Urban Village 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 Outstanding. At this assessment the rating was changed.

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.

Urban Village Medical Practice (UVMP) had a proactive and positive culture of safety, with the aim of openness and honesty. They actively listened to concerns about safety and investigated and reported safety events. Lessons were always learnt.

The provider had processes for staff to report incidents, near misses and safety events. Staff identified that safety was a top priority. Staff told us that managers encouraged them to raise concerns when things went wrong and confirmed that, in the main, there was an open culture.

It was not always easy to confirm how learning from individual incidents was shared systematically with staff teams. Staff described that updates were shared through different forums, however, evidence and reports reviewed did not provide linear information such as a root cause analysis, associated learning, recommendations for and actual change.

Meeting notes did not confirm a consistent process for updating the entire staff team about local safety events and the associated learning.

Leaders also described ‘closed’ meetings called restorative supervision for nurses’ to enable debriefing about difficult situations in a totally supportive forum.

Leaders should consider how learning from these closed meetings can be shared safely if trends arise.

People who gave feedback stated their concerns were identified and dealt with and felt supported to raise concerns. People said staff treated them with compassion and understanding.

There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. However, complaints records that were reviewed showed written responses were written in medical and legalistic terms. We noted the information could be difficult to understand. During the CQC assessment, leaders began a process of developing a quality improvement plan to review the information provided to patients when a complaint investigation was completed.

Leaders however learnt from complaints which resulted in changes that improved care for others. The complaints summary gave examples of actions taken which included making certain topics a priority for staff training and amending information for patients, making it easier to understand.

Urban Village 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 and took steps to strengthen systems when gaps were identified.

The service worked with other providers to deliver shared care.

There were regular clinical review meetings to which health visitors and other community-based health professionals were invited.

There were systems in place for processing information relating to new patient’s. There was a high turnover rate of patients and systems were robust enough to manage this without a significant number of incidents.

Referrals and test results were managed in a timely way; the leaders stipulated 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.

Clinical and admin leaders met daily to review any risks identified, discuss complex cases and confirm all tasks for the afternoon could be managed.

Urban Village 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 practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. However, some processes in place needed to be strengthened to ensure concerns about vulnerable children were quickly identified if they presented to other NHS health care services.

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.

Staff had completed specialist training for working with and recognising abuse and vulnerabilities for people with learning disabilities. Staff had also completed specialist training in dealing correctly with instances of domestic abuse.

Multidisciplinary team working was well established and there were well embedded processes for ensuring teams worked together well, particularly for the homeless service.

Health visitors shared and provided information for clinical meetings and attended when possible.

The safeguarding lead attended and reported to multiagency safeguarding meetings as required.

We completed clinical searches as a part of the assessment processes. The searches indicated gaps in achieving best practices policy for flagging children on the child protection or at-risk register and linking them to members of their household.

Electronic alerts were not always in place which meant staff in other services, such as AE or out of hours, may not be immediate aware of a child at risk if they or a member of their household presented for care and treatment.

This was reviewed further during the location visit. We found that outcomes in this area were mixed. Not all, but most, children at risk were flagged. Patient records confirmed risks could be identified if these were read, but a red alert box did not always appear as is best practice. We also found it was not always easy to confirm that adults at the same address as children as risk were identifiable as either a main carer or resident. It was noted however that significant adults such as parents, were flagged and associated with children even if they were not registered with UVMP.

During the assessment period leaders took immediate action, including seeking advice from the child protection team, about the correct codes to use, to ensure all vulnerable children were flagged and all associated adults identified, their status made clear and linked to each child. Leaders agreed to keep this process under review.

The service always worked well with people to fully understand and manage risks by thinking holistically. They provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

People told us 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.

Patients were well informed about the actions they should take if they were not contacted for diagnostic appointments within a specified timeframe.

We noted there were robust processes in place to ensure continuity of care for patients transferring from another practice or service to another. Processes were especially robust in the homeless service.

The provider fulfilled their contractual obligations by working innovatively. For example, the practice employed a team of staff to support homeless people by working between the practice, community resources and secondary care. This facilitated the best possible outcomes for patients as they moved between services.

This specialist nurse role included working with the patient in accessing accommodation providers; specialist charities and other community-based organisations; as well as direct communication with the hospital wards and multidisciplinary discharge teams. This meant people benefited from comprehensive individual support packages, giving the care package the best chance of a positive outcome.

Robust and efficient processes were also evident for processing patients transferring from or to other GP practices. This was especially important because UVMP had a high turnover of patients. Leaders reported processing approximately 2000 patient transfers into and out of the practice annually, however, the list had only grown by about 100 patients. This meant processes for transferring information including test results; medication reviews and care plans needed to be efficient. There were no complaints raised about care and treatment relating to transfers. People who gave feedback generally praised the practice because it was easy to join and receive the care needed without a delay.

All staff had been trained in emergency first aid appropriate to their role. Staff could recognise a deteriorating patient and knew of action to take.

Permanent staff were aware of where equipment was held, and leaders had reorganised how staff responded to emergency alarms as a result of learning.

We observed that emergency equipment was available and maintained.

Appointment booking staff had completed triage training to ensure specific questions pertaining to the severity of an illness were recorded and responded to correctly.

Urban Village Medical Practice detected and controlled potential risks in the care environment.

The premises was not owned by the practice. It was purpose built and hosted a number of practices; a community mental health team and a dental practice.

The tenants had frequent and regular meetings with the building management team.

We saw that fire safety and other premises checks were completed and actions plans put in place to address any shortfalls. Health and safety risk assessments and audits had been undertaken and risks identified were being addressed.

Leaders had ensured the safety of all equipment, facilities and technology under their control, and so, promoted the delivery of safe care.

At the time of the assessment visit the defibrillator was not fully accessible to UVMP staff. This was discussed with the leadership team who immediately responded by purchasing a defibrillator for the practice and amended standard operating procedures such as the Locum Induction pack to reflect the change.

We saw that checks and calibrations needed for equipment, were up to date.

The practice had a business continuity plan which was monitored and updated as required.

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

Urban Village Medical Practice employed a team of highly qualified, skilled and experienced staff, who received effective support, supervision and development.

The practice is the lead practice integrated health Homeless Health Service. This service is exemplary in relation to staffing and accessibility for the homeless communities in Manchester City centre and associated hostels and shelters.

The staff were spilt between those who predominantly worked in the commissioned Homeless service and those who predominantly provided care and treatment to people on the main practice list.

There were a range of clinical and non-clinical including, GPs, specialist nurses and advanced practitioner roles. Roles also included a very accessible Health Coach.

Urban Village Medical Practice is a teaching practice providing placements for GP trainees. GP trainees are qualified doctors training to become GPs. Their training is closely supervised by practice doctors who are qualified supervisors.

We found training was up to date, and topics were comprehensive. Learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Staff were given support through study time and funds to attend courses and obtain specialist qualifications in areas such as Homelessness, Women’s Health and Sexual Health.

Safe recruitment practices were followed.

Staff told us they were supported to gain knowledge and learn new skills for the benefit of patients and in response to changes in best practice guidance and new techniques.

Staff worked together well to provide safe care that met people’s individual needs.

GP’s, nurses and administrators each had designated professional leads who were experts in their field. Leads were responsible for ensuring staff who reported to them were competent in their role and worked to the highest standards.

There were formal systems in place to periodically, spot check and peer-review the records and consultations of most clinical and support staff. However, this did not include GPs. Although it is accepted that GPs go through annual appraisals and validation, there was evidence that more frequent and targeted monitoring would be beneficial. This was discussed during the assessment visit. Leaders immediately developed a quality improvement plan which would introduce regular review of GP consultations and record keeping ensuring care, treatment and records were completed as expected and potential gaps addressed.

People told us there was continuity of care because they were generally seen by the same doctor or nurse throughout a course of treatment.

Urban Village Medical Practice, in the main, assessed and managed the risk of infection well. They detected and controlled the risk of it spreading and provided evidence that concerns were shared with appropriate agencies promptly.

The practice had a designated infection, prevention and control lead and all staff had completed relevant training.

Cleaning schedules were in place and followed. Risk assessments and audits, including hand-hygiene audits, were completed, and actions taken to make improvements where needed.

The specialist Homeless service used had a mobile clinic and documents confirmed effective infection prevention control processes were in place. The interior and exterior of the van were visibly clean.

Contracts were in place to ensure safe collection and disposal of clinical waste and reports confirmed that when collected waste had been packaged securely.

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

We found that additional diligence was needed in relation to where some equipment was held. This was because, by looking at a cold chain breach we were told the ‘spill over’ vaccine fridge was kept in the sluice room which is an unsuitable and potentially contaminated room. We found it was ‘custom and practice’ to use this fridge whilst it was still in the sluice room to store spare vaccines. At the time of the CQC assessment we were told this fridge was not in use. Discussion with leaders indicated this fridge would be decommissioned and removed from the sluice room.

Urban Village Medical Practice had effective systems in place to promote safe medicines and treatments.

The service involved people in planning their medicines regime.

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

We observed processes in place concerning the administration and recording of medicines and noted these 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 did not identify any significant shortfalls in patient medicines monitoring.

The clinical searches showed processes for dealing with alerts were in place and 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.

The clinical searches included checking what was written for each patient during a medicine review. Medical records though brief indicated reviews had been completed. This was discussed with leaders during the search.

The provider used learning from specific incidents to identify where coding could be improved.

Medicines viewed during the location visit were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Medical gases, such as oxygen, were safely stored and required safety risk assessments had been completed.

Staff took steps to ensure they prescribed medicines in a manner 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 national averages.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.