Trent Vale 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

The service had a good learning culture and people could raise concerns. Although root cause analysis was not always identified, incidents were investigated. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained, and any risks mitigated and flagged where appropriate to the building landlord. 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. Staff managed medicines well and involved people in planning any changes. A system was in place to record the stock of blank prescriptions; however, issues were identified with the management of blank prescriptions. We found medicines management issues. For example, some patients requiring thyroid function test were overdue their monitoring. At this assessment, we found a breach of regulation 12, in relation to safe care and treatment. People on high-risk medicines and with long term conditions were not always being monitored appropriately. People were not always involved in their medication reviews. We have asked the provider for an action plan in response to the concerns found at this assessment.

This service scored 59 (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.
People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Staff felt there was an open culture, and that safety was a top priority. The provider 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. However, root cause analysis was not always apparent therefore we were not fully assured that robust mechanism was in place to ensure learning was fully embedded.
 

The service 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 systems in place for processing information relating to new patients. 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. A system was in place to record the stock of blank prescriptions; however, the stock was not reconciled, each prescription was not easily traceable.

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.
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. Safeguarding registers were monitored and updated on an ongoing basis.

The practice had a safeguarding lead where the reconciliation of safeguarding registers with safeguarding teams were discussed at team meetings.

 

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.
Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew what action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. The practice made reasonable adjustments for patients including disabled patients, older adults, safeguarding concerns, learning disabilities, homelessness and military veterans’ family members

The service detected and controlled most of the potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.
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. There was a business continuity plan in place which was monitored and reviewed. Some areas had been identified as requiring action following the last Fire Risk assessment June 2025, for example, issues identified with accessed fire doors. The provider was aware prior to the assessment and reassured that those areas would be monitored and actioned.

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.
There were a range of clinical and non-clinical roles within the practice. We found most of the training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Safe recruitment practices were followed.
Annual appraisals were completed for all staff, while individuals with enhanced roles received regular competency assessments and clinical supervision. Non-medical prescribers’ prescribing had oversight and were subject to regular audits and any knowledge gaps supported with additional learning and support.
The practice had organised an Occupational Health nurse to review staff immunisation and vaccines, wellbeing initiatives and DSE awareness. The practice was working through an action plan which outlined any outstanding immunisation, vaccinations and incomplete assessments.
 

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.
 

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.
Our clinical searches identified that there had been 369 medication reviews completed in the previous 3-month period.
The practice had a process in place for medicines that required monitoring, however a small number of patients were overdue monitoring of bloods to monitor their heart failure medications. Patients could have an increased risk of acute kidney injury, but this was actioned by the provider following our feedback.

Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. Staff did not always manage prescription stationery appropriately and securely. Staff did not always follow protocols to ensure they prescribed all medicines safely, and did not always ensure people received all recommended medicines reviews and monitoring. 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 and completed safety risk assessments.
The provider had effective systems to manage and respond to safety alerts and medicine recalls. However, staff did not always follow established processes to ensure people 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.
Our clinical searches found one patient receiving valproate (medication for epilepsy and bipolar disorder) had not had effective medication review.
Our clinical searches found example of patients with asthma were not always receiving monitoring for medicines prescribed for their long-term conditions.

The practice reassured a follow up plan for the cohort of patients would be in place. The practice will be working alongside PCN pharmacy team to address the issues identified following our clinical searches.