The 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

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.

The service had a good 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 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 regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.

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. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good service.

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. Learning was shared via minutes taken at meetings which were stored on the service’s computer system and emailed out to staff.

Significant event meetings included reviewing actions taken to ensure changes had been made.

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 people moved between services. Referrals and test results were managed in a timely way.

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. Staff were able to give examples of safeguarding concerns they had raised and the process they followed. The service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

Multidisciplinary team meetings with other health professionals were held regularly. Meetings were minuted however there was more detail and information in the minutes for children’s safeguarding meetings. The service was working on standardising meeting minutes so that all relevant information would be captured for both child and adult safeguarding 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 of actions to take. People were advised on risks related to their condition and actions to take if their condition deteriorated.

The service detected and controlled 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.

Fire drills were carried out regularly, but the service did not always note the time taken to evacuate the building. Actions were taken in response to fire drills where needed.

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 service. 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 systems were followed.

Staff were supported to undertake further training courses, such as non-medical prescribing courses. Allocated study time was provided as part of their working week. Non- medical prescribers were clear on the areas they would prescribe for, and auditing of clinical practise had recently been implemented.

A paramedic had received training on administering joint injections and was starting to carry these out independently. There were plans to audit their work at a suitable time in the future.

There were appropriate supervision and appraisal systems in place. Staff were able to reflect on their clinical work with their peer through reflective practice sessions.

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 service 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. There was a programme of audits in place these included room checks and safe management of sharps bins, which are used to dispose of needles and syringes. Hand hygiene audits were carried out regularly and the service had a strict ‘bare below the elbow’ policy, which staff were aware of. An annual statement on infection control was completed in line with current 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. The service had a dedicated staff member to undertake regular medicine safety reviews for those people on medications that require monitoring. The service ran quarterly medication safety audits looking for common dangerous interactions and omissions.

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. 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 people. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. 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 antimicrobials issued by the provider was lower than local and national averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

Our remote clinical searches showed that when people experienced an exacerbation of their asthma, they were not always followed up. We shared our findings with the service, and they provided us with evidence to show that necessary actions had been taken, such as a review of the consultation record and a review of appointments being booked.

Our clinical searches also showed that improvements were needed in monitoring of other long-term conditions, such as kidney disease, to ensure relevant blood tests had been carried out and reviews were booked. The service monitored how they were managing chronic diseases and produced a ‘State of Play’ report, which showed what reviews had taken place and reviews of the care due. The service carried out monthly safety searches and made improvements to the searches after our site visit to ensure follow up appointments were offered when needed.

There was a process to manage safety alerts, and we saw action had been taken where required. However, improvements were needed so that people’s records clearly showed what had been discussed. This was addressed by the service at the time of the site visit.

There were safe systems in place for dispensing medicines, and staff were suitably trained and had annual appraisals, and competency checks to make sure they were managing medicines safely.

The dispensaries were overseen by a dispensary manager and a lead GP. There were Standard Operating Procedures (SOPs) in place. These were regularly reviewed and signed by staff. There were suitable arrangements for ordering and disposal of medicines and for Controlled Drugs.

There were fridges for keeping medicines needing cold storage. The temperature range was recorded daily. However, some maximum temperatures were recorded as being higher than the recommended range with no actions being taken, which was not in line with the SOP for managing these medicines. Some fridges kept outside of the dispensary areas were not locked, meaning that access to these medicines was not restricted to authorised staff. These issues were addressed during the inspection.

The surgery offered a delivery service to housebound people and there were safe systems in place for managing this. Systems were in place to report any incidents or errors. These were investigated and measures put in place to reduce the risk of recurrence, and there were suitable systems for managing medicines alerts and recalls. Some medicines were prepared into blister packs, and there were safe systems in place for managing this.

Dispensary staff managed prescription stationery, and there were suitable systems in place. Records were kept to track the movement and location of these forms around the service.