Walkden 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

The service had a good learning culture and people could raise concerns. We looked for evidence that people were protected from abuse and avoidable harm and found, with regards to safeguarding and child protection, people were protected and kept safe. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. Staff managed medicines well and involved people in planning any changes. There were enough staff with the right skills, qualifications and experience and managers made sure staff received training. However regular appraisals and supervision to maintain high-quality care was not apparent for all staff, especially administrative staff. Managers did not always investigate incidents thoroughly. Staff did not always understand and manage risks consistently.

At our last assessment, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 63 (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 positive culture of safety, based on openness and honesty. They listened to concerns about safety but did not always thoroughly investigate. However, lessons were not always learnt to continually identify and embed good practice.

The provider had processes for staff to report and investigate incidents, near misses and safety events, but the documents in place did not match the written policy or procedure, and the information provided about investigations and learning was generally sparse or incomplete.

Managers encouraged staff to raise concerns when things went wrong and people felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service.

It was clear that leaders listened to concerns about safety, however, investigations and outcomes for reported safety events were not always robust. Lessons were not always learnt and shared to continually identify and embed good practice. For example, we saw evidence that the patient triage policy had been updated to improve how patients who report headaches were triaged, however, there was no evidence of robust changes being initiated when concerns relating to referrals and other issues were investigated.

There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support.

The service did not always work well with people and health system partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care.

Lack of standardised script or algorithm in the triage hub meant best practice might not always be followed. It was not possible to confirm whether triage arrangements and systems to determine the clinical urgency of appointments worked effectively.

There were no standardised procedures or documented ways of checking and confirming all referrals had been made and responded to in a timely manner.

We found that patients were informed about referrals that were going to be made, however, because of the lack of consistency and standardised procedures, effective monitoring and safety netting was not possible, and there was no system to ensure that referrals had been made and received including two week wait referrals.

There were systems in place for processing information relating to new patients. The service worked with other providers to deliver shared care and when patients moved between services.

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.

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. We saw that GP’s conducted or arranged welfare visits to patients when there appeared to be an unexplained change in their behaviour pattern.

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.

Emergency equipment was available and maintained.

Staff had completed basic first aid training, could recognise a deteriorating patient due to cardiac or respiratory emergency and patients were advised on risks related to their condition and actions to take if their condition deteriorated in these instances.

However, more action is needed to ensure staff know about the actions related to dealing with sepsis. This is due to there being no evidence that the whole staff team received appropriately robust training or additional guidance following a concern raised and findings related to how the potential for sepsis had been managed at the service.

The service 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. 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 service 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.

Staff, however, did 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. Staff records indicated that many staff had not received appraisal or supervision since 2022. This was also confirmed by staff. We noted however, that the provider had an appraisal plan in place.

We found training was up to date, however, there was no evidence from supervision, appraisal or competency records that learning needs and development of staff was managed appropriately, or that staff were working within their agreed areas of competence.

One induction completed check-list was available, the record consisted of a tick box and there were no notes or evidence of discussion about progress with the staff concerned.

From our review of staff records we found safe recruitment practices were followed.

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 lead and all staff had received relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The provider worked with two outside pharmacies. One community based the other based within the local hospital trust. They ensured that medicines and treatments were safe and met people’s needs, capacities and preferences. They ensured people were involved in planning and included when changes happened.

Overall, we found that outcomes in medicines management were good. In the main staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely.

Pharmacy 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 followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Medicines including controlled drugs were stored securely and at appropriate temperatures. 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. During the inspection we noted some gaps in the monitoring of a minority of patients prescribed gabapentin. This was raised with the practice and immediate action was taken.

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 keeping with local and national averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

The provider could strengthen this area further by ensuring consistency in communication between all staff and the pharmacy teams.

We found that most of the medicine reviews had been documented to a high standard, however, they could take steps to ensure all medicine reviews are always completed to the same high standard.

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

We noted the prescribing policy and dealing with MHRA alerts standard operating procedure had recently been updated and so any changes needed to be embedded.