Bridgeway 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 our last assessment, we rated this key question as good. At this assessment, the rating remains the same. This meant safety was a priority, and people were protected from abuse and avoidable harm.

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. People were supported to raise concerns and staff treated them with compassion and understanding. Leaders encouraged staff to raise concerns when things went wrong. Incidents were discussed and learning disseminated through staff meetings. Staff generally 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.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The service shared concerns quickly and appropriately. Clinicians we spoke with were aware of safeguarding and specifically talked about how they respond to potential concerns about female genital mutilation (FGM). Whilst there was no evidence of poor practice, the practice’s safeguarding policy needed updating to reflect the statutory framework, to include FGM, modern slavery and human trafficking. The service took action to update the policy immediately. Staff were appropriately trained in safeguarding procedures. The service maintained a list of vulnerable people and acted on concerns by working in partnership with other organisations. Multidisciplinary team meetings were used to raise awareness of potentially vulnerable groups of people. There were systems in place to follow up people who failed to attend important appointments in primary and secondary care or, were frequent attenders to the emergency department.

The service worked with people to understand and manage risks. Care was provided to meet people’s needs. Systems were in place for checking and monitoring emergency equipment and medicines. The practice kept recommended emergency medicines and equipment, including oxygen, and had access to a defibrillator used by other services within the premises. All staff had been trained in basic life support. Staff could recognise a deteriorating person and knew the action to take. People were advised on risks related to their condition and the actions to take if their condition deteriorated.

The service is located within a health centre managed by NHS Property Services, who maintained the majority of the premises risk assessments and cleaning arrangements. Records showed fire alarms were routinely tested, and the practice had appointed their own fire marshals to direct patients and staff in the event of a fire. Staff completed fire training and attended regular fire drills. Electrical equipment had been calibrated and tested. Safety alerts relating to equipment were shared with the relevant staff and acted on.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff received appropriate training and told us they were supported to progress within the team. The service had access to additional staff employed through their primary care network (PCN), who included a GP, physiotherapist, pharmacist and social prescriber. They worked together well to provide safe care that met people’s individual needs. There was a non-medical prescriber employed by the practice in the role of advanced nurse practitioner. Whilst our clinical searches did not identify any concerns with their prescribing practice, the service did not document how they maintained oversight of this. They immediately remedied this by formulating a consultation audit policy for non-medical prescribers. The service was building resilience in the staff team through training staff to be able to work in a range of roles. Staffing levels were adequate, despite some long-term sickness absence within the team, and there were no active vacancies. Safe recruitment processes were mostly in line with regulations. We reviewed 5 staff files and we found that information about physical or mental health at the time of employment was not explicitly recorded in case reasonable adjustments were required . Whilst the practice could demonstrate this was asked at interview, they immediately remedied this by implementing a health questionnaire to be completed before people commenced employment.

The service assessed and managed the risk of infection. They detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly. There were systems in place to assess and manage the risk of infection. Infection Prevention and Control (ICP) audits had been completed. There was a designated infection, prevention and control (IPC) lead who staff were aware of. Staff had received relevant training in IPC. Risk assessments and audits were completed, and action plans were in place to mitigate potential risks. Clinical waste procedures were in place. Eligible staff had a complete record of staff immunisations, in line with national guidance.

Systems were in place to manage and respond to Medicines and Healthcare Products Regulatory Agency alerts, however, for a small number of people, not all alerts had been fully adhered to. For example, five people receiving methotrexate did not have the day of administration recorded on their repeat prescriptions, in line with an alert raised due to risks associated with patients and/or carers erroneously taking them daily. One person with heart failure required further oversight to ensure they had started taking vitamin D as they had been advised. The system for monitoring people receiving topiramate required strengthening by completing essential documentation for continued prescribing, a pregnancy prevention plan and an annual risk assessment. People receiving clopidogrel required review as when co-prescribed with omeprazole there are increased risks of stroke, heart attack or arterial thrombosis. The provider acted on these findings immediately and completed all actions, with plans to discuss these further with the wider clinical team involved in monitoring medicines such as the pharmacists. Systems for managing the prescribing of medicines were safe and met people’s needs. Protocols effectively supported the safe prescribing of medicines and staff involved people in reviews of their medicines. Medicines were prescribed appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. Systems were in place for checking the stock levels and expiry dates of all medicines, including emergency medicines and vaccines. Medical gases, such as oxygen, were stored securely. Prescription stationery was stored securely and tracked throughout the practice.