Sacriston Medical 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 provider 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. Managers encouraged staff to raise concerns when things went wrong. There was a culture based on transparency, but some staff felt actions taken by leaders did not always meet expectations, when they raised concerns. During staff meetings, teams discussed and learnt from clinical issues. 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. Examples of this include the reiteration of practice policy to check that correct documentation was signed and dated before giving injections to patients. This was highlighted following a review by the pharmacy team. We saw evidence of this being actioned during the assessment. They told us it would be discussed at team meetings. As this was a recent change, more time was needed to ensure they had embedded this into practice.

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.

There were systems in place for processing information relating to new patients. The provider 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 provider 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 provider shared concerns quickly and appropriately.

Safeguarding policies were in place and known to all 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. The practice was going through a period of change with their safeguarding leads, but leaders told us they were keeping all procedures under review. The practice had an appropriately trained adult and children’s safeguarding lead. The practice had a safeguarding administrator who assisted the leads in their role and the practice used a specialist trigger tool to monitor electronic patient records. They could review AE attendances and note or action these daily, which leaders felt was a robust system.

The provider 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. Routine equipment checks were done regularly and appropriately documented. 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 including contacting emergency services or local pharmacies.

The provider 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. At the time of the assessment an external company were about to undertake a yearly review. Leaders confirmed they would implement a system to maintain their own oversight of safety documentation, including retaining copies and monitoring renewal dates, to provide assurance that required checks were in place. There was a disaster recovery and business continuity plan in place which was monitored and reviewed periodically.

The provider made sure there were enough qualified, skilled and experienced staff, who received support, supervision and development. They worked together to provide safe care that met people’s individual needs.

There were a range of clinical and non-clinical roles within the practice. This included at the time of the assessment; 4 GP partners and 5 salaried GPs, 3 practice nurses, 2 health care assistants (HCAs), 1 nursing associate and 2 advance nurse practitioners (ANPs). There were 10 reception/admin staff, 2 medical secretaries, 2 care co-ordinators, 1 data quality improvement officer (part-time), 2 pharmacists, 1 pharmacy technician and 1 pharmacy administrator, plus an assistant manager and a managing partner/practice manager. 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 followed.

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 designated infection, prevention and control leads and all staff had completed relevant training. Cleaning schedules were in place and followed; leaders told us a new cleaning checklist was being implemented following an audit to address concerns regarding accuracy and recording tasks being completed. IPC risk assessments and audits were completed, and actions taken to mitigate risks. For example, all treatment rooms had had new flooring installed following a medical emergency.

The provider 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. Leaders told us following feedback that to enhance security they would install new lockable printers in treatments rooms. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. 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. There was a defibrillator on site that was regularly checked and fit for use.

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. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. The practice had a high-risk patient list and discussed these patients at regular meetings. The practice pharmacy team attended (plus clinicians and administrator) and discussed issues including the prescribing of certain medications and putting in place appropriate action plans.

As part of our assessment, a CQC GP specialist advisor (SpA) conducted a series of remote clinical searches of patient records to assess the practice’s procedures around prescribing and medicines management. The clinical searches identified good working being done by the practice to recall patients, reviewing missed appointments and generally encouraging patients to follow agreed action plans. The provider had effective systems to manage and respond to safety alerts and medicine recalls.