Ledbury Health Partnership

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. This is the first inspection for this service since the two practices merged. This key question has been rated as good.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns, reported and investigated them. The practice had processes for staff to report incidents. Themes were identified and lessons were learnt to embed good practice. Managers encouraged staff to raise concerns that were later discussed in meetings. Clinical concerns were discussed in the ‘lunch and learn’ sessions. People felt supported to raise concerns and felt staff treated them with compassion and understanding. Complaints were summarised and learning points were noted to ensure patient care was improved. Representatives from the patient participation group(PPG) felt the practice listened to their feedback and took appropriate action to make improvements to the service.

The practice worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. The practice worked with other providers and services to ensure continuity of care, including when people moved between different services. There were systems in place for managing incoming correspondence for patient’s medical records, including processing information relating to new patients. Staff understood the referral system and were able to tell us about the process for dealing with referrals, ensuring they were followed up accordingly. Triage systems were in place for staff to follow. The practice employed a biomedical scientist that followed robust clinical pathways to support safe care. They worked with a platform that streamlined administrative tasks and improved efficiency in delivering safe patient care that ensured urgent tasks were reviewed and actioned promptly.

The 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. Staff knew how to identify, report and act when dealing with safeguarding concerns. They worked well with other healthcare professionals to ensure the concerns were addressed appropriately. An effective system was in place for the management, oversight and reviewing of safeguarding concerns. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The safeguarding lead worked closely with the safeguarding co-ordinator. Staff were aware who the safeguarding lead was. The practice had oversight of a list of vulnerable people that was reviewed regularly. Vulnerable people were coded on their system and had alerts added to their records. Safeguarding meetings were held every 8 weeks, and regular communication was maintained in between these meetings. The practice acted on concerns and worked in partnership with other organisations. For example, they followed up children who attended AE and those that failed to attend their appointments. Staff were chaperone trained to maintain patient privacy during intimate examinations.

The practice worked well with people to understand and manage risks. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. 87%of respondents to the National GP Patient Survey felt they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. This is lower than the local average of 93% and national average of 91%. Emergency equipment was available and well maintained.

The practice completed health and safety audits to identify and control potential risks in the environment. The practice had procedures to ensure equipment, facilities and technology supported the delivery of safe care. There was a business continuity plan in place that was regularly reviewed. Portable appliance testing and calibrations were completed. Systems were in place to check safety equipment including fire alarms and emergency lighting. Fire evacuation drills had been completed. During the onsite visit, the premises were visibly clean and tidy. Cleaning schedules were in place to maintain a clean and safe environment.

The practice made sure there were enough qualified, skilled and experienced staff that worked well together to provide safe care and meet people’s individual needs. Managers explained their recruitment processes to ensure appropriate numbers of suitably trained staff were employed to support the delivery of good quality care which met the needs of the patients. There were a range of clinical and non-clinical roles within the practice. Leaders were aware of the growing patient population and closely monitored staffing levels. Staff were working within their agreed areas of competence. Staff were happy within their roles and were given opportunities to learn and develop whilst being supported to do so. We reviewed personnel files during the onsite visit and found that most of the necessary recruitment documents were accessible in the staff files, except for some interview notes. However, the practice explained that the identified staff members were employed with different management. We saw evidence of interview notes for more recently employed staff which assured us that new processes were in place and followed. Most staff had completed their mandatory training at the time of the site visit, and we saw evidence of annual appraisals. Clinical supervision was evident, offering staff a supportive environment and dedicated time in the diary to discuss clinical matters.

The practice assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns promptly. The practice had a designated infection, prevention and control (IPC) lead. Staff knew who the IPC lead was. Most staff had completed appropriate IPC training relevant to their role. Staff told us they knew their roles and responsibilities around IPC. IPC policies and cleaning schedules were in place and followed to ensure the premises and equipment were kept clean. Clinical rooms had adequate provision of personal protective equipment (PPE) and handwashing facilities. IPC audits were completed, and actions were taken when necessary to mitigate any risks.

As part of our assessment, a series of patient clinical record searches were carried out by a CQC GP specialist advisor. This assessed whether clinicians were prescribing a range of medicines safely and whether they reviewed patients on medicines that required monitoring.

Our clinical record searches reviewed medicines that require monitoring. We reviewed patients prescribed Methotrexate (an immune system suppressant medication). We identified 60 patients prescribed this medicine and all patients were monitored in line with guidance and were appropriately coded on the system. We also reviewed patients that had heart failure that were prescribed Aldosterone Antagonist (a medication that helps lower blood pressure and reduce fluid retention). We identified 101 patients prescribed this medicine and found 4 patients were overdue monitoring. However, the practice assured us these patients have the required blood test appointment booked. The practice updated their high-risk medicines policy to ensure a more robust formal escalation protocol for outstanding monitoring.

There was a process in place for recording and sharing Medicines and Healthcare Products Regulatory Agency (MHRA) safety alerts. Safety alerts were discussed in clinical meetings. Our clinical record review highlighted that safety alerts were actioned in line with guidance. We identified a total of 4 patients that were prescribed citalopram40mg (a medication used to treat mental health conditions) or escitalopram20mg (an antidepressant medication). The dosage should be reduced for patients older than 65 years old. All patients had been contacted to discuss the risks involved and given an option to reduce the dosage.

Our clinical record search identified 1 patient who was overdue a repeat blood test and therefore may have a potential missed diagnosis of chronic kidney disease stage 3, 4 or 5. The practice acknowledged this feedback and have assured us that this patient has since attended an appointment for the required blood test to determine the potential diagnosis.

We identified a total of 2,840 medication reviews that had been completed for patients in last 3 months. We reviewed a random sample of 5 of these medication reviews and found that 2 out of 5 medication reviews lacked context and was therefore unclear about what discussion had taken place during the review. The practice acknowledged this feedback and developed a medication review template to set the quality of the reviews to ensure clarity. Evidence has been provided for the 2 patients identified during the clinical searches to show they have had a repeat medication review with the context outlined.

We reviewed non-steroidal anti-inflammatory medication (NSAID - used to reduce pain, fever, and inflammation) prescribed to patients over 65 years of age; and antiplatelet medication (used to inhibit the formation of blood clots) prescribed for patients over 75 with no Proton Pump Inhibitor (PPI). PPIs are a group of medicines that decrease stomach acid production. National Institute for Care and Health Excellence (NICE) guidance recommends prescribing PPI medication for elderly patients taking NSAID or antiplatelet drugs to reduce the risk of gastrointestinal bleeding. We reviewed a random sample of 5 patient records and identified 4 patients that were not prescribed the Proton Pump Inhibitor (PPI). Staff acknowledged our feedback and have contacted these patients to start a PPI prescription.The practice have carried out targeted work on this cohort of patients and reduced the number of patients requiring gastroprotection from 124 (25% of the total) to 14 (3% of the total) with the aim to reduce this number further.

The practice adhered to an antibiotic stewardship policy that measures the appropriate use of antibiotics and optimises the use of antibiotics to improve patient outcomes.

Staff regularly checked medicine stock levels and expiry dates, including emergency medicines and vaccines. Medical gases such as oxygen were stored safely. Fridge temperatures were monitored daily, and staff knew what action to take if the temperature was out of range.