The Calverton 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 good. At this assessment, the rating remains the same. This meant safety was a priority, and people were protected from abuse and avoidable harm. The service had a strong learning culture and people could raise concerns. Managers investigated incidents thoroughly. Staff understood and managed risks. 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 appraisals to maintain high-quality care. Some appraisals were overdue but had been scheduled.

The practice did not hold the relevant information relating to the immunisation status for all staff but were in the process of gathering this.

Staff managed medicines well and involved people in planning any changes.

This service scored 78 (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. The practice held learning event meetings when events including clinical issues were discussed and learnt from. Information was disseminated to those who were not present at the meeting. 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. For example, following a complaint relating to a deceased patient the practice had added a pop-up box to patient records to identify more clearly when a patient had passed away.

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 well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. They had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. There was a dedicated safeguarding care co-ordinator and the practice maintained a list of vulnerable people and acted on concerns working collaboratively with other organisations. The GPs attended case conference meetings for example in respect of child criminal exploitation and used their wider knowledge of families and communities to inform these meetings.

The service worked with people to understand and manage risks using a holistic approach. 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 were trained to recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

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. The practice held learning event meetings when events including clinical issues were discussed and learnt from. Information was disseminated to those who were not present at the meeting. 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. For example, following a complaint relating to a deceased patient the practice had added a pop-up box to patient records to identify more clearly when a patient had passed away.

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 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.

Staff were supported to develop and were positive about the training and development opportunities given. We found that staff had received regular appraisals but some were now overdue. We were assured that those outstanding were scheduled to take place in the month following our assessment.

Processes had been established to ensure staff working for but not directly employed by the practice were recruited safely, had received appropriate and up to date training and were working within their agreed areas of competence.

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 received relevant training. Cleaning schedules were in place, followed and monitored. Risk assessments and audits were completed, and actions taken to mitigate risks.

At the time of our assessment, we found the practice did not hold the relevant information relating to the immunisation status for all staff but were in the process of gathering this.

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 managed prescription stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received recommended medicines reviews and monitoring.

However, as a result of our clinical searches we found that the follow up of patients after an acute asthma attack within an appropriate timeframe was inconsistent. Immediately after our assessment the provider told us that in order to improve this, they had introduced a pop-up box in the clinical records system to remind clinicians to arrange a follow up 48 hours after a steroid has been prescribed to an asthmatic patient.

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. We found the practice did not stock two emergency medicines recommended in national guidance but did have a risk assessment in respect of this. However, they ordered these medicines on the day of our onsite visit. The medicines refrigerator in the dispensary was overstocked and we found the data logger in this refrigerator was not working. A data logger is used as a second thermometer independent to the integral thermometer in the vaccine fridge to cross-check the accuracy of the temperature and monitors the temperature if the electricity supply to the vaccine fridge is interrupted. Both of these issues were resolved on the day of our onsite assessment.

Dispensary staff had received appropriate training and regular checks of their competency. Dispensing incidents and near misses were recorded and reviewed regularly.

Waste medicines were disposed of appropriately including medicines returned by patients. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

The provider had systems in place to manage and respond to safety alerts and medicine recalls, however we found that risks had not always been coded as being discussed with patients. This was acted upon by the practice immediately following our assessment.

Staff followed 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. A small number of patients were overdue a review and the practice told us these patients had now been invited for a review and shorter prescriptions would be used where appropriate going forward to encourage attendance for reviews.

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