Christchurch Family 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 assessed all quality statements in the safe key question.

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment in August 2023, we rated this key question as requires improvement. At this assessment, the rating has changed. This key question is rated as Good.

We found that the practice fostered a positive learning culture where people felt able to raise concerns. Events and incidents were regularly reviewed, investigated, and analysed, with lessons learned to improve safety. When things went wrong, staff took appropriate action to protect people and safeguard them from abuse. The practice had effective systems for the safe and appropriate use of medicines, and patients were involved when changes were made to their prescriptions. Facilities and equipment were clean, well-maintained, and met the needs of patients. There were sufficient staff with the right skills, qualifications, and experience to deliver safe care. The practice also had procedures to monitor patients prescribed medicines that required additional oversight. However, during our clinical searches, we identified some gaps in this monitoring. The practice responded promptly, addressing the issues and implementing further systems to reduce the risk of recurrence.

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 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 felt supported to raise concerns and felt staff treated them with compassion and understanding.

Managers encouraged staff to raise concerns when things went wrong. Staff received feedback and learnt from incidents through individual discussions and team meetings. Teams reflected on events and shared learning to improve safety and care. Staff described an open culture where safety was prioritised. The provider had systems for reporting incidents, near misses and safety events. Complaints were recorded and investigated. When incidents occurred, staff apologised and offered support. Learning from complaints and incidents led to improved care. Governance meetings included significant events and complaints. Learning from incidents was shared at clinical meeting, However, the practice had identified this this was not consistent across all staff teams and had action to improve how learning was shared with relevant staff and across wider teams. For example, General Practitioners (GPs) investigated and responded to complaints made against them. This had raised a concern about impartiality. The practice introduced a new process where complaints were investigated by an independent staff member who was not involved in the event. This supported a fair and objective approach to complaint resolution. There was an active Patient Participation Group (PPG) who liaised with and were supported by the Patient Experience Lead. The practice displayed a poster in the waiting rooms to encourage others to join the group. The PPG had suggested that for some digitally excluded people using e-triage (an electronic form submitted to the service used to request health care) was challenging. As a result, a laptop was placed at reception at each site where staff were available to support with navigating the e-triage process.

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. The service worked with people and healthcare partners to maintain safe systems of care, where safety was managed and monitored. There were systems to process information for new patients, including the summarisation of patient records. Referrals and test results were managed in a timely way. Staff had clearly defined responsibilities and followed established processes to ensure continuity between secondary and primary care. This included managing referrals to other healthcare providers and updating patient records with hospital discharge information. However, the practice could not evidence the effectiveness of the referral process to specialist services. Following the site visit, the provider sent us evidence that as part of their ongoing quality improvement work, they will consider completing a dedicated audit to assess the current referral processes, identify any gaps or delays and ensure that referrals are made in line with best practice and patient need. The practice had introduced a digital eConsult triage system one year prior to this inspection. It was managed by a team of trained staff. Some patients reported that access was challenging and felt the service did not always meet their individual needs. Of those who provided feedback, 35.64% indicated that access was an issue. Analysis of complaints data showed that 51.28% of complaints related to accessing appointments. In response, the practice began investigating alternative digital triage systems to improve responsiveness and streamline access to appropriate care.

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 with relevant partners.

We looked for evidence that people were protected from abuse and avoidable harm and found that the service concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse discrimination, avoidable harm and neglect. Staff had undertaken up-to-date safeguarding children and vulnerable adults training at the appropriate level for their roles. They could identify the practice’s safeguarding leads and knew how to raise concerns. The practice had a safeguarding policy which was accessible to all staff via the practice’s computer system.External arrangements for safeguarding and sharing concerns pathways were documented in the Safeguarding policy. The practice discussed safeguarding concerns at regular multidisciplinary team meetings attended by the safeguarding lead. Safeguarding concerns were recorded on individual patient electronic clinical records. Staff were made aware of patients with identified safeguarding concerns, by way of an alert on patient clinical records. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

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.

The service worked collaboratively with people to understand and manage risks, delivering care that was both safe and supportive. Staff responded positively to individuals expressing needs, emotions, or distress, ensuring their rights and dignity were protected. This was reflected in complaint data, where only 4.36% of concerns related to staff culture. All staff were up to date with basic life support training. Emergency medicines and equipment were available, regularly maintained, and audited. Staff were able to recognise deteriorating patients and understood the appropriate actions to take. The service worked with people to understand and manage risks. They provided care to meet people’s needs that was safe, and supportive Patients were informed of risks associated with their conditions and advised on steps to take if their health worsened.

The service 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. There was a business continuity plan which was monitored and reviewed. All staff were up to date with fire safety and health and safety training. Lead roles for health and safety were clearly defined. The practice had a health and safety policy and business continuity plan detailing what actions were to be taken in the event of any incident which would hamper the running of the services

Both the main and branch sites were well-maintained, clean, and free from clutter. Clinical waste bins were secured and dated correctly. Clinical rooms were appropriately equipped, with curtains that were clean and evidencing the date on which they were changed. Chaperone information, and safeguarding contacts were visible. Health information leaflets were available in waiting areas. Fire equipment checks, fire drills, and electrical safety testing were documented and up to date. The practice conducted a range of risk assessments and audits, including fire, electrical systems and Legionella bacteria (an organism that can cause severe chest infection through contaminated water sources such as water outlets). However, we found that actions from the Fire Risk Assessment were not recorded. Following the site visit, the practice provided assurance that all recommendations had been implemented.

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

Staff told us there had been times when the service was short staffed. This had improved following the recruitment of 7 administrative staff. These staff worked flexibly across six administrative roles to maintain service continuity during absences and enhance operational efficiency. Most staff feedback said that the current staffing level was enough to provide safe care. Additional Roles Reimbursement Scheme(ARRS) funding was used to recruit to Clinical Pharmacists roles. The practice was in the process of recruiting an additional 2 GPs. Safe recruitment practices were followed in line with the provider’s recruitment policy. A review of 3 staff files during the site visit confirmed appropriate recruitment checks had been completed. We reviewed training records and found all staff were up to date with their mandatory training in line with the practice policy. Staff received induction appropriate for their roles and were working within their agreed areas of competence. Annual appraisals took place; however, we found appraisals were not consistently documented. Following the site visit, the provider had introduced a Clinical Supervision Policy and a documentation form with scheduled review dates to improve oversight and consistency.

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 were aware of who this was. All staff had received relevant IPC training in line with their roles and responsibilities. The IPC policy was accessible to all staff and was under regular review. Staff knew how to manage clinical waste and specimens. Cleaning schedules were followed, and the practice met with the external cleaning company regularly to review the completed cleaning audits and discuss any issues. Staff knew where spillage kits were kept, and which staff were trained to use the kits. External clinical waste bins were locked and stored in a secure area. Up-to-date IPC risk assessments and audits were completed, and actions were taken to mitigate risks. We observed the practice was visibly clean and tidy on the day of inspection. Personal Protective Equipment (PPE) was available to staff and there were hand washing facilities in all clinical areas. However, at the time of our site visit it was observed that there were no sharps bins available in the emergency equipment grab bags, for the disposal of sharps equipment such as needles, at either site. An isolation room was available if a patient was suspected of having an infectious disease.

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

The practice had 2 clinical pharmacists who supported the GPs in the practice and were responsible for medicines management. The practice regularly audited non-medical prescribers (healthcare professionals, such as nurses and pharmacists, who can prescribe medicines but are not GPs) to ensure medicines prescribed were necessary, correctly prescribed and monitored when needed. The practice had a policy for the management of medicines including repeat prescribing. The practice had a process for authorising staff to administer medicines including Patient Group Directions (PGDs - a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition) or Patient Specific Directions (PSDs - a written instruction from a doctor or other independent prescriber for a medicine to be supplied or administered to a named patient).We reviewed a sample of PSDs and PGDs during the site visit and found they had been completed correctly in line with national guidance.

Medicines including controlled drugs were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, 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 carried out regular clinical audits focused on improving prescribing safety and effectiveness. Staff followed established processes to ensure people prescribed high risk medicines received appropriate monitoring.

The provider monitored medicines with the potential for misuse. For example, when someone uses the NHS app to request strong painkillers like opioids, safety checks are in place to stop inappropriate requests from being sent to the GP. The Medicines Management team reported that these measures contributed to enhanced patient safety, and a reduction in unnecessary prescribing.

As part of our assessment a number of clinical record searches were undertaken by a Care Quality Commission (CQC) GP specialist advisor. These searches were visible to the practice. These searches identified no shortfalls in the management of medicines.

However, prescribing data, reviewed as part of our assessment, identified gaps in the monitoring of patients following an exacerbation of asthma, missed appointments and post-hospital discharge continuity. Following the site visit, the provider had reviewed affected patients identified learning and implemented a new process to regularly monitor these patient groups.

Clinical searches identified 1679 patients on the practice’s asthma register, 103 of them had been prescribed 2 or more rescue steroids (treatment for severe asthma episodes) in the last 12 months. We reviewed 5 of these patient records and found reviews for asthma management post-exacerbation follow-ups, steroid prescribing, and coordination with specialist services was missing. Following the site visit, the provider had identified areas for improvement to follow-up reviews, medical coding accuracy and implemented a new process to monitor this specific patient group.