Northway 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 remains the same.

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.

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.

Managers encouraged staff to raise concerns when things went wrong. The provider had established systems for staff to report incidents, near misses and safety events. The practice had recorded 17 significant events in the last 12 months. A root cause analysis was undertaken and learning from incidents and complaints resulted in changes that improved care for others.

Staff we interviewed during the CQC assessment demonstrated awareness of the significant event process and confirmed that learning points were shared in relevant meetings.

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 to ensure all patient information including laboratory test results and referrals were reviewed and actioned in a timely manner. Referrals to specialists and urgent services, including 2-week-wait (2WW) referrals, were managed through a clear process.

The provider was part of the primary care network (PCN) and attended regular meetings with other agencies across the locality to share and discuss information relating to patient care and treatment. There were a range of structured meetings in place. These included safeguarding, multi-disciplinary and practice team meetings.

The service 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 service shared concerns quickly and appropriately.

The service had effective systems in place to protect people from the risk of abuse and neglect. Staff worked collaboratively with partner agencies to safeguard patients and ensure appropriate information sharing when concerns were identified.

Clear safeguarding systems and processes were established to enable timely action where abuse or neglect was suspected. A nominated safeguarding lead was in place, and staff received safeguarding training appropriate to their roles and responsibilities. Staff demonstrated a good understanding of safeguarding and were confident about the actions they needed to take if they had concerns about a patient’s safety.

Patient records included up to date clinical read codes and alerts to clearly identify safeguarding concerns, supporting effective monitoring and continuity of care.

Recruitment procedures were in place to ensure that staff were suitable to work within the service, including appropriate pre-employment checks.

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.

All staff were trained in basic life support and staff could recognise a deteriorating patient. They knew of the action to take if they encountered a deteriorating or acutely unwell patient and had been given guidance on identifying such patients. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Emergency equipment was available and maintained.

Leaders told us that they worked with services locally to understand and manage risks. The practice also had registers in place to support those patients who were vulnerable or who had mobility or communication needs.

The service was located in a purpose-built building with all required aids, adaptations and facilities to ensure the premises were fully accessible for all people.

The provider detected and controlled potential risks in the environment. They made sure equipment, facilities and technology supported the delivery of safe care. Regular checks were carried out on the premises, facilities and equipment provided. Contracts were in place to ensure the premises were clean and well maintained.

Health and safety related assessments and procedures to manage health and safety were in place, including those related to fire safety. Staff had been provided with training in health and safety related topics such as fire safety and infection control. Staff told us that they had no concerns with the arrangements in place for ensuring health and safety.

There was a business continuity plan in place to provide guidance for dealing with a major disruption to the service, for example an IT failure.

The service made sure there were enough 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.

The practice employed a range of clinical and non-clinical staff to support service delivery. Staff training was up to date, and learning needs were appropriately identified and supported. Staff were working within their defined areas of competence which was supported through audits and protocols.

A recruitment policy was in place, and a review of personnel files confirmed that safe recruitment was consistently followed. Records of staff immunisation status were maintained, and all staff had completed annual appraisals. New staff participated in a structured induction programme and were required to complete mandatory training within appropriate timeframes. Staff were supported to deliver safe care through access to relevant training and development opportunities.

The service 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 prevention and control (IPC) lead, and all staff had completed training relevant to their roles. Staff were aware of the systems and processes required to ensure clinical specimens were handled safely.

The practice had IPC policies in place, which were accessible to staff. An infection control audit was completed in the last 12 months to identify potential risks and ensure appropriate action was taken where required. At the time of the assessment, the practice had achieved 99% overall compliance.

The service always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They always involved people in planning, including when changes happened.

We carried out a random selection of clinical searches to review how patients’ medicines were monitored and if the appropriate care and treatment was being received. For example, clinical searches identified 4 patients prescribed methotrexate, an immunosuppressant medicine, within the previous 6 months who may be overdue monitoring. We reviewed the records of 4 patients and found that appropriate monitoring was in place in line with guidance.

As part of the assessment, we reviewed the number of people who had been prescribed medicines to reduce the risk of blood clots forming called direct oral anticoagulants (DOACs), who had not received the appropriate monitoring in the past 10 months. The search identified 20 patients on these medicines who were overdue monitoring. We reviewed 5 clinical records and found these to be satisfactory.

We carried out a search to identify the number of patients with a potential missed diagnosis of diabetes. The review of HbA1c (HbA1c is a blood test that shows the average level of blood glucose) results demonstrated that all patient results had been appropriately reviewed and acted upon in line with clinical guidance.

A search was undertaken to identify patients who had received a medication review within the previous 3 months. This search identified 815 patients. A random sample of 5 patient records was reviewed. Whilst medication reviews had been completed in all sampled cases, the level of detail recorded in the patient records, in some instances, lacked sufficient detail.

The practice worked with the clinical pharmacists from the local Primary Care Network (PCN) to monitor people and the prescribing of medicines. All safety alerts were sent to the practice manager to disseminate the information. The provider was able to demonstrate they had processes in place in relation to safety alerts issued by the Medicines and Healthcare products Regulatory Agency (MHRA). We carried out a clinical search to identify women of childbearing age who were prescribed teratogenic medicines, which have the potential to increase the risk of birth defects. The search identified 19 patients prescribed these medicines who required a Pregnancy Prevention Programme (PPP) and an annual risk acknowledgement form. We reviewed 5 patient records and found that 1 patient was no longer prescribed the medicine, 2 patients had completed the annual risk acknowledgement form, and 2 patients required this to be completed. The practice confirmed this would be actioned. Other clinical searches undertaken in response to safety alerts demonstrated that appropriate compliance arrangements were in place. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

Emergency medicines, vaccines and medical equipment had clear monitoring processes in place. There were appropriate arrangements in place for the management of vaccines and for maintaining the cold chain. We saw fridge temperatures were routinely monitored and vaccines reviewed at random were in date and stored appropriately. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. 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 in line with national averages.