Albrighton 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.

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

The service was in breach of legal regulation in relation to safe care and treatment.

The service had patients at the heart of what they do and provided a service based on the patients need. During the assessment we identified gaps in the processes to show compliance and assurance which when highlighted to leaders were acknowledged, learnt from and actions taken to rectify. The leaders and staff were open and approachable to the feedback provided and were able to provide reassurance that measures had been put in place and welcomed the opportunity to learn and continually develop.

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 did have a culture of safety based on openness and honesty. They did listen to concerns about safety, however these were not always investigate and reported consistently. Lessons were not always learnt to continually identify and embed good practice.

People using the service felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the PPG felt the service took concerns seriously and proactively made improvements.

There were processes in place for staff to report incidents, near misses and safety events. Staff felt happy and confident to raise any concerns with all leaders and understood the process to do this. There was a system to record and investigate complaints, however there were inconsistencies in the process and learning wasn’t always followed through in a timely, documented and effective way.

Significant events were reported; however the process was not consistent and lacked details for reassurance that a full review had been completed. There was a significant delay in timescale from identifying the event to reviewing in the clinical governance meetings.

Following the onsite assessment, the service leaders provided evidence to demonstrate actions had been completed, they had reassessed the way the process was used and put measures in place to improve the consistency of learning outcomes.

The service 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 services.

The referrals process was clear with various measures in place to ensure they were completed in a timely manner and two week wait referrals were prioritised and actioned promptly. Staff understood how their own role and other roles ensured the process was completed effectively.

There were systems in place for processing information relating to new patients. The service worked well with other services to deliver shared care, such as the out-of-hours service and social support groups such as Shropshire Supports Refugees.

The service made referrals to various additional support services such as a Social Prescriber and Mental Health Practitioner who were available through the Primary Care Network (PCN) and worked collaboratively with various community groups to enhance service users’ health and wellbeing.

The service had already identified an improvement opportunity relating to the processes around incoming information, such as test results, and system tasks completion and monitoring. We saw evidence of improvements and the service openly shared evidence of the audit, outcomes and actions taken so far and plans to implement best practice moving forward.

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 service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

Staff we spoke to had a good understanding of safeguarding and were able to demonstrate confident knowledge on their role and processes relating to safeguarding. There was evidence of staff showing clear compassion and awareness of the importance of following up on all concerns.

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 could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated and all staff were competent in how to identify and act if an emergency occurred or they were concerned about a person’s condition.

The service 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.

Contracts were in place to ensure the premises were maintained. There was a business continuity plan in place which was monitored and reviewed. Work had been completed around fire safety to mitigate risks previously identified within the premises and the service had engaged well with the fire service relating to this.

A health and safety annual review had been completed, this omitted information from other relevant documents such as electrical installation condition report and lacked details of recommendations, required actions and expected completions dates. We have since been provided with evidence that a review has taken place and these have now been included for a clear and accurate review.

Risk assessments had been completed; however they omitted to show assurance that risks had been fully considered. Some risk assessments required more details on control measures to mitigate the risks, confirmed acceptance of risk or details of additional actions required. The service welcomed this feedback and following the onsite assessment had provided evidence, of the new risk assessment format and copies of re-evaluated risk assessments

A sample of medical equipment was checked for routine calibration and testing, most equipment reviewed had received testing within the correct time scale. One clinical room had some medical equipment, such as a blood pressure monitor, which was overdue the required testing and calibration. This equipment was found in storage and brought to the attention of the service, they explained that the room was used ad hoc by visiting clinicians who generally brought and maintained their own equipment, they acknowledged the equipment should have been checked during the annual testing day, it was immediately removed to avoid use and set aside for testing.

The service had a process in place to ensure there were enough qualified, skilled and experienced staff, however, there were inconsistencies in the use of the process.

Staff received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence.

A recruitment policy was in place, but a review of personnel files showed that safe recruitment was not always followed. There were gaps in employment history which hadn’t been checked and clarified. Some newly employed staff had DBS checks completed after starting employment, with no risk assessment in place to mitigate risks. Some files had documented evidence missing such as right to work and qualifications. There was no evidence of safe recruitment assurances for staff conducting Additional Roles Reimbursement Scheme (ARRS) roles employed through the PCN. The service provided reassurance immediately for most gaps on the day of the assessment and has provided the remaining evidence following the assessment, as well as reassurance of processes moving forward.

Records of staff immunisation status were maintained. All staff had completed annual appraisals and were given time during their working day to consider discussion points before the appraisal. New staff participated in an induction programme and all were required to complete mandatory training within appropriate timeframes. Staff were supported to deliver safe care through access to relevant training and development opportunities

Staff had opportunities for development to enable extended knowledge in their current role or gain skills and qualification to move into a new role. Clinical staff had support day to day as required as well as allocated time for one to one supervision sessions to discuss cases, treatment plans and guidance.

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 service had a designated infection, prevention and control lead who ensured they kept up to date with guidance and attended role related training courses. All staff had completed relevant training. Cleaning schedules were in place, followed and audited. Risk assessments and audits were completed, such as hand hygiene audits and routine premises and processes audits with actions taken to mitigate risks.

Staff vaccination was maintained in line with current UK Health and Security Agency (UKHSA) guidance if relevant to their role.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.

Medicines at the service were stored securely, and medical gases such as oxygen were stored safely with appropriate safety risk assessments completed. Stock checked in the dispensary was in date.

On inspection it was found that there was no list available to state which emergency medicine was stocked for a specific indication. The risk assessment available lacked details to demonstrate the rationale for not stocking certain recommended emergency medicines. Emergency medicines were stored in different areas within the surgery, which meant there was a risk that staff would not know where to find them when needed. As there was no list of all stocked emergency medicines, regular checks including expiry checks were not being carried out. This could place patients at risk if these medicines were required in an emergency. The clinical lead GP indicated that these issues would be addressed and advised that a review would be undertaken. Following the onsite assessment, we have received evidence that this review and all actions have now been completed.

The service mostly managed prescription stationery securely, and in line with national NHS guidance. Paper prescriptions were mostly tracked safely. The printer in reception was not being checked and printed prescriptions no longer required were found in a clinical room not securely stored in line with national NHS guidance.

On inspection we found that room temperature checks were not being carried out for medicines stored in the dispensary. This service does not follow national guidance, which states that room temperatures should be monitored and recorded daily to ensure medicines were stored within the recommended range. Fridge temperatures were monitored appropriately. Following the assessment we have received evidence that room temperature checks were now in place and monitored as per national guidance.

Controlled drugs (CDs) medicines requiring additional security measures due to the potential for misuse and diversion were stored securely. However, we found that staff did not always document when they had carried out stock balance checks. We were told that checks were completed weekly but not recorded. In addition, staff did not follow the service policy for accurate recording of CDs in the register. We highlighted this on inspection and action was taken immediately.

Prescriptions in the dispensary were not always signed by a prescriber on the day of issuing. Numerous examples were seen of prescriptions awaiting collection from patients that had still not been signed by the GP. This was not in accordance with the service’s own policy, which stated that prescriptions should be signed on the same day. As a result, medicines were being dispensed without appropriate authorisation, potentially compromising patient safety. We highlighted this on inspection and immediate action was taken. Dispensary staff were carrying out dispensing medicine reviews however there was no clear protocol for staff to follow to support them to conduct them safely and appropriately. The dispensary lead GP advised that a protocol would be developed following inspection to ensure a consistent safe approach. We received evidence that the protocol had been reviewed and actioned taken within the team following the site visit.

Staff did not always have the appropriate authorisations in place to administer medicines under Patient Group Directions (PGDs). Two examples were seen where PGDs had been signed and dated by staff after being signed and dated by the GP. As a result, the legal requirements for authorisation under PGDs were not consistently met. We received evidence that a review had taken place and all PGDs were now appropriately signed and dated and a tracker put in place to ensure process was being followed and audited.

Following a recent incident the service still did not have effective systems to manage and respond to patient safety alerts. We were told safety alerts were shared but there was no documented evidence of sharing, actions completed and assurance that all the relevant staff members were aware and understood. As a result, there was a risk that important safety information might not be acted upon in a timely manner, potentially compromising patient safety. Clinical searches showed a review of all safety alerts was required.