Ribblesdale 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 our last assessment, we rated this key question as good.. At this assessment, the rating remains the same.

Leaders responded quickly and effectively when highlighted, however during the assessment, we found some gaps in the management of specific high-risk medicines and, the management of the blood results suggesting people were pre-diabetic needed to be strengthened. The provider took immediate and satisfactory actions to deal with these findings.

People were involved in planning any changes in their care and treatment, including medicine optimisation.

People were overwhelmingly complimentary about their experiences of dealing with the service.

The service was well managed and notwithstanding the areas for improvement, in general, the managers had processes in place to enable effective oversight of the risks and strengths of the service.

People using Ribblesdale Medical Practice were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. Staff involved those important to people and took decisions in people’s best interests where they did not have capacity and lived in their own homes.

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 Ribblesdale Medical Practice 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.

People who gave feedback stated their concerns were identified and dealt with.

Staff told us that managers encouraged them to raise concerns when things went wrong and felt there was an open culture. Staff frequently identified that safety was a top priority.

Staff meeting records confirmed that during staff meetings, the whole team discussed and learnt from clinical issues.

The provider had processes for staff to report incidents and safety events. During the assessment we discussed the suggestion to update the reporting incident policy to include ‘near-misses.’

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.

Leaders reviewed and prepared an interim report for the purpose of the assessment. Early trends were identified which included blocks in processes which reduced access to face to face appointments and the need to for leaders to be assured that all consent was dealt with correctly and consistently by all staff. Action taken had included, updated staff training, we increased the number of telephone lines into the practiceand installation of a more efficient telephone system. In response to concerns raised about consent to care and treatment, the provider reviewed and updated the consent policy and ensured staff updated their training on human rights topics focused on consent; mental capacity and safeguarding; for adults, children and young people and people with learning disabilities.

Ribblesdale Medical Practice collaborated with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services.

The service worked with other providers to deliver shared care.

People described receiving joined up care after leaving hospital and returning home.

There were systems in place to ensure letters and information from secondary care was generally well-managed to ensure treatment was modified as suggested. These processes were monitored and reviewed.

There were weekly clinical review meetings which included health visitors and other community-based health professionals.

There were systems in place for processing information relating to new patients.

Referrals and test results were managed in a timely way; the leaders stipulated that that practitioners were tasked to review test results within a maximum of 24 hours of the result being returned. Urgent tests were tracked and tagged as such. The service treated failure to achieve this target as a serious incident resulting in a detailed investigation and learning outcomes for the team.

Ribblesdale Medical Practice 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.

Safeguarding policies were in place and known to staff, who were trained to the correct level for their responsibility in safeguarding procedures.

All clinical staff had completed Safeguarding adults and Child protection training level three. All staff, clinical and non, had completed specialist training for working with and recognising abuse and vulnerabilities for people with learning disabilities.

The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. Health visitors attended, or informed, the practices clinical meetings when possible. The safeguarding lead attended and reported to multiagency safeguarding meetings as required.

We reviewed the electronic child protection list as a part of CQC assessment process. It was discussed that vulnerable children could move between the child protection list and the looked after children list. The practice confirmed that these lists were reconciled each month. It was also confirmed that best practice was followed by ensuring carers or parents of vulnerable children or children in care would be identified by the practice.

Ribblesdale Medical Practice 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.

People told CQC that their care and treatment was discussed with them, they confirmed doctors, nurses and other staff made sure they knew how to manage their condition and what to do if they failed to improve.

We observed that emergency equipment was available and maintained.

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. Patients described instances when the GP gave advice to ensure they were effectively triaged when contacting emergency ambulance services. People also described attending the practice and being supported to escalate their care and treatment immediately by doctors on duty.

All staff had been trained in emergency first aid appropriate to their role.

Appointment booking staff had completed triage training to ensure specific questions were recorded correctly. Processes to support this included a A-Z care navigation manual to support the correct routing and signposting of patients. This manual was developed in practice as one of the practices Quality Improvement Projects in 2024, and used for staff training to upskill the reception team and build their confidence. This was so, the appointment system prompted the most appropriate type of consultation and ensured people were signposted correctly to alternative clinical care such as the clinical pharmacist.

Ribblesdale Medical Practice 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. We saw that all checks and calibrations needed were up to date.

There was a business continuity plan in place which was monitored and updated as required.

We also observed that all areas, including public areas and seating looked in good repair.

Ribblesdale Medical Practice 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.

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. Safe recruitment practices were followed.

People told us staff were knowledgeable, competent and good at their jobs.

Staff told us they were supported to increase their knowledge and learn new skills for the benefit of patients and in response to changes in best practice guidance and new techniques. For example, staff had completed specialist training in supporting women at the perimenopause stage of life. Some women who gave feedback specifically mentioned the helpfulness of this service.

Ribblesdale Medical Practice 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 lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits, including hand-hygiene audits, were completed, and actions taken to mitigate risks.

We observed that staff were clean and tidy and wore a uniform that ensured they remained bare below elbows while on duty. This further promoted effective hand hygiene.

Ribblesdale Medical Practice employed a clinical pharmacist to oversee all aspects of medicines optimisation and management. Responsibilities included, ensuring appropriate staff, including the trainee pharmacist, received regular training and supervision in medicines optimisation.

The service had systems in place to promote safe medicines and treatments, however we found these were not always used effectively for responding to clinical needs and some processes needed to be strengthened.

The service always involved people in planning their medicines regime when contact was made.

People told us that staff involved them in reviews of their medicines and helped them understand how to manage their medicines safely.

People told us they knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms, people especially praised the time taken by the pharmacists at the service to provide information and review medicines and make changes and give advice about reducing side effects.

We observed processes in place concerning management of the storage, administration and recording of medicines would keep people safe. Staff managed prescription stationery appropriately and securely.

As part of the assessment a CQC GP specialist advisor carried out a number of set clinical record searches to review medicines requiring monitoring. These searches were visible to the practice. A sample of patient records were checked to ensure the required monitoring was taking place. The clinical searches identified shortfalls in patient monitoring for certain medicines. Following the assessment the provider sent evidence of the changes put in place and an action plan to ensure medicines optimisation would immediately improve and be more stringently monitored

The clinical searches showed processes for dealing with alerts were in place and in the main staff followed protocols such as responding to medicine alerts and considering best practice guidelines to ensure they prescribed medicines safely. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. However, this area needed to be strengthened because processes need to be monitored more closely to ensure the risk of omissions are reduced and quickly discovered if they occur.

Records made about medicine management for patients needed to be reconciled. The clinical searches included checking what was written for each patient during the medicine review. The notes looked at did not always confirm the information and advice given or that the correct tests had been requested for patients. This was discussed with the provider who indicated that the information was recorded in a different system to that looked at for the clinical searches. The provider discussed possible ways of ensuring all records available were reconciled and reflected the care and treatment actually provided to patients.

During the site visit we saw that the provider had checked the alternative records for people identified during the clinical search. We saw that these records were detailed and confirmed appropriate discussions were had with patients.

We saw that special codes used to highlight in people's notes when extra attention was needed were not always responded to or applied correctly. The provider reviewed these findings and provided evidence that people were being cared for appropriately, however, such omissions meant there was an ongoing safety risks if the process was not strengthened. Initial corrective measures were immediately taken.

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. 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.

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. For example, the number of antimicrobials issued by the provider was in line with local and national averages. There was a programe of regular clinical audits of prescribing that focused on improving care and treatment.