East Park Medical Centre - R P Pandya

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 people were protected from abuse and avoidable harm. At our last assessment, we rated this key question as requires improvement. At this assessment, the rating has changed to good. People were safe and protected from avoidable harm.

This service scored 66 (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. Staff followed their processes and listened to concerns, reported and investigated them. Managers encouraged staff to raise concerns. Incidents and complaints were discussed in practice meetings to ensure lessons were learnt and embedded in good practice. Compliments were also shared amongst staff. Representatives from the patient participation group (PPG) felt the practice listened to their feedback and took appropriate action to make improvements to the service.

The practice worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. The practice worked with other providers and services to ensure continuity of care, including when people moved between different services. There were arrangements to ensure a safe and timely review of test results. Staff understood the referral system and were able to tell us about the process for dealing with referrals, ensuring they were followed up accordingly.

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. An effective system was in place for the management, oversight and reviewing of safeguarding concerns, including a safeguarding register and regular safeguarding meetings. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. Staff knew how to identify, report and act when dealing with safeguarding concerns. There were two safeguarding leads that who gave examples to showcase their work to safeguard patients. They worked well with other healthcare professionals to ensure the concerns were addressed appropriately. Chaperones were available upon request.

The practice worked well with people to understand and manage risks using a holistic approach. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. 90%of respondents to the National GP Patient Survey felt they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. This was in line with the national average. Patients identified as being at increased clinical risk were proactively monitored and reviewed, helping to reduce avoidable harm and unplanned hospital admissions. Patients received clear, timely information about the risks associated with their condition and were supported to understand what steps to take should their health deteriorate.

The practice detected and controlled potential risks in the care environment. However, they did not always make sure equipment, facilities and technology supported the delivery of safe care. The practice did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. Portable appliance testing and calibrations was completed for most equipment. However, during the site visit, we found the defibrillator in the main site was not up to date with its calibration. Following this feedback, leaders provided evidence that an appointment had been made to address this issue. At both the main practice and branch location, the battery for the defibrillators was found to be detached from the devices and stored separately. This meant there was a risk that the defibrillators would not be immediately available for use in an emergency. During the visit, the practice provided evidence showing the defibrillators were regularly monitored to check functionality.

The practice completed health and safety audits to identify and control potential risks in the environment. Although external fire and legionella risk assessments had not been completed, these appointments had been booked, and the practice had completed their own internal risk assessments. Systems were in place to check safety equipment such as fire alarms and fire evacuation drills were completed on a quarterly basis. There was a business continuity plan in place that was reviewed on an annual basis.

The practice made sure there were enough qualified, skilled and experienced staff that worked well together to provide safe care and meet people’s individual needs. Except for the GP partners, all GPs working at the practice were employed on a long term locum basis, therefore continuity was not impacted. Appropriate recruitment processes were followed to help ensure a safe and effective workforce. Personnel records contained the required recruitment documentation, except some immunisation records were not complete.

There were a range of clinical and non-clinical roles within the practice. Staff were working within their agreed areas of competence and had completed mandatory training. Staff had annual appraisals including a personalised development plan which have staff an opportunity to learn and develop. Alongside appraisals, clinical staff had supervision and regular notes audits. Staff feedback reflected they were happy within their roles and felt supported by their colleagues.

The practice did not always assess and manage the risk of infection appropriately. During the visit, we identified a phlebotomy chair at the branch site that was ripped with the sponge exposed. The chair could not be sufficiently cleaned and therefore had a high infection risk. The provider addressed this feedback promptly and took action to replace the chair. Cleaning contractors had completed cleaning sheets ahead of time, this made it difficult to identify when the toilets had last been cleaned. However, the premises were mostly clean, except for some areas of the practice with carpet. Clinical rooms were clean and had adequate provision of personal protective equipment (PPE) and handwashing facilities. The practice had appointed a designated infection prevention and control (IPC) lead, and staff had completed appropriate IPC training relevant to their role. There was an IPC policy, and IPC audits were completed. There were arrangements for clinical waste to be collected regularly.

All medicines, including emergency medicines were stored in a heavy locked box with no tamper proofing which was not practical in the event of an emergency. Leaders responded positively to feedback and took action to improve this. Staff regularly checked medicine stock levels and expiry dates, including emergency medicines and vaccines. Medical gases such as oxygen were stored safely. Fridge temperatures were monitored daily, and staff knew what action to take if the temperature was out of range.

Aspart of our assessment, a series of patient clinical record searches were carried out by a CQC GP specialist advisor. This assessed whether clinicians were prescribing medicines safely and whether patients were reviewed when taking medicines that required monitoring.

We identified a total of 2,068 medication reviews that had been completed for patients in last 3 months. We reviewed a random sample of 5 medication reviews and found 3 patient records lacked sufficient detail to provide assurance that medication reviews had been fully documented in line with best practice. The practice was responsive to this feedback and took action to strengthen documentation processes, implementing changes to improve the quality and consistency of medication review records.

Our clinical record searches reviewed medicines that require monitoring. We reviewed patients prescribed Methotrexate (an immune system suppressant drug). All patients identified were monitored in line with guidance. We also reviewed patients prescribed Warfarin (a drug used to prevent blood clots). All patients identified were monitored in line with guidance.

There was a process in place for recording and sharing Medicines and Healthcare Products Regulatory Agency (MHRA) safety alerts. Our clinical record review highlighted that safety alerts were actioned in line with guidance.

Our clinical record search reviewed patients that had a potential missed diagnosis of diabetes or chronic kidney disease (stages 3, 4, or 5). We concluded there were no missed diagnoses.

Another clinical search reviewed patients prescribed bisphosphonate (a drug used to maintain or increase one density) for 5 years or more. All patients identified were monitored in line with guidance.