Carn to Coast Health Centres

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. We assessed all the quality statements in the safe key question. Our rating for this key question remains good. The service had a positive learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were visually clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience to deliver the service. Managers made sure staff received training and regular appraisals to maintain high-quality care. The practice had systems for the appropriate and safe use of medicines which required additional monitoring.

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 service had a proactive and positive culture of safety, based on openness and honesty. Policies and procedures supported and encouraged a learning culture. The service listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Staff felt there was an open culture, and that safety was a top priority. Leaders encouraged staff to raise concerns when things went wrong. The service had processes for staff to report incidents, near misses and safety events. 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 service took concerns seriously and proactively made improvements to the service.

The staff worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. The staff were aware of the importance of continuity of care, including when people moved between different services. There were systems for processing information relating to new patients, including the summarising of new patient records. The service worked with other providers to deliver shared care and when patients moved between services. A dedicated frailty team supported the co-ordination of medical and social care by liaising with community teams. The daily ‘huddle’ meeting brought together the day’s duty GPs and community teams to highlight any immediate concerns and to pre-empt potential complications. Referrals and test results were managed in a timely way. Partner organisations shared positive feedback about how they worked together to support people: ‘they act on the needs when we request them. They will respond to queries and complete annual medication reviews. They come and visit when they deem appropriate.’

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The service shared concerns quickly and appropriately. Safeguarding policies were known to staff, who were appropriately trained in safeguarding procedures. A safeguarding officer supported the safeguarding leads to maintain a list of vulnerable people and act on concerns working in partnership with other organisations. There were regular discussions between the service and other health and social care professionals to support and protect adults and children at risk of significant harm. The practice informed the Out of Hours service of any relevant safeguarding information.

The service worked with people to understand and manage risks by thinking holistically. Appropriately trained staff completed consultations and provided specific advice to people. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. People received advice on risks related to their medical needs and the actions to take if their condition deteriorated. Emergency medicines and equipment were available and maintained. Staff could recognise a deteriorating patient and knew the action to take. People said they were involved as much as they wanted to be in decisions about their care and treatment. Our remote clinical searches found gaps where patients had not been informed of the risks associated with the medicines they had been prescribed. The practice addressed this immediately and instigated further systems and processes to ensure patients already prescribed theses medicines were informed of the risks.

The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care. Contracts with external organisations ensured the premises were maintained. The service made reasonable adjustments when people found it hard to access services such as having step-free access and ground floor level rooms. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. We saw equipment was fit for purpose and had been maintained to ensure it was in good working order. Clear signage around the building supported people and staff in the event of an emergency evacuation. There was a business continuity plan which was monitored and reviewed. During our assessment, we identified a concern regarding the low number of staff who had completed fire warden training. Following our assessment, the service was proactive in addressing this and provided assurance that staff had now completed or were allocated this training. We also saw some confidential patient records on display which had been left unattended in 2 of the sites we visited. The practice took action by reviewing their processes and reiterating patient confidentiality to staff.

There were a variety of clinical and non-clinical roles within the practice. The service regularly reviewed their staffing arrangements to ensure 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. The service was able to demonstrate staff had the skills, knowledge and experience to carry out their roles. 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. Some staff had also completed specific training in their specialist area. Staff were supported to meet the requirements of professional revalidation with appropriate regulatory bodies such as the General Medical Council and the Nursing and Midwifery Council. There was a system that demonstrated appointments were allocated to appropriate, competent clinicians. Leaders were aware of the financial challenges they faced when trying to ensure safe staffing levels to respond appropriately to meet the demands on the service. Safe recruitment practices were followed.

The staff assessed and managed the risks of infection. For example, detecting and controlling the risk of cross infection and shared concerns with appropriate agencies promptly. The practice had a designated infection, prevention and control lead and all staff had completed relevant training. Policies and procedures were available to staff. Cleaning schedules were followed. Risk assessments and audits were completed, and actions taken to mitigate risks. Appropriate standards of cleanliness and hygiene were met. The premises were visually clean and hygienic. There were arrangements for managing waste and clinical specimens. Sharps bins were appropriately managed. Staff had access to personal protective equipment(PPE). There was a process to record, and risk assess staff vaccinations in line with national guidance.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They 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, had their competencies assessed, and felt confident managing the storage, administration and recording of medicines. Blank prescription stationary was stored securely. However, it was not always tracked through the service meaning the service would not know if any of the stationery went missing. The service addressed our concerns immediately and implemented a new process to manage the stationary. 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. Staff followed established processes to ensure people who were prescribed medicines with specific risks, received recommended monitoring. There were suitable processes for staff to follow when dispensing medicines. 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 the antibiotics; co-amoxiclav, cephalosporins and quinolones, was lower than expected for the year 2024.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. We reviewed a sample of Patient Group Directions (PGDs) (a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition by named registered health care professionals without them having to see a prescriber) and Patient Specific Directions (a written instruction from a doctor or other independent prescriber for a medicine to be supplied or administered to a named patient) and found they had been completed correctly in line with guidance.

Staff were aware of the protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. The service had systems to manage and respond to safety alerts and medicine recalls. However, our clinical searches identified 308 patients aged over 65 and prescribed non-steroidal anti-inflammatory drugs (NSAIDs) or antiplatelets or over 75 years old who should have been prescribed or considered for a medicine to protect their stomach lining in line with national guidance. We reviewed 5 records and found the stomach protecting medicine had not been considered for 4 of these patients placing them at increased risk. The service took immediate action to ensure these patients were reviewed by their named GP.