Hurley Clinic

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 inspection, we rated this key question as requires improvement. At this inspection, the rating for this key question was good, although we found that there was a single area in which the service was not providing safe services.
This was because patient group directives (PGDs) used to authorise nursing staff to administer vaccinations, and some other medicines did not provide the correct authority for treatments to be provided. This mean the service was in breach of the regulation in relation to medicines optimisation.
 

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.

Staff we spoke with were aware of how to raise incidents. They told us learning was shared with them on both an individual basis, and organisation wide. Leaders detailed how they supported the process, and staff as required.
There was a system for recording and acting on events and incidents. The service provided details of how they reviewed and investigated all reported events in the past year. The documentation included where learning had been shared with both individuals and the wider team. The service identified themes and took action to improve safety in the service. A newsletter was also in place to share learning from complaints and internal reviews.
The service learned from external safety events and had a system for monitoring patient safety alerts. Alerts were clearly documented, including details of actions taken following receipt.
 

Staff we spoke with were aware of care pathways, including referrals and managing care of patients who had been discharged from other services. Leaders at the service shared relevant information with staff in team meetings.
The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored, and had processes in place to ensure that referrals and discharges were managed quickly. There were also systems in place to ensure that where care was also being provided by community or secondary care providers, information was shared between organisations, for instance, when blood tests and monitoring were undertaken by another provider.
 

The practice had 2 safeguarding GP leads who were allocated time to review patients when there were safeguarding concerns. Staff at the service with whom we spoke were aware of how to make safeguarding referrals and knew the identity of the safeguarding lead if further advice was needed.
The service worked with other agencies to support patients and protect them from neglect and abuse. Staff took steps to protect patients from abuse, neglect, harassment, discrimination and breaches of their dignity and respect.
The provider carried out staff checks at the time of recruitment and on an ongoing basis where appropriate. Disclosure and Barring Service (DBS) checks were undertaken where required. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.
All staff received up-to-date safeguarding and safety training appropriate to their role.
 

The service worked 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.
Leaders told us staff were informed in managing risk, and safeguarding and incidents were standing items to be discussed at all meetings. Staff reported they were included in risk management, and that they felt supported and listened to when things went wrong. Staff also received fire safety and health and safety training.
 

We observed both premises were fit for use. All equipment had been checked and calibrated as required. The service had a full range of emergency medicines and equipment (for instance, a defibrillator and oxygen) in place at both sites to ensure emergencies could be safely managed.
Staff at the service were aware of where all emergency equipment was stored. Leaders at the service were able to detail the policies and procedures in place to ensure the environment was safe.
The service had undertaken a full range of risk assessments to ensure the environment in both premises was safe. This included health and safety assessments. Where there was learning from these risk assessments, we saw the service acted quickly to address any specific issues raised.
 

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 worked within their agreed areas of competence. Safe recruitment practices were followed. Staff worked together well to provide safe care that met people’s individual needs. We found the service used an innovative approach to improving outcomes for patients requiring gynaecological care by employing a primary care consultant gynaecologist. The service demonstrated that access to a gynaecologist led to earlier interventions and improved outcomes for patients. The service had a clear induction program. Staff told us the induction when they started at the service had been helpful. Staff also received 1 to 1 and team support from managers and received appraisals. The service made sure there were enough qualified, skilled and experienced staff to provide safe care. Employees who we spoke with said they felt there were sufficient staff at the practice.
 

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 at both sites from which the service operated. Risk assessments and audits were completed, and actions taken to mitigate risks.
We observed 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 with knew how to access and use a spillage kit when needed. However, we noted that some of the clinical rooms at the Riverside Medical Practice site contained a spare chair (not for the patient) with fabric bases and backings which were not wipeable.
 

The service did not always make sure processes in place to oversee medicines and treatments were safe and met people’s needs, capacities and preferences.
As part of the assessment, we reviewed patient group directives which authorise non-medical staff to administer specific treatments including vaccinations. We noted several of these directives were recorded on incorrect templates. The service should have been utilising London/southeast ICB templates but instead were using templates for East of England. As a consequence, these directives were not valid for the purpose for which they were being used, and staff were therefore not authorised to administer medicines.
We noted all of the clinical rooms at the service had medicines for treatment of anaphylaxis. We noted 2 of the rooms at the Hurley Clinic site were very warm on the day of the assessment, and did not have thermometers in place to monitor the heat of the room. Adrenaline was stored in these rooms which must be stored at 25 degrees Celsius or lower. We were not assured that medicines were always stored at the correct temperature. Provider representatives told us they would address this following the assessment.
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.
We carried out searches on the practice’s clinical records as part of our assessment. When blood tests were required for certain prescribed medicines, these were up to date in the majority of records we reviewed. For example, we reviewed patients who had been prescribed an angiotensin-converting enzyme (ACE inhibitor) or Angiotensin II receptor blocker. Of 1215 patients prescribed these medicines, only 14 were not up to date with monitoring. We reviewed 5 of these 14 cases and in all cases, patients had been regularly followed up, with reduced doses of medicines provided until tests were up to date.
Provider representatives told us that they would address these omissions following the assessment.