Norton 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 Requires Improvement, at this inspection the rating has remained the same.

The service was in breach of legal regulation in relation to safe care and treatment and fit and proper persons employed.

This service scored 56 (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 did not have an proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not investigate or report all safety events. Lessons were not learnt to continually identify and embed good practice. People reported feeling discriminated against when they raised concerns about safety and ideas to improve, and the providers primary response was to dismiss these.

Staff told us they did not feel supported in raising concerns or speaking to leaders. We reviewed information where staff had attempted to discuss poor practice and had been told by leaders that it was not to be discussed. The same incident had not been recorded on the significant events log that we reviewed. Representatives from the Patient Participation Group (PPG) felt the provider did not take concerns seriously and felt that more recently aside from changes to the triage system, there had been a lack of any other changes.

Managers did not encourage staff to raise concerns when things went wrong. Staff did not feel there was an open culture, and that safety was a top priority. The provider had processes for staff to report incidents, near misses and safety events. However, we were not assured all incidents were being logged. At the time of assessment, we reviewed information relating to patient safety. We found this was not being logged accurately or in a timely manner. Furthermore, we established this was not reported to NHS England in line with their Reporting Safety Incidents Policy. We identified errors within Patient Specific Directions (PSD’s) that had not been identified by staff within the practice.

There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. However, staff told us they were only directly invited to meetings if the context was relevant to them. This meant that opportunities to share learning more widely across the staff team were missed. It was unclear at the time of our inspection how important information was shared. The practice manager told us staff had requested changes in communication; however, this had not been embedded.

The practice worked well with people and healthcare partners to establish and maintain safe systems of care. There was continuity of care, including when people moved between different services. Since our last assessment the practice had made improvements regarding care home patients, and how they sought feedback on how these patients were cared for. We received feedback from care home managers who told us the practice had been pro-active in improving issues raised at the last assessment.

There were systems in place for processing information relating to new patients. The practice worked with other providers to deliver shared care and when patients moved between services. Referrals and test results were managed in a timely way. Staff told us they were concerned that this system was at risk due to changes in staffing policies, and changes to overtime. Leaders told us they had procedures in place to prevent this, which considered staffing skill mix and utilising this across the practice. For example, a clinical coder would cover reception when required. These changes were new. Leaders told us that staff were only asked to cover for others on an ad hoc basis.

We could not be certain at the time of the assessment the impact cross cover working would have. This will be reviewed at our next assessment.

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. The practice shared safeguarding concerns quickly and appropriately. 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. The processes around safeguarding had improved since our last assessment and the practice had taken steps to ensure that the administrative lead had completed extra training to carry out their role effectively. We saw evidence that safeguarding meetings were happening regularly. Staff members knew who safeguarding leads were.

The practice 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.

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. Leaders provided us with 2 recent examples of scenarios where this policy had been initiated due to patients requiring emergency attention within the practice. Teams involved in these incidents were invited to a de-brief to discuss what had worked well.

The practice 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, prior to our inspection the practice had taken on new cleaning staff. The practice was clean at the time of our site visit and cleaning logs were up to date. 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. The practice had carried out a recent fire drill which involved all staff.

The practice did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

There were a range of clinical and non-clinical roles within the practice. We found training was mostly up to date, learning needs and development of staff was managed appropriately.

We are aware that since our assessment, a number of staff have left the practice. We are unsure of plans to recruit into these vacancies.

Safe recruitment practices and local policies were not always followed. We are aware that 2 members of staff have been recruited without following local policies. Two members of staff had been recruited without a formal interview. One of these members of staff had no Disclosure and Barring Service (DBS) check in place at the time of commencing employment. This member of staff also had no references in place at the time of commencing employment.

Staff told us that within their own departments they felt supported, however they felt managers ignored their reported concerns relating to staffing numbers. Leaders told us they were training staff to provide cover for others, for example, using administrative staff to cover reception where required.

The practice did not always ensure that all staff, including agency staff, had the right qualifications, skills, knowledge and experience to do their job. We noted gaps in management and support arrangements for staff, such as appraisal, supervision and professional development. We are not assured leaders had oversight of staff competency levels. We noted untrained staff carrying out duties they were not competent to do, whilst this was one incident, leaders and management were unaware until highlighted by CQC during our inspection. We also saw Patient Specific Directions (PSD’s) had not been completed accurately by various members of staff. Staff told us they were also unsure of the working patterns of management, and who was the responsible leader within the practice on any given day. We were told of an incident that took place within the practice recently, whereby staff needed a member of management and no-one was available on site to support them. A GP partner had to offer support in the middle of a clinic.

The practice 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 control lead and staff told us they knew who this was, and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks where required. All staff we observed during our site visit were working within expectations of infection control policies. We observed the practice was clean, tidy and accessible for patients. The cleaning storage was tidy.

The practice did not always make sure that medicines and treatments were safe. They involved people in planning, including when changes happened.

We saw errors in the prescribing of vaccinations; this resulted in 78 patients being vaccinated by a member of staff who the provider had not assured themselves at the time was trained to administer these. We also reviewed evidence which indicated the practice had not managed the Patient Specific Directions (PSD’s) accurately. PSDs are specific guidance on the administration of medicines authorising nurses and health care assistants to administer them. We informed the practice of this immediately, and reported the incident to appropriate external agencies, who told us they would follow this up.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely and were in the process of implementing a new approach to reviews which would provide more streamlined care for patients. Staff managed prescription stationery appropriately and securely.

Staff ensured people received all recommended medicines reviews and monitoring. Since our last assessment the review process had been updated and was working well for patients.

Medicines were stored securely and at appropriate temperatures and we reviewed a clear log and audit trail for medicines. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring.