risks.

The provider mostly made sure that medicines and treatments were safe and met people’s needs.

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 were regularly competency assessed on medicines optimisation and safe prescribing. Nursing teams and GPs worked together to flag and assess repeat requests for high-risk medicines. Staff managed prescription stationery appropriately and securely.

Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. There were emergency grab bags for different conditions, such as anaphylaxis.

The provider had systems to manage and respond to safety alerts and medicine recalls. We saw examples of where actions taken had been recorded and patients contacted as required. We saw examples where medicines monitoring was effective, and patients received correct and timely monitoring.

The overall effectiveness of monitoring for some medicines was variable, as our clinical searches showed 26% of patients on certain medications used to treat high blood pressure, heart failure, and chronic kidney disease, were potentially overdue blood monitoring. We looked at 5 of these patients in more detail and noted these were overdue, however the practice were able to respond and show that these 5 patients had now received the required monitoring, with 2 done after the clinical searches, 2 having been done elsewhere, and one patient sent multiple reminders prior to the inspection and now completed.

Our clinical searches identified some patients who were being prescribed high risk medicines and had not had the required monitoring carried out within the correct timeframes. For instance, we saw that 19% of patients on certain blood thinning medications were potentially overdue monitoring, we checked 5 of these in detail and all were overdue. These patients are all now booked in where necessary, and we saw one of the patients had been sent reminders prior to the inspection.

33% of patients on certain medications to lower blood pressure were potentially overdue monitoring. 20% of patients over 65 on certain anti-inflammatory medications were not also prescribed a medication to protect the stomach lining, which was not in accordance with best clinical practice. The practice were in the process of following these up; in some cases the medication had been stopped due to side effects.

The practice made use of prompts within the clinical prescribing system, which provided alerts and prompts during prescribing. These alerts highlighted when medicines were requested outside recommended parameters or when review may be required. Although the medication review process was adequate, our clinical searches highlighted that the quality and recording of the review process was variable.

The practice had been highly successful in decreasing prescribing rates over time of certain medicines which carry increased risks such as Gabapentin and Pregabalin, and opioids. These medicines can be associated with serious harms or lead to dependence; they may also be misused or diverted to illegal use. The practice had carried out considerable holistic project work and over time had successfully reduced prescribing rates to within expected national averages, and was now the lowest prescriber in the local area, having previously been one of the highest prescribing practices in the area.

The practice also showed decreasing prescribing rates of certain antibiotics, which minimises the risk of antimicrobial resistance, whilst still ensuring patients are effectively treated and side effects are minimised.