Ashfields Primary Care 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 assessed all the quality statements in this key question. At our last assessment, we rated this key question as good. The rating remains good following this assessment.

Systems were in place to protect people from abuse and avoidable harm. We found safety was a priority, and the provider took concerns seriously. Feedback from people who used the service indicated that overall, they felt they received safe care and treatment. The provider acted upon feedback from people and made improvements to the service in response. Safety events were investigated, and lessons were learnt to identify any shortfalls, prevent a recurrence, and embed good practice. Overall, members of the staff team provided positive feedback about staffing levels. Systems and procedures were in place to safeguard patients who may be at risk of abuse. Staff had undergone checks to ensure they were suitable for employment, and they had been provided with safeguarding training at a level appropriate to their role. Procedures for managing health and safety were in place. The premises were safe and well maintained. There were processes for monitoring patients’ health in relation to the use of medicines including medicines that require regular review. We found that medicines were managed safely. We identified some areas for improvements that were either being worked on by the provider or were addressed by the provider during the assessment process.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong staff apologised. Learning from incidents and complaints resulted in changes that improved care for others. The provider held a log of significant incidents and a log of complaints which they used to identify themes and trends. The provider was piloting the NHS England national approach to responding to patient safety incidents for the purposes of learning and improving services. They reported that the reporting rate of incidents had increased with improved systems to support this. Leaders told us how they encouraged staff to raise concerns when things went wrong. Staff feedback indicated they knew how to report a safety incident. Most staff felt that they would be supported to raise concerns. We saw evidence of meetings with staff to discuss safety concerns and actions taken. However, some staff told us they were not always given the outcome of safety incidents and actions required.

Feedback showed that people felt involved in decisions about care and treatment pathways. Reception staff had been trained in care navigation to direct patients to the most appropriate service or services to meet their presenting needs. The provider worked with people who used the service and healthcare partners to establish and maintain safe systems of care. There were systems and processes to share information with staff and other agencies to enable them to deliver safe care and treatment. Clinicians followed care and treatment pathways for treating and referring people to other services. Regular multi-disciplinary meetings were held where the needs of patients with more complex needs or those approaching the end of life could be discussed. Processes were in place to ensure referrals to secondary or specialist care were made promptly, and urgent referrals were monitored to ensure people had undergone the required investigations. There were safe processes in place for reviewing test results. Correspondence from secondary care such as discharge letters/summaries were processed appropriately. Non-clinical staff processed some results in accordance with clear guidance, procedures and clinical support. We noted that although there was clinical oversight of this process, these checks were not recorded.

The service worked to safeguard people from the risk of abuse. This included working with partner agencies to share information. There were systems and processes to respond when it was suspected that people may be subject to abuse or neglect. Staff had been provided with safeguarding training at a level that was appropriate to their roles and responsibilities. Safeguarding updates were provided at staff meetings. Staff, including safeguarding lead staff, had a clear understanding of safeguarding and how to take appropriate action to respond to concerns. Alerts were added to the patient record system when there were safeguarding concerns about a patient so that all relevant members of the staff team could readily identify this. The service worked with stakeholders to safeguard patients and was working alongside local police on a hate crime reporting project to enhance accessibility to hate crime reporting and therefore improve patient safety.

The service worked with people to understand and manage risks. A system was in place to respond to medical emergencies. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Patients were directed to the most appropriate clinician or service to meet their needs and this included supporting people that may need urgent care and treatment. Staff were trained in the management of long-term health conditions such as diabetes and chronic obstructive pulmonary disease (COPD). A system was in place to recall people for regular checks on their health when they had a long-term condition. When people did not attend, they were followed up. People who used the service were referred to services that could provide them with specialist advice to manage their condition and the risk of deterioration.

The provider had systems in place to identify and manage potential risks in the environment. They made sure equipment, facilities and technology supported the delivery of safe care. Regular checks were carried out on most of the premises, facilities and equipment provided. Contracts were in place to ensure the premises were well maintained however the emergency lighting was tested regularly but had not been serviced in the last 12 months. A plan was in place to address this. Health and safety related assessments and procedures to manage health and safety were in place. This included fire safety. An accessibility assessment had also taken place. Staff had been provided with training in health and safety related topics such as fire safety, infection prevention and control and moving and handling. Staff told us in discussions and feedback forms that they had no concerns with the arrangements in place for managing 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.

There were enough qualified, skilled and experienced staff, who received effective support, supervision and opportunities to develop. All new staff underwent an induction programme and were required to undertake mandatory training within an appropriate timescale. There was a system to monitor staff training to ensure mandatory updates were completed. Staff were supported to develop their skills and learning. Staff told us they had protected learning time for them to undertake training and professional development and that they had received training appropriate and relevant to their role. There had been a number of staff changes in the last two years, there were currently minimal vacancies and processes had been put in place to encourage staff retention. Overall, staff told us that they felt there were enough staff to provide safe care, and they worked effectively as a team. The provider made sure that staff were suitable for employment. We looked at the recruitment records for a sample of staff. These showed recruitment practices were carried out in line with legal requirements. However, we noted that continuous professional development had not been robustly recorded in one record we looked at to demonstrate on-going competence and skill. This was brought to the attention of the provider to be addressed.

The facilities and premises were appropriate to support cleaning and infection prevention. Personal protective equipment was in sufficient supply and located appropriately around the premises. Procedures were in place to prevent the risk of infection. There were clear roles and responsibilities around infection prevention and control with a dedicated lead person. Staff had been provided with training in infection prevention and control, and they told us they were aware of their roles and responsibilities in this. Cleaning schedules were in place and infection prevention control and cleaning audits were carried out on a regular basis. Cleaning equipment was stored securely. The arrangements for managing waste and clinical specimens kept people safe.

We reviewed clinical records for patients who had been prescribed medicines which required routine monitoring. Our review showed that medicines were managed safely overall and the approach to medicines reflected current and relevant best practice guidance. The provider had standard operating procedures for managing repeat prescribing for patients who failed to attend for related health checks. Staff had access to emergency medicines and equipment including oxygen and a defibrillator. These were regularly checked for stock availability and to ensure they were in date. Vaccines were stored appropriately, and regular checks were carried out. The provider had effective systems to manage and respond to safety alerts and medicine recalls. We looked at a sample of medicines reviews and although appropriately coded they did not contain information about what was done, and which medicines were reviewed. The provider told us that clinicians worked to a protocol for how medicines reviews were carried out. The provider told us work was taking place to put this into a template so that this could be standardised in patients records. From a sample of patient records we found that not all patients who had been issued 10 prescriptions for benzodiazepines or Z drugs (medicines that produce a calming effect and usage can lead to adverse side effects and dependence) had received a medicines review in the last 12 months. The provider was working on a process to encourage patients to attend these reviews with a review to reducing their use. We noted that the specific information relating to medicines used for minor operations was not recorded in patients records. The provider put a template to address this in place during the assessment.