Cockfosters 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 69 (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 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.

There was a system to record and investigate complaints, and when things went wrong, apologies and support given to those affected. Staff meetings were used as an opportunity to discuss incidents and complaints, and to ensure any learning was logged and embedded as good practice within the practice. Staff felt there was an open culture, and that safety was a top priority. The practice told us that all staff knew the importance of reporting all incidents, regardless of severity.

The practice had processes for staff to report incidents, near misses and safety events. Learning from relevant incidents were also logged and embedded as good practice within the practice.

Five significant events had been recorded in the previous 12 months, and the practice had systems in place to review these as part of an annual significant event analysis (SEA) to recognise trends or themes. Those we sampled had been reviewed, analysed and shared in line with practice policy. Significant events were discussed with staff to enable actions to improve patient safety, quality of care, and operational effectiveness.

The practice 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 practices.There were systems in place for processing information relating to new patients. The practice collaborated with other practices to deliver shared care and when patients moved between practices. We found systems were in place to ensure referrals and test results were managed in a timely way.We saw that people who had received care in hospital had follow up appointments and medication reviews. There were a range of structured meetings in place including team meetings and short daily meetings. These meetings were used to support safe systems by facilitating discussion and oversight of safeguarding, palliative care, and clinical and operational matters.

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 concerns quickly and appropriately. Safeguarding policies were in place and understood by staff, all of whom were appropriately trained in safeguarding procedures.

Staff had access to a designated safeguarding lead for adults and children. The practice maintained a register of vulnerable individuals and responded proactively to concerns, implementing actions and learning in collaboration with partner organisations and during multi-disciplinary team meetings. We found that safeguarding registers were routinely reviewed and relevant information was shared effectively within the team.

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 and staff could recognise a deteriorating patient and knew of action to take.Staff were trained in sepsis awareness, anaphylaxis, and basic life support training. Staff told us they were comfortable approaching the management team for any advice. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.Reception and administration staff who managed calls to the practice and arranged appointments with the clinical team were aware of potential red flag symptoms. They knew when to notify a GP or other clinicians with concerns about a patient who may be acutely unwell and/or deteriorating. Staff had been provided with training in health and safety related topics such as fire safety, basic life support and resuscitation training.People were engaged in managing risks to their health. They were consulted when changes were made to medicines and were advised of the reasons behind the changes.The practice told us that people with Long Term Conditions (LTC), were reviewed within timeframes and this was supported by our review of clinical notes.

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

During our site visit we found the premises were well maintained. Regular checks were conducted on the facilities and the equipment. The practice detected and controlled potential risks in the environment. Contracts were in place to ensure the premises were clean and well maintained. There was signage around the building to support people and staff in the event of an emergency evacuation. Environmental audits were completed including daily cleaning logs, and weekly inspections. There was a business continuity plan in place which was monitored and reviewed.

The practice made sure there were enough qualified staff, however leaders did not always make sure staff received effective support, supervision and timely development. They worked 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 a mixed uptake of staff training over the last 12 months. The practice used face-to-face training companies alongside online training platforms for staff training. We reviewed 5 staff files and found gaps within all the staff files we viewed. For example, we found that only 3 members of staff had completed health and safety training within the last 12 months. All but 1 member of staff had undertaken infection prevention control training during the last 12 months. Systems were in place to ensure staff received regular supervision and annual appraisals. The sample of staff files we reviewed showed staff received supervision and appraisals annually. Safe recruitment practices were in place. Staff immunisation status records were maintained, and appropriate pre-employment checks had been completed. Where required, individual staff risk assessments had also been conducted.The practice had clear recruitment policies, and all staff had disclosure and barring checks completed. During the assessment we reviewed 5 staff files which confirmed that appropriate checks, including verification of previous employment history had been undertaken.

The practice assessed and managed the risk of infection. It detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

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

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. 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 assessed in relation to medicines optimisation, and felt confident managing the storage, administration and recording of medicines.

Systems were in place for checking and monitoring emergency equipment and medicines. The practice kept recommended emergency medicines and equipment, including oxygen, and defibrillator on site.

Staff used protocols to ensure they prescribed medicines safely, and ensured people received recommended medicine reviews and monitoring. We found minor inconsistencies in using some clinical protocols at the practice, which we discussed with the practice during the clinical records review. As a result of this discussion, the practice provided us with an update of actions they had taken to rectify the inconsistencies identified after the remote clinical records review.

As part of the assessment, we reviewed the practice prescribing of oral nonsteroidal anti-inflammatory drugs (NSAIDs) to over 65 years or antiplatelet medication (medicine prescribed to prevent blood clots) to over 75 years with no proton pump inhibitors (PPIs), to confirm that the practice was prescribing and monitoring these medicines in line with national guidelines. PPIs are primarily prescribed to manage stomach-related illnesses. We identified the practice had 229 patients recorded as being on these types of medication. As part of remote clinical records review, we identified 24 patient records that did not have monitoring undertaken in line with national guidelines. We looked in depth at 5 patient records and spoke with the lead GP at the practice about our findings. After our clinical records search of the practice, the assessment team received assurances from the practice, that all patients identified had been contacted and invited into the practice to discuss treatment.

Established processes were in place to ensure that people prescribed medicines with specific risks received recommended monitoring. The practice prescribing of antibiotics to treat infections was comparable to the national average of prescribing of these drugs.

Relevant staff received regular training and were assessed on medicines optimisation. Staff felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely. Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Waste medicines were disposed of appropriately. Staff stored medical gases, such as oxygen safely.

The practice had systems to manage and respond to patient safety alerts and medicine recalls, but these systems were not always followed. As part of our remote clinical records review, we reviewed prescribing of the medicine Mirabegron (a medicine prescribed for bladder conditions) to specific patients. During our remote clinical records review, we identified that 8 patients out of 45 on Mirabegron did not have a required recent blood pressure reading on their patient record. We looked in depth at 5 patient records and identified that four patients had been contacted by the practice prior to our assessment to provide blood pressure readings. Our clinical records search found that the practice had discussed the risks of taking this medicine with patients.

The practice worked closely with its primary care network (PCN) clinical pharmacist to ensure that prescribing at the practice was in line with local and national guidance.