Rothwell and Desborough Healthcare Group

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. The practice had systems to assess, monitor and continue to improve the quality and safety of service. There was some evidence to support a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. The facilities and equipment met the needs of people, were clean and well-maintained. Although audits were completed, identified risks were not always actioned within designated time frames. There were enough clinical staff with the right skills, qualifications and experience. However, the practice was struggling with recruitment and retention of reception staff. Managers made sure staff received regular appraisals. There was a system to oversee mandatory training which was monitored to encourage completion. There were processes for monitoring patients’ health in relation to the use of medicines including medicines that require regular reviews. This key question has been rated as good.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice listened to concerns about safety and investigated and reported safety events. The practice had processes for staff to report incidents. Reporting forms were used and there was evidence these were investigated thoroughly. Themes were identified and lessons were learnt to continually identify and embed good practice. Quarterly reviews of significant events and complaints were presented to staff to encourage improvement. Staff described a no blame culture and said they were encouraged to report incidents.

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. Representatives from the patient participation group (PPG) felt the practice listened to their feedback and took appropriate action to make improvements where possible.

The practice 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 effective systems in place for processing information relating to new patients. Leaders advised there was dedicated staff to support timely registrations and review of new patient records to ensure clinical staff had up to date knowledge when reviewing patients. The service worked with other providers to deliver shared care and when patients moved between services. There were systems in place for managing incoming correspondence for patients’ medical records. Referrals and test results were managed in a timely way.

The practice worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. They had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They always shared concerns quickly and appropriately. The clinical safeguarding lead worked closely with the non-clinical safeguarding administrator. Staff were aware who the safeguarding lead was. The practice maintained oversight of lists of vulnerable people which were reviewed regularly. Vulnerable people were coded on the system and had alerts added to their records.

Staff knew how to identify, report and act when dealing with safeguarding concerns. They worked well with other healthcare professionals to ensure the concerns were addressed appropriately. An effective system was in place for the management, oversight and reviewing of safeguarding concerns. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. Safeguarding meetings were held twice monthly, and regular communication was maintained in between these meetings. The practice acted on concerns and worked in partnership with other organisations. For example, they followed up children who attended AE and those that failed to attend their appointments.

Staff worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs which was safe, supportive, and enabled people to do the things which mattered to them. Emergency equipment was available and maintained. The service managed significant events effectively. For example, leaders advised that following a significant event involving aggressive behaviour towards staff, protocols were updated and staff advised of improved safety mechanisms to provide better protection in future. 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.

The practice was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care. Portable appliance testing and calibrations were completed. There was a business continuity plan in place which was monitored and reviewed. 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. Systems were in place to check safety equipment including fire alarms and emergency lighting. Fire evacuation drills had been completed. We observed fire exits were clear and fire safety equipment was easily available and regularly checked. Staff were aware of what to do in an emergency and where emergency medicines and equipment were stored. Allocated staff also knew how to safely manage spillages of bodily fluids.

Staff we spoke with and those we received written feedback from provided a varied response to their experiences of working at the practice. Leaders and staff advised they had faced ongoing difficulties with the recruitment and retention of reception staff, with a recruitment campaign underway during our assessment. The pressures on the reception team had resulted in the need for other staff teams to step in and support. Leaders advised they were now recruiting for new staff who would be trained to work across reception and administrative teams to reduce pressures across teams, provide varied work and reduce the risk of pressure points developing in the future.

The practice employed non-medical prescribers and had established formal processes to monitor and audit their clinical practice. This formal process included audits of their prescribing practice, regular appraisals, feedback, and support. A sample of staff files we reviewed showed that all staff were suitably qualified, maintained their professional registrations and their continuing professional development (CPD) and had up-to-date specialist training appropriate to their role. We reviewed evidence that demonstrated safe recruitment practices were followed. All staff had appraisals and access to regular clinical supervision if required. Whilst some staff stated they received protected time to complete mandatory training and felt they had been trained appropriately to complete their roles, others stated they did not. We reviewed the system for monitoring staff training and noted that the majority of staff were up to date with their training and those outstanding were being encouraged to complete any outstanding as a matter of urgency. Staff and leaders acknowledged that teams did not always work together well due to ongoing conflicts in the team.

The practice had some systems to assess and manage the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Leaders ensured that facilities and equipment were safe, and that equipment was maintained according to manufacturers’ instructions. Prior to our assessment, the infection prevention and control (IPC) lead had stepped down from the role. The practice had implemented a recovery plan to support oversight of IPC, whilst they sourced an appropriate training course for a new permanent IPC lead. A member of the management team was supporting the role in the interim. Leaders advised they were searching for an appropriate IPC lead course for the individual to attend. Cleaning schedules were in place and followed. There was a policy for IPC available to all staff. An IPC audit had been undertaken and we saw action plans had been established; however, multiple actions had not been completed in the time specified.

As part of our assessment, a GP specialist advisor undertook a series of patient clinical record searches, to assess whether clinicians were prescribing a range of medicines safely and whether patients were being reviewed in line with national guidelines. The results of our searches were positive.

We reviewed patients prescribed a disease-modifying antirheumatic drug (DMARD) used to treat active rheumatoid arthritis and psoriatic arthritis by suppressing the immune system to reduce joint inflammation, pain, and stiffness. It is often prescribed to slow disease progression and prevent structural joint damage. The search identified 2 patients who may not have received the required monitoring. We found that although these patients were overdue their monitoring, there was evidence of efforts made by the practice to arrange appointments for them.

There was a process in place for recording and sharing Medicines and Healthcare Products Regulatory Agency (MHRA) safety alerts. Safety alerts were discussed in clinical meetings. Our clinical record review highlighted that safety alerts were actioned in line with guidance. Specifically, we reviewed patients prescribed a combination of medicines used to support patients with heart failure, to check they had received appropriate monitoring as required. Our search identified 24 patients who were overdue their monitoring. We reviewed records for 5 of these patients and found that all patients had been sent reminders to book an appointment for review.

We reviewed patients potentially at risk of having a missed diagnosis of diabetes. Our search identified 16 potential patients and we reviewed records for 5 of these patients and found none of them had diabetes.

Our searches identified a total of 387 medication reviews that had been completed for patients in last 3 months. We reviewed a random sample of 5 of these medication reviews and found that all reviews had been completed appropriately.

We reviewed the prescribing of medicines used to treat pain in the elderly to ensure appropriate monitoring systems were in place. Our search identified 69 patients and we reviewed records for 5 of these. We found that all 5 patients had been managed appropriately.

The practice adhered to an antibiotic stewardship policy that measured the appropriate use of antibiotics and optimised the use of antibiotics to improve patient outcomes. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

Staff regularly checked medicine stock levels and expiry dates, including emergency medicines and vaccines. Medical gases such as oxygen were stored safely. Fridge temperatures were monitored daily, and staff knew what action to take if the temperature was out of range. Staff managed prescription stationery appropriately and securely.