Corbett 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 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 people were safe and protected from avoidable harm.

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 provider had a strong, proactive and positive culture of safety based on openness, transparency and continual learning. Learning and development were embedded within the culture of the practice. Clinical governance and training meetings were held monthly, and staff described a culture where new information, learning and changes to guidance were routinely shared and discussed.

People felt supported to raise concerns and told us staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and acted on feedback. For example, following concerns about how a patient interaction had been managed, leaders responded constructively, provided additional training and used the feedback as a learning opportunity. The PPG member told us they had seen improvements as a result. This meant the provider was open to feedback, encouraged transparency and used concerns raised to drive learning and improvement.

The provider took a proactive approach to identifying and addressing potential risks. For example, the practice manager raised concerns about the security of a new NHS digital system. Their concerns were taken seriously and led to changes which improved security arrangements and helped protect patient information. This demonstrated leaders were willing to speak up, challenge processes and take action when they identified potential risks.

Following a national clinical system outage, the provider implemented contingency arrangements in accordance with its business continuity plan and subsequently reviewed the response to identify learning and further strengthen emergency preparedness.

Staff told us there was an open culture where safety was a priority and they felt confident raising concerns. There were clear processes for reporting incidents, near misses and complaints, and learning was routinely shared through team meetings. When things went wrong, staff were supported to be open and honest, and learning was used to improve care and reduce the risk of recurrence.

The provider worked 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.

There were effective systems for processing information relating to new patients, managing shared care arrangements and supporting patients when moving between services. Referrals and test results were managed in a timely way.

The provider had robust systems to support continuity and oversight of patient care. GPs worked within a 'triplet' system, where results and clinical correspondence were overseen across groups of three clinicians, including trainee GPs. This helped ensure information was reviewed promptly, including when clinicians were absent, retired, no longer working at the practice or working as locums. Medical secretaries also routinely monitored referral pathways and followed up outstanding actions to reduce the risk of delays in patient care.

Duty GP’s maintained oversight of patients requiring assessment. Patients identified as needing same-day care were contacted directly by a GP where appropriate, and end-of-day safety-netting checks provided additional assurance that urgent concerns had been reviewed and acted upon.

During our assessment, we identified some areas where existing systems could be strengthened. This included implementing a more robust process to ensure cervical screening results were received, reviewed and acted upon where required. We also identified opportunities to improve the recording of information when medicines or vaccinations were supplied under written clinical instructions. Following our feedback, the provider took action to make improvements.

The provider 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 provider had a knowledgeable safeguarding lead and a deputy, who provided cover when the lead was unavailable. Other staff were also knowledgeable about safeguarding procedures and knew what action to take if both were unavailable. Relevant safeguarding policies, guidance and contact details were readily accessible to staff and safeguarding contact details and procedures were also displayed in clinical rooms.

The provider worked with people to understand and manage risks by thinking holistically. They provided care which was safe, supportive and enabled people to do the things which mattered to them.

The provider maintained regular contact with local care homes and undertook planned reviews of residents with complex health needs. This enabled risks to be identified early, and appropriate action taken, helping to keep people well and reduce the likelihood of avoidable hospital admissions.

Patients were involved in managing risks associated with their care and treatment. Staff provided information about warning signs, what action to take if their condition deteriorated and when to seek further support. Patients identified as being at increased clinical risk were proactively monitored and reviewed, helping to reduce avoidable harm and unplanned hospital admissions. Systems were in place to ensure patients whose needs changed during a telephone consultation could be reviewed face to face on the same day where clinically required.

Staff were able to recognise and respond appropriately to deteriorating patients. This helped ensure risks were identified promptly and managed safely.

The provider 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 that was regularly monitored and reviewed. For example, following an 8 hour power failure, during which the business continuity plan was implemented, a learning event was held to identify areas for improvement. The findings from this event were used to strengthen both business continuity arrangements and patient safety.

The practice had remodelled the reception area to improve accessibility and patient safety. A lower reception desk had been installed to better accommodate wheelchair users, benefiting both patients and staff. Additional internal windows overlooking the waiting areas had also been installed, enabling reception staff to maintain greater visibility of patients and respond promptly if a patient became unwell or in the event of an emergency.

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and development opportunities. Staff worked collaboratively to provide safe care which met people’s individual needs.

The provider demonstrated a strong commitment to workforce development and education. Staff received appropriate training, supervision and support, and learning needs were regularly reviewed. GPs held training or educational roles, and the practice provided structured supervision and mentoring for a wide range of healthcare professionals, including GP trainees, pharmacists and medical students. The practice provided week-long work experience placements for sixth-form students from local schools. All students who had participated over the previous 6 years had gone on to study medicine. This demonstrated the practice's commitment to supporting the development of the future workforce, which would benefit people using NHS services both now and in the future. Protected time was available to support staff development and supervision.

There was a range of clinical and non-clinical roles within the practice, and staff were working within their areas of competence. Safe recruitment practices were followed, and training records showed staff remained up to date with required learning.

The provider made effective use of a stable and experienced workforce. Use of locum staff was minimal and, where locum clinicians were required, these were usually clinicians already known to the practice. This supported continuity of care, safe decision-making and effective teamwork. Staff told us they felt well supported in their roles and had opportunities to develop their skills and knowledge.

The provider 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 staff had received relevant training. Cleaning schedules were in place and followed, and the provider assessed and managed infection prevention and control risks through risk assessments and regular audits.

During our assessment, we identified an opportunity to strengthen existing audit processes to reflect that some areas of the practice were carpeted and how this could affect cleaning arrangements. Leaders responded positively to feedback and took action to review and improve these processes.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in decisions about their medicines, including when changes were made.

Staff involved people in reviews of their medicines and helped them understand how to manage them safely. Patients knew what to do and who to contact if their condition did not improve or they experienced unexpected symptoms. Staff received appropriate training, were competency assessed where required, and felt confident managing the storage, administration and recording of medicines.

Medicines, including controlled drugs, vaccines and emergency medicines, were stored securely and at appropriate temperatures. Staff regularly monitored stock levels and expiry dates and managed prescription stationery securely. Waste medicines and medical gases were stored and disposed of safely in line with requirements.

During our assessment, we identified opportunities to strengthen medicines management and emergency preparedness arrangements. Patient Specific Directions (PSDs) required more robust documentation to ensure key information, including dosage and dates, was consistently recorded. These are written instructions from a prescriber, such as a GP or independent nurse prescriber, for a medicine to be supplied or administered to a named person after they have been assessed.

We also found the emergency Ambu-bag (a hand-held device used to give emergency breathing support to people who cannot breathe well or at all) was not sealed and only one set of defibrillator pads was available on site. Leaders responded positively to the findings and took action to address the issues identified.

The provider had effective systems to support the safe prescribing and monitoring of medicines. Staff managed safety alerts and medicine recalls appropriately and ensured people prescribed medicines requiring additional monitoring received recommended checks. Prescribing data reviewed as part of our assessment showed the provider took steps to promote safe and effective prescribing, including the appropriate use of antibiotics. Regular prescribing audits were undertaken to support continuous improvement in care and treatment.