Newport Pagnell 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

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. Some issues were identified during our clinical searches, as well as with completion of PGDs. Evidence sent after the inspection confirmed that necessary action was being taken.

The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care.

At our last assessment, we rated this key question as outstanding. At this assessment, the rating has changed to good.

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.

Staff and leaders consistently reported incidents and near misses, fostering a culture of safety and transparency. They actively participated in investigating significant events and complaints, identifying valuable learning opportunities. Learnings and subsequent action plans were then effectively communicated and implemented across the practice.

Care home representatives gave examples of how the practice had invited them to take part in learning activities to improve care going forward. Representatives were very positive about the care and treatment and provided examples of where feedback had been given and systems subsequently improved.

Staff understood their responsibility to identify and report concerns. They provided specific examples of improvements made following incidents and complaints, such as increased awareness regarding medicine side effects.

The management actively fostered a supportive environment where staff felt encouraged to raise concerns when errors occurred. Clear processes allowed staff to report incidents, near misses and complaints. Every event was reviewed to see what happened and how to improve. These investigations identified key lessons and required changes, ensuring that learning resulted in better care for everyone.

Representatives from the PPG felt the provider took concerns seriously and proactively made improvements to the service.

Practice staff worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They worked with other providers, the community and the voluntary sector to deliver shared care when people moved between services.

The service worked with other providers to deliver shared care and when patients moved between services. Referrals and test results were managed in a timely way.

The practice used clear systems to manage daily tasks and ensured clinicians reviewed all necessary actions. Clinical tasks, test results, and referrals were handled promptly, with tracking in place to confirm all requests were completed. Staff reported having the information necessary to provide safe care and were clear on their roles. Additionally, leaders conducted monthly audits of administrative work to ensure correspondence was processed accurately. Any issues found were discussed with the team to drive continuous learning.

The practice had fail-safe systems to ensure all cervical cytology results were received from samples sent.

The practice maintained aduty of candour policy, ensuring patients were involved when significant events or errors occurred. A clear system was used to record and investigate all complaints. The sample records reviewed confirmed that the practice responded to complaints promptly, offered apologies where necessary, identified lessons learned from each concern and took appropriate action to improve care quality.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They provided an example of a proactive safeguarding intervention when a patient was identified as being at risk of neglect. They worked with care providers and emergency services to ensure that urgent hospital care and treatment was provided. Children who were home-schooled were identified. If they had not been seen in the practice for the last 12 months, these patients were invited to attend an appointment with their usual GP.

The practice 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 appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

Staff who we received feedback from told us they were confident to report any concerns and knew who the practice safeguarding lead was. Staff gave examples of how they supported vulnerable people, for example home visits to people who may be at risk.

Arrangements were in place to follow up vulnerable people who had not attended for their appointment, which included for example, secondary care appointments. A weekly report was run to identify any children who had failed to attend their appointments. Additionally, a report was run to identify children and patients on the Safeguarding, Vulnerable and Learning Disability registers who had missed an appointment. Records were reviewed to ensure that these patients were seen.

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.

Effective arrangements were in place to help people identify, minimise and manage risks to their health. People were advised on the risks of their condition and the necessary steps to take if it worsened. Systems were also established for staff to identify, assess and manage people whose health was deteriorating and how to handle medical emergencies. Staff had completed relevant basic life support and anaphylaxis training.

Staff were clear about their roles and responsibilities during an emergency, and they understood what actions were required when an emergency incident was identified. When an emergency incident occurred in the practice, an alert was raised either by shouting ‘CRASH’ verbally or through the tannoy system. All available clinical staff and the Team Leader responded immediately. After the initial assessment, the response was scaled down to the duty doctor, a member of the Urgent Care team and the Team Leader, who continued to manage the situation as required. All necessary emergency equipment was collected en-route to the patient to ensure it was available on arrival.

Emergency incidents were reviewed periodically to identify opportunities for learning and improvement.

Practice staff detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Arrangements were in place to ensure the premises were maintained. Ongoing checks included fire safety, electrical safety and equipment calibration. Health and safety risk assessments were completed which included premises, falls and sharps (needles, scalpels etc). The practice had a business continuity plan which contained both internal and contractor contact details.

All staff we received feedback from told us they had suitable and sufficient equipment to undertake their work and were satisfied with the health and safety arrangements in place. Staff had received fire safety and health and safety training.

During the site visit, we observed fire exits were clear and fire safety equipment easily available and checked. Actions identified in the fire risk assessment had been completed.

Practice leaders 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. Feedback from people was positive in relation to the knowledge, skills, care and treatment provided by clinical staff.

Safe recruitment practices were followed in line with the practice’s recruitment policy. Appropriate recruitment checks were carried out which included professional registration and Disclosure and Barring (DBS) checks for all staff. The practice’s chaperone policy detailed the specific roles and responsibilities of chaperones. All chaperones were staff who had received training in-house for this role.

Clinical registrations were verified during recruitment and routinely monitored. All new staff completed inductions tailored to their roles. Records confirmed that leaders met with staff regularly for performance reviews, which included reviewing patient feedback collected after clinical appointments. There was a comprehensive approach to appraisals, which included seeking feedback from approximately 15 colleagues.

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. Staff who were responsible for long term condition reviews, childhood immunisations and cervical screening had completed training, and their competency was checked on an ongoing basis. Arrangements were in place for the clinical oversight of staff working in extended roles, which included those who prescribed medicines.

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 lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks. Staff knew who the Infection Prevention Control (IPC) lead was and had received appropriate training. They could describe the systems in place for safely dealing with clinical specimens and spilt bodily fluids. Policies and guidance were available for staff and staff received training relevant to their roles, starting from their induction.

During our on-site visit, we observed the practice to be clean and tidy. We saw documented checks of cleaning and arrangements in place to effectively communicate with the cleaning company to resolve any issues.

The practice obtained an immunisation history for all staff upon employment.

There were arrangements to ensure that medicines and treatments were safe and met people’s needs, capacities and preferences, although some improvements were needed. Feedback from people was positive in relation to medicines management. Care home representatives explained the process when a patient’s medication was changed and told us that the practice pharmacist conducted regular medication reviews of all patients living at the home.

Medicines were stored securely, with those needing cold storage kept in serviced, temperature-monitored fridges. Staff regularly checked stock levels and expiration dates. Medical gases, such as oxygen, were stored safely following required safety risk assessments. Staff ensured prescription stationery was managed appropriately and securely and ensured people received all recommended medicines reviews and monitoring. Medicines including controlled drugs were stored securely and at appropriate temperatures. There were appropriate arrangements in place for the safe management, use and oversight of controlled drugs.

At our previous inspection, we found that Patient Group Directions (PGDs) were not always signed in line with national guidelines. At this inspection, we found that whilst PGDs were complete at the main site, this was not the case at the two branch locations, and some of the documentation had not been completed. Following the inspection, we were sent evidence to confirm that action had been taken.

The practice had systems in place to receive, review and act on safety alerts. At our previous inspection, we identified some cases where the practice had not taken the appropriate action for all patients in response to some Medicines and Healthcare products Regulatory Authority (MHRA) safety alerts. At this inspection, we found that appropriate actions had been taken with regards to this.

At our previous inspection, we identified some gaps in patient monitoring. At this inspection, we found that while those specific issues had been resolved, further action was still needed to ensure patients prescribed a certain anti‑inflammatory medicine were coded correctly when offered a drug to prevent gastric problems.

Additionally, whilst patients prescribed medicines for heart rhythm disorders were being monitored, not all required checks had been completed. Two members of the pharmacy team told us that these additional checks were now being added to patients’ script notes, and searches were to be carried out to identify any other patients who may have been missed.

Prescription paper was stored securely and the practice maintained a record of prescription serial numbers. We found emergency equipment and emergency medicines at both the main site and the branch site.

The practice had systems in place to identify patients who were at risk of developing a long-term condition in most instances. However, during our clinical searches, we found that there were 2 instances where patients had a missed diagnosis of diabetes. Following our inspection, these patients were booked in for a review and systems were put in place to ensure that patients were identified, diagnosed and coded moving forwards.