Brune 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

Safe – this means 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 has changed to Requires Improvement.

The service was in breach of legal regulation in relation to Safe care and treatment. During our clinical searches, we identified the practice did not have fully effective and embedded processes for monitoring patients’ health in relation to the use of some high-risk medicines. The practice had started to take action to address shortfalls in care to ensure patients would be monitored to continue safe prescribing of their medicines, such as audits of patients with outstanding blood monitoring and medication reviews.

This service scored 62 (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.

Staff were encouraged to raise concerns when things went wrong. They told us that significant events, complaints and examples of patient feedback were shared and discussed during regular all-staff meetings. Staff felt there was an open culture and understood their duty to raise concerns and report incidents. Leaders provided examples of how incidents were investigated and resolved.

There were policies and processes in place to record, investigate and take action from incidents and complaints. These were discussed in monthly governance meetings and minutes made available to staff who were unable to attend. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support in line with the duty of candour. Learning from incidents and complaints resulted in changes that improved care for patients.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

There were designated safeguarding children and adult leads at the practice. There were monthly multi-disciplinary meetings where safeguarding issues were discussed and these were attended by GPs and members of the nursing team. External stakeholders were invited to safeguarding meetings where relevant. Systems were in place to appropriately refer people to the local authorities and information was shared amongst community teams where required. Safeguarding and chaperoning policies were in place and accessible to staff.

A mixture of clinical and non-clinical staff members had chaperone responsibilities as part of their role. Those staff members had completed Disclosure and Barring Service (DBS) checks to ensure they would be appropriate to undertake this role.

We reviewed a sample of patient records as part of our remote clinical searches and found care plans noted how people were to be supported to remain safe. There were safe systems and processes in place to ensure children had been appropriately followed up with when they failed to attend appointments.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

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 were enough staff to manage workloads to prevent further backlogs of tasks and working excessive hours. Staff rotas were completed with oversight of cover where required, so that should a clinician be absent at short notice, their pre-booked appointments could be put into protected available same day slots with another clinician. There were effective staffing arrangements to ensure in the event of emergency, the risk of unsafe practice was mitigated to prevent lone working.

Staff told us that there were opportunities to ask for support, raise concerns and appraisals were carried out annually. Staff could discuss clinical queries in relation to their medicine prescribing or care and treatment planning with leaders who they said had an ‘open door’ policy. The duty GP held weekly clinical supervision sessions to discuss performance, care and treatment. We found examples of supervision records which had demonstrated a strong focus on mentorship, continuous professional development and evaluation of records to ensure care was in line with evidence-based practice.

All recruitment and Human Resource (HR) records were kept in-line with practice policy and Schedule 3 requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We carried out a review of the provider’s recruitment checks in relation to 3 members of staff and information was available and up to date in line with practice policy.

Staff received a formal induction relevant to their role and responsibilities and were supported through ongoing appraisals and supervisions, including prescribing checks for relevant clinical staff.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service did not always ensure that medicines and treatments were safe and met people’s needs, capacities and preferences.

During our remote clinical searches, we identified not all patients who had been prescribed certain high-risk medicines had been appropriately monitored and reviewed in line with national guidelines. For example, patients prescribed Aldosterone Antagonists (a diuretic medicine used to treat heart failure) and Angiotensin-converting-enzyme inhibitors (medicine used for the treatment of high blood pressure and heart failure) had not always received the required blood and blood pressure monitoring set out in national guidelines and therefore there was a risk of patients experiencing worsening renal symptoms.

Medicine reviews were not consistently carried out for some patients receiving high-risk mental health medicines. Prior to the inspection, the provider had identified shortfalls in relation to monitoring patients prescribed mental health high-risk medicines and were working towards establishing and embedding systems to ensure the safe prescribing and monitoring of medicines. A randomised review of medication reviews determined that not all records contained qualitative information to inform future care planning in one out of the three clinicians we had reviewed samples of.

However, the practice had shown improvements in the monitoring of other high-risk mental health medications. For example, from there was an 82% reduction in outstanding reviews for patients prescribed lithium over the past 12 months. There was also a reduction of 22% for patients prescribed pregabalin or gabapentin (medicines used to treat seizures and nerve pain) requiring a review over the past 12 months.

The service had described how they had taken steps to deprescribe anti-psychotic medication for those with dementia as well ensuring patients prescribed sodium valproate and topiramate (medicines used to treat bipolar disorder) had an annual risk acknowledgment form (ARAF) in place.

The service told us they had implemented additional training and ‘ten footsteps’ to review and support deprescribing for patients on 120mg of morphine (medicine used to treat severe pain). This was a multi-disciplinary approach including GPs, pharmacists, GPs with Extended Role, Long Term Condition Nurse, First Contact Practitioner, and Health and Wellbeing Coach.

During our on-site visit we found Patient Group Directions (PGD) and Patient Specific Directions (PSD) were in place which relevant staff worked to. Prescription stationery was logged and stored securely.

Medicines were stored securely throughout both sites. The practice held appropriate emergency equipment and emergency medicines at the main practice and branch site. The practice maintained appropriate fridge temperature records where vaccines were being stored and observation of variances of temperature had been addressed and logged.

Leaders were able to demonstrate that there was an effective system to ensure safety alerts were acted upon in a safe way to patients. During our clinical searches we found patients who were affected by medicine safety alerts were contacted to inform them on the risks and prescriptions were reviewed appropriately.

Staff were aware of how the practice managed information changes to a patient’s medicine including changes made by other services, for example, the out of hours provider (OOH).