St John's 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 has changed to requires improvement. We found that the service was not always providing safe services.
The service was in breach of regulations in relation to medicines optimisation and emergency equipment. This was because not all prescribed medicines were being monitored in line with national guidelines. We also found one site did not hold some of the recommended emergency equipment and the service was not able to provide a formalised risk assessment.
 

This service scored 62 (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. The provider had processes for staff to report incidents, near misses and safety events. Lessons were learnt to continually identify and embed good practice. Staff we spoke to said managers were supportive and they felt able to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. 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.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. There were systems in place for processing information relating to new patients. The service made sure there was continuity of care, including when people moved between different services. Referrals and test results were managed in a timely way by specialist teams who were responsible for overseeing these processes.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

Staff we spoke to were aware of how to make safeguarding referrals and knew the identity of the practice safeguarding leads if further advice was needed. They also shared examples of how they identified and shared concerns quickly and appropriately.
 

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.
Leaders told us that staff were informed in managing risk, and that standing items such as safeguarding and incidents were discussed at all meetings. Staff reported that they were included in risk management, and that they were happy to report when things went wrong. Staff also received fire safety and health and safety training.
 

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.
Staff we spoke to knew where to find emergency medicines and equipment. However, we found that at one site that emergency equipment was not always available and maintained. For example, the site did not hold oropharyngeal airways. The service was not able to provide a formalised risk assessment for not holding this equipment, although one of the missing items was ordered by the practice during the assessment.
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.
 

There was a range of clinical and non-clinical roles within the practice, and staff received effective support, supervision and development. 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. They worked together well to provide safe care that met people’s individual needs.
The service made sure there were enough qualified, skilled and experienced staff to provide safe care. However, staff we spoke to felt they would be more effective if staffing levels were increased.
 

The service assessed and managed the risk of infection. The practice had a designated infection, prevention and control lead and all staff had received relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.
We observed that the service was clean, and all the clinical areas at the practice were fit for use. Curtains were changed regularly, and sharps and other clinical waste management was managed appropriately. Staff we spoke to knew how to access and use a spillage kit when needed.
 

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.
Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely.
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.
The provider had systems to manage and respond to safety alerts and medicine recalls, however they were not always effective. The service was unaware of a safety alert regarding mirabegron (used to treat bladder conditions), which advised there was a need for regular blood pressure monitoring.
We also found that the provider did not have effective systems in place to monitor patients who had been prescribed some high-risk medicines. Most medicines were being prescribed safely; however, we noted that not all prescribed medicines were being monitored in line with national guidelines. We reviewed clinical records for patients who had been prescribed medicines which required routine monitoring. Patients who had not received the required monitoring included those who had been prescribed medicine used to treat mood disorders, patients prescribed a medicine commonly used to treat neuropathic pain and patients prescribed a medicine used to treat bladder conditions. The provider has since taken steps to address these omissions.