Belmont Medical 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

The practice had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Staff managed medicines well and involved people in planning any changes. There were systems in place to ensure that Medicines and Healthcare products Regulatory Agency (MHRA alerts) were followed. Patients on high-risk medicines were recalled for monitoring in a timely manner.

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

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 practice had processes for staff to report incidents, near misses and safety events. The practice had a positive culture of safety and leaders encouraged staff to raise concerns when things went wrong. Staff felt there was an open culture, and that safety was a top priority. Lessons were learnt to continually identify and embed good practice. Learning from incidents and complaints was discussed in meetings and resulted in changes that improved the service. Patient feedback we received indicated that patients felt supported to raise concerns and felt staff treated them with compassion and understanding.

Leaders were committed to learning, and we discussed an example of a significant event and the actions the practice had taken in response to the learning identified. This involved changes to the practice safeguarding policy to ensure any child patient who fails to attend a referred appointment will be flagged to the safeguarding team for review. In addition, all patient deaths were now reviewed at the bi-monthly palliative care meetings to identify learning opportunities and trigger formal significant event analyses where appropriate. A new communication protocol had been introduced where minutes from external meetings are shared with the management team and discussed at the next management team meeting. An escalation plan had also been developed where in cases of a clinician disagreement with external bodies, an alternative point of contact within the practice will be designated and all correspondence will be copied to relevant team members to ensure transparency.

The practice worked with patients and healthcare partners to establish and maintain safe systems of care. Staff worked to facilitate continuity of care, including when patients moved between services. There were protocols in place for managing incoming correspondence into the patient’s medical records. Patient referrals to specialist services were documented in the referrals systems and patient record. We found referrals were managed in a timely manner.

Safeguarding policies and procedures were in place to keep people safe and safeguarded from abuse. The practice had two safeguarding leads, and all staff had completed the relevant safeguarding training for their role and shared concerns quickly and appropriately. The practice maintained a list of vulnerable adults and children and acted on concerns working in partnership with other organisations. Clinical system alerts were used to identify people who were at risk of harm or abuse including household contacts. There were systems in place to respond to concerns and act on correspondence. For example, they followed up children who failed to attend their appointments or were frequent attenders to the accident and emergency department.

We saw evidence of regular safeguarding meetings with the practice safeguarding leads and the primary care network safeguarding co-ordinators where safeguarding risks and patient care was discussed.

Emergency equipment was available and maintained. Systems were in place to check the emergency equipment and medicines regularly. Staff could recognise a deteriorating patient and knew what action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. There were processes in place to ensure care was prioritised for their most clinically vulnerable patients.

The practice facilities were fully accessible to patients. The building was step-free for patients, with full access for wheelchair users. Consultation rooms were located on the ground floor.

The practice detected and controlled potential risks. They made sure equipment, facilities and technology supported the delivery of safe care. Contracts were in place to ensure the premises were maintained. Systems were in place for the checks of fire alarms, fire extinguishers and fire evacuation procedures. Portable appliance testing was completed annually to ensure equipment was safe to use. The practice provided us with evidence of health and safety risk assessments which showed that risks were properly managed. There was a business continuity plan in place which was monitored and reviewed.

Leaders explained their recruitment processes to ensure appropriate numbers of suitably trained staff were employed to support the delivery of good quality care which met the needs of the patients.There were a range of clinical and non-clinical roles within the practice. We reviewed personnel files during the onsite visit and found that not all necessary recruitment documents were accessible in the staff files. For example, most staff files were missing their employment history, interview notes and immunisation records. Not all clinical staff had completed their mandatory training, including sepsis training. We were assured however staff knew what to do in urgent circumstances as procedures were in place and reception staff could communicate with the duty GP for additional support in an emergency. The practice acknowledged our feedback on staff personnel files and training and wanted to improve these processes. Following our onsite visit, the management team made arrangements to ensure all staff completed sepsis training by adding “Sepsis Awareness” training to the staff training profile.

Staff received appraisals and clinical staff had daily supervision slots in the diary to discuss patients. GP registrars received daily supervision from GPs in the practice who were either GP trainers or had completed a supervision course. Non-medical prescribers were supervised by the duty GP. Nurse Practitioners were provided with daily slots to discuss patients as needed. Medical Students were supervised by one of the GPs who was a Training Programme Director (TPD). The Additional Roles Reimbursement Scheme (ARRS) staff working at the practice were supervised by various GPs across the primary care network. ARRS staff are healthcare professionals employed to offer a wide range of services to patients and alleviate work pressures on GPs. Leaders told us they operated an open-door policy at the practice and invited any questions or queries at any time from these staff members.

The practice 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 (IPC) lead and all staff had completed relevant training. Risk assessments and audits were completed, and actions taken to mitigate risks. Clinical waste procedures were in place. The practice had effective oversight of the external cleaning company to ensure cleaning schedules were followed and cleanliness met the required standard.

The practice made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved patients in planning, including when changes happened.

Staff involved patients in reviews of their medicines and helped them understand how to manage their medicines safely. Patients knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

Medicines were stored securely and at appropriate temperatures. Refrigerators used to store vaccines and medicines were monitored to ensure temperatures were maintained and products were appropriately stored within them. Staff regularly checked stock levels and expiry dates for all medicines, including emergency medicines. There were Patient Group Directions (written instructions to help specific healthcare professionals supply or administer medicines to patients)in place which relevant staff worked to.

The practice had effective systems in place to manage and respond to safety alerts and medicine recalls. We found that there were processes in place to regularly review these.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. This included audits on antibiotics; direct oral anticoagulants (drugs used to help prevent blood clots) and blood testing; and sodium valproate (a drug used to treat epilepsy and bipolar disorder).

Prescribing data reviewed as part of our assessment found practice performance was in line with national averages for Pregabalin and Gabapentin medicines (primarily anticonvulsant drugs, also prescribed for pain); psychotropic medicines (used to treat various mental health conditions); hypnotic drugs (used for the management of severe insomnia); and antibiotics.

As part of our assessment a Care Quality Commission GP Specialist Advisor undertook searches of patient records on the practice’s clinical system. Our clinical records review identified the following:

Azathioprine (a drug used to treat rheumatoid arthritis): We identified 14 patients prescribed this medicine and found all 14 patients had received the required monitoring and were appropriately coded on the clinical system.

Leflunomide (a drug used to treat rheumatoid arthritis): We identified 4 patients prescribed this medicine and found all 4 patients had received the required monitoring and were appropriately coded on the clinical system.

Angiotensin-converting-enzyme (ACE) Inhibitors (a drug used primarily for the treatment of high blood pressure and heart failure): We identified 1196 patients prescribed this medicine and reviewed in detail the clinical records of 5 patients and found all 5 patients had received the required monitoring and were coded appropriately on the clinical system.

Methotrexate (an immune system suppressant drug): We identified 42 patients who had been prescribed this medicine in the last 6 months and found 1 patient had not received the required monitoring. We found the practice had identified this patient was overdue monitoring and had already taken steps to address this. However, when reviewing this patient’s record, we identified the day of the week the medicine should be taken was not indicated. As the prescribed dose of Methotrexate should be taken once weekly on the same day each week, this day should be documented and clearly communicated to the patient. When this was fed back to the practice, it was addressed immediately.

Short-acting beta-2 agonist (SABA) inhalers (“reliever" inhalers used for quick relief from asthma symptoms like wheezing and breathlessness): We identified 4 out of 1299 patients had been over-prescribed these inhalers and reviewed their care records. We found all 4 patients had received a medication review following the acute exacerbation of their asthma to assess if their regular asthma treatment needed to be adjusted. We identified one patient who had an asthma review done via an online survey rather than a face-to-face appointment. We recommended that the practice invite this patient for a face-to-face appointment and the practice actioned this immediately.

Medication reviews: We reviewed a random sample of 5 medication reviews out of a total of 1647 reviews that had been completed for patients in the previous 3 months. We found 2 of these 5 medication reviews had been coded but lacked information, such as monitoring arrangements or details about what had been reviewed or changed as a result of the review. Staff took on board our feedback on this issue and recognised the importance of documentation for medication reviews.