Prospect Medical Group

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 good.

This service scored 66 (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. Managers encouraged staff to raise concerns when things went wrong. We saw examples of staff meetings minutes were, the team discussed and learnt from clinical issues. Staff told us there was an open culture, and that safety was a priority. The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints.

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.

Arrangements were in place to safeguard adults and children from abuse that reflected relevant legislation and local requirements, and policies were accessible to all staff. The policies outlined who to contact for further guidance if staff had concerns about a patient’s welfare. Patient records were tagged with alerts for staff if there were any safeguarding issues they needed to be aware of. Staff gave us examples of safeguarding issues and how they had dealt with them. They attended meetings where this was discussed.

At our previous inspection we saw that not all staff who undertook chaperone duties received appropriate training. At this assessment we saw that staff had been trained for this role.

We saw staff who required a disclosure and barring service (DBS) check had one recorded, including those acting as chaperones. However, there was no individual considerations, documented rationale or appropriate risk assessment for those members of staff who had not received a DBS check.

The service worked with people to help them to understand and manage risks. They provided care to meet people’s needs that was generally 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 action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The service managed and controlled potential risks in the practice. They made sure equipment, facilities and technology supported the delivery of safe care.

At our previous inspection we saw that fire drills were not completed at the frequency outlined in their fire risk assessment. At this assessment we saw these were carried out at the correct frequency.

Prior to our assessment the practice sent us records of risk assessments for health and safety, fire and electrical safety.

We carried out a walk around of the practice on our site visit and saw the environment was well maintained. We checked for example, the emergency equipment medication, appropriate calibration of equipment and portable appliance testing (PAT). These were all appropriately maintained.

The service took steps to ensure there were 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.

We saw the practice had a recruitment policy which was updated regularly. Recruitment checks were carried out. We sampled recruitment checks for staff and saw that checks had been undertaken prior to employment. For example, proof of identification, references, qualifications, registration with the appropriate professional body, and staff had a contract of employment.

Some staff raised concerns about there not being enough GPs.

The service did not always assess the risk of infection. However, there were some measures in place to manage the risk of infection.

There was an infection control policy in place. However, there was no overall infection control audit. The policy stated that the practice would produce an annual infection control statement concerning infection transmission statements, infection control audit and risk assessments. However, the risk assessments and audits had not been carried out annually and were not in place.

The practice had recently appointed a new infection control lead who was a nurse. They were awaiting training and intended to carry out an audit once this training was received.

Staff had received infection control training and were aware of who the infection control lead was. Hand hygiene audits had been carried out.

We carried out remote searches of clinical records as part of our assessment to check how the practice monitored patients’ health in relation to the use of high-risk medicines. We found that patients did not always receive appropriate monitoring at the required intervals. Medication could be issued beyond the review dates with no fail-safe process for review in place. For example; For the monitoring of angiotensin-converting enzyme (ACE) inhibitors, which are used to treat heart failure and high blood pressure, 5% of patients had not been monitored at the required time scales of 12 months, some were over 18 months since their last checks. The practice did not have searches on their clinical system to monitor these patients and medication could be prescribed beyond the review date. The practice told us after our assessment that they were in the process of changing their monitoring approach. Following our assessment all patients had been contacted and monitoring was completed for them within a week.

We looked at the practice system to see if they were following instructions from NHS bodies regarding patient safety. Generally this was being done except in the records of patients who were prescribed medication to reduce blood sugar levels. There was no evidence in the notes that that they had been informed of the risks of taking this medication, which included the potentially life threatening risk of Fournier’s gangrene associated with these medicines.Following our assessment the practice told us this had been carried out.

However, we found, for example, that reviews of Disease-Modifying Antirheumatic Drugs (DMARD) were good and the standard of the reviews by the pharmacy team were thorough. From the medicines optimisation (prescribing) data which is received by CQC from the NHS Business Services Authority (NHSBSA) we saw that the practice data was either in line with national prescribing or better, for example, for the prescribing of antibiotic medication. Staff received regular training on medicines optimisation. Medicines including controlled drugs were stored securely, expiry dates checked and at appropriate temperatures.