Yarm 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 inspection in December 2015 this key question was rated 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. Staff and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Staff felt that they were involved in learning that took place. Staff consistently reported feeling comfortable raising concerns and were able to describe incidents and the learning and changes that took place as a result. Leaders consistently listened to safety concerns and thoroughly investigated issues. At present, the provider’s systems did not include a formal end of year analysis of incident themes and trends, which could help to identify small gradual changes.

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.

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. 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. Communications from secondary care, such as discharge summaries, were processed efficiently to ensure continuity of care.

Reception staff were trained in care navigation and demonstrated a strong awareness of local services and support networks. This supported them to direct patients effectively, based on their needs, and promote preventative healthcare through social prescribing. Staff consistently described clear care pathways and good relationships both internally and externally which promoted good information sharing.

The service was proactive in safeguarding people from the risk of abuse, working closely with partner agencies to ensure a coordinated approach. Clear systems and processes were in place to respond promptly when concerns arose about abuse or neglect. All staff had received safeguarding training appropriate to their roles and responsibilities and consistently demonstrated a good understanding and high awareness of safeguarding procedures. The provider had carried out a recent safeguarding audit of their procedures. This and significant event analysis had identified there was potential for ‘child not brought’ to appointment information not being correctly flagged. The IT systems had since been altered to include an automatic prompt for this.

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, although our clinical searches identified that not all household members were clearly linked, creating a risk that a clinician unfamiliar with the patient may not be able to find all relevant information easily. The practice has since fully audited all of their safeguarding records and this is now remedied. The provider shared concerns quickly and appropriately with other agencies as required.

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.

The service collaborated with individuals to understand and manage risks effectively. Care and treatment was delivered safely and appropriately. An effective system was in place to respond to patient safety alerts and patients were given advice on the risks related to their conditions with clear guidance on what actions to take if their health deteriorated.

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

Emergency equipment was available and maintained. Recent improvements had been made to the system as a result of learning from an incident, including grab bags for different conditions.

Staff showed a consistently high awareness of recognising signs of a deteriorating patient and knew what action to take, such as escalating to the on call GP. Staff described good communication between clinical and non-clinical teams and an open door policy enabling efficient sharing of information. The practice used a system to code patients based on their communication needs and health conditions. Patients identified as higher risk had a named GP and the option of longer appointment times.Incoming patient requests were triaged either through care navigators or via a duty doctor system.

The provider detected and controlled potential risks in the care environment. They made sure 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. There was a business continuity plan in place which was monitored and reviewed.

The service operated from a purpose-built 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.

They worked together well to provide safe care that met people’s individual needs. Staff consistently 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. Often staff were multi-skilled in different roles which helped them cover each other.

A minority of staff said they were stretched within their roles due to low staff levels. The provider had been actively recruiting and had new starters at the induction phase.

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. GP registrars (qualified doctors in the final stages of their specialist training to become GP’s) received ongoing clinical competency feedback and support.

We were supplied a copy of a Disclosure and Barring Service (DBS) Policy for recruiting staff. This had not as yet been personalised to the practice; however all necessary checks had been carried out. We did identify incomplete recording of the immunisation status for clinical staff; which the practice had been actively working on to complete.

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 made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff 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, and were competency assessed on medicines optimisation. 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.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. We did find a minority of cases where patients medicines were not prescribed in line with current best practice, as they had been the subject of older alerts, and also where patients were overdue for some of their required monitoring. These have now all been rectified.

Staff had access to emergency medicines and equipment including oxygen and a defibrillator. These were regularly checked for stock availability and to ensure they were in date. There was a comprehensive medical emergencies policy.

The practice monitored prescribing patterns and best practice and showed significant positive variation in some high risk prescribing areas such as multiple psychotropics (substances that affect brain function, such as anti-depressants). Whilst often clinically necessary, prescribing of multiple psychotropics carries a number of increased risks that warrant close monitoring.