Archived: Mersea Island Medical Practice

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.

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 practice demonstrated a positive culture of safety. We saw they listened to concerns about safety and investigated and reported safety events. Evidence was seen that lessons were learnt and actions had been taken to embed good practice.

Staff told us they felt able to raise concerns without retribution. Leaders told us they encouraged staff to raise concerns. We reviewed meeting records and found the team discussed significant events, learnt, and acted on them. The practice had processes for staff to report incidents, near misses and safety events. They used a system to record and investigate complaints and saw staff apologised and gave people support when things went wrong. The practice shared events and actions taken with both the practice staff and the PPG.

The practice worked with local healthcare partners to establish and maintain safe systems of care, where safety was managed and monitored. They explained how continuity of care was maintained, including when people moved between different services.

We received positive feedback from the people we spoke with relating to the timely management of their test results, appropriate referrals, and access to repeat prescriptions. Residential home representatives confirmed people who had recently moved into a residential home were able to register with the practice, and the service provided met their residents’ needs.

We saw tests results at the time of our assessment had been acted on within 48 hours. The practice had a process to ensure cervical cytology results were received and acted on appropriately. The practice worked with other healthcare providers to deliver shared care including when people moved between services.

The practice worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The practice protected peoples’ right to live safely, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The practice shared concerns appropriately. People we spoke with had no specific views or concerns in this area. Staff told us they had received training in safeguarding children and adults; they were confident to report any concerns and knew who the safeguarding leads were at the practice. Safeguarding policies and procedures were in place, and staff knew where to find them.

The practice understood the needs of vulnerable people and reviewed those at risk regularly. The practice held regular meetings where safeguarding concerns were discussed. We reviewed the meeting minutes and saw actions to be taken were discussed and documented in people’s records.

We viewed the arrangements were in place to follow-up vulnerable people who had not attended for a healthcare appointment, this included for example, post-natal, and secondary care appointments for children and vulnerable adults. We found the safeguarding review process at the practice included recording all household members to support staff understand the concerns affecting all those in a household that could be at risk.

People told us staff worked with them to understand and manage their health risks. Staff showed us they had the appropriate information available to provide care that met people’s needs. This ensured people were safe and supported, and staff had documented what mattered.

Residential home representatives told us practice clinicians involved people, their carer’s, and family appropriately to ensure care and treatment plans met individuals’ needs and preferences.

Staff confirmed they had guidance to recognise, assess, and manage people whose health was deteriorating, and to manage medical emergencies. Emergency equipment was available and maintained. Staff we spoke with told us they knew the action to take if people’s health was deteriorating. The practice had an accessible daily duty GP available for advice and support during the practice open core hours when necessary.

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

We saw potential risks were monitored with risk assessments to mitigate risks in the practice environment. The practice equipment, facilities and technology supported the delivery of safe care. People who provided feedback at this assessment told us they felt safe receiving their care and treatment and had no concerns about the practice’s environmental safety.Ongoing checks relating to fire safety, electrical safety and equipment calibration were up-to-date and completed.

During the onsite assessment, we observed fire exits were clear and fire safety equipment was available and had been checked.

There was a business continuity plan in place which was held securely off site, it was regularly reviewed and updated.

Staff told us they were encouraged by leaders within the practice to undertake both mandatory and role specific training and were given time and support to undertake training and development. Staff told us they worked well together as a team to provide safe care to meet people’s individual needs.

Feedback from people and representatives from residential homes were positive about the knowledge of clinical staff and the clinical care provided by the practice.

We reviewed the practice recruitment processes including assurance that professional registration of clinical staff was checked at the time of recruitment and on an ongoing basis. All new staff had received a comprehensive induction programme tailored to their role, with shadowing until they were confident.

Staff members told us they felt supported by leaders and colleagues in their teams and received appropriate supervision and audited their work for assurance it met their agreed areas of competence for example, the advanced nurse prescriber’s work was regularly audited.

We observed appropriate processes and procedures in place at the practice to assess and manage the risk of infection. The practice had an updated policy and an infection prevention and control (IPC) lead. The IPC lead carried out regular monitoring, audits, trained practice staff in IPC techniques, and attended IPC meetings. The legionella water checks, and handwashing audits ensured staff followed safe practices. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings). The IPC lead had support from the Integrated Care Board (ICB) IPC lead, and a GP Partner at the practice for advice.

Feedback we received from people at the time of this assessment was positive in respect of the cleanliness of the practice environment.

We saw cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions had been taken to mitigate risks.

There were records of equipment cleaning and appropriate arrangements to manage clinical waste in place.

Staff told us they had no IPC concerns about the systems in place for safely dealing with clinical specimens and spillage kits were available.

The practice had systems in place to support the safe and effective use of medicines. The practice ensured medicines and treatments were safe, and met people’s needs, capacities, and preferences. People told us they were involved in managing their medicine, this included when changes were made to their care and medicine treatments.

Medicines were stored securely, and prescription stationery was tracked and logged. Fridge and room temperatures were monitored daily at the practice. The policy showed the process for responding to temperature control for medicine, including escalation, quarantine, and 2 temperature sources to ensure the accurate capture of information about any deviations from the required temperature control.

Emergency equipment such as a defibrillator and oxygen cylinder were available and routinely checked. Expiry dates of emergency medicines were recorded, and at the time of this assessment we found emergency medicine stock to be appropriate and in line with best practice guidance.

We received positive feedback from 4 people in relation to medicines management during the onsite assessment. They told us they were regularly called into the practice to have their medicine reviewed. The residential home representatives told us the repeat prescription ordering process worked well, people’s medicines were regularly reviewed, and staff answered and dealt with any queries in a timely manner.

Repeat prescribing was supported by effective procedures and staff were clear about the escalation process for urgent reviews. Discharge summaries were reconciled promptly and uploaded to the clinical system, ensuring timely actions when other providers changed medicines.

Patient Group Directions (PGDs) were in place, up to date, and authorised by the clinical lead. Nursing staff were appropriately authorised to administer medicines under PGD’s. Staff also described designated lead roles among nurses, covering areas such as diabetes, respiratory care, infection prevention and control, and residential homes support.

The practice received safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA). There was a standing item on the weekly practice meeting to discuss alert, and we saw evidence that actions for people affected had been acted on and completed.

A CQC GP Specialist Advisor (GP SpA) performed remote searches of patient records and identified 4 people prescribed a medicine subject to a patient safety alert who did not appear to have received the information required for the medicine they were taking. During the site assessment 2 days after the remote searches had been performed, we were given assurance these people had received information or no longer required the information, and people’s records were documented appropriately.

Searches indicated that some people prescribed a direct oral anticoagulant (DOAC) some had not received all the monitoring to meet best practice guidance within the suggested time frames. This was discussed with the GPs at the remote interview with the GP specialist advisor. We were given assurance at the site assessment that these people were having monitoring arranged.

Searches indicated that people prescribed Disease Modifying Anti-rheumatic Drugs had all received their appropriate monitoring however, in the 4 randomly selected records reviewed; 4 did not have the condition they were taking the medicine for recorded in their records, and 4 did not show the day of the week the medicine should be taken. At the site assessment we were given assurance that changes had been made to people’s records and that checks in the future would ensure these were not missed from records.

Searches indicated people prescribed a medicine used in heart failure had not all received monitoring within the last 6 months. This was discussed with the GPs at interview, and we received assurance at the site visit that monitoring had been arranged, we were told that future checks would ensure they were not missed.

Searches indicated people prescribed medicine to reduce blood sugar levels had not all received the correct advice. This was discussed with the GPs at interview, and we received assurance at the site visit that this advice had been given however not coded in records so the searches could not identify the advice. At the site visit we received assurance that a new process to code the advice given would ensure the effective practice future monitoring.

Searches indicated people prescribed medicines that require an additional medicine to reduce stomach acid damage revealed some had not received the medicine or there was no recorded reason why they had not received the medicine. This was discussed with the GPs at interview, and we received assurance at the site visit that those not receiving the medicine were being reviewed. A new practice process ensured people received the medicine appropriately or the reason they were not taking the medicine was recorded.

Searches revealed people prescribed medicines that require a follow-up after being prescribed a steroid showed not all received it within the guidance timeframes, we also noted that it had not been recorded in peoples notes if they had been provided a steroid card. This was discussed with the GPs at interview, and we received assurance at the site visit a new process had been put in place.

Searches indicated not all people with hypothyroidism had received monitoring within the guidance timeframe. This was discussed with the GPs at interview, and we received assurance at the site visit these people were having monitoring arranged and a new process had been put in place to ensure they did not miss future monitoring.

Searches revealed we saw all people had received the correct monitoring within the guidance timeframe who had chronic kidney disease.

During the searches, the GP specialist advisor identified that people with Diabetes, were appropriately monitored.