Lawrence Hill Health 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 looked for evidence that people were protected from abuse and avoidable harm.

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

The practice had a positive learning culture where people felt comfortable to raise concerns. Leaders investigated incidents however, we saw examples where some incidents had not been thoroughly investigated and learning was not always identified. The facilities and equipment met the needs of people, were clean and well-maintained. Risk assessments were completed but did not always thoroughly identify risks and mitigating actions. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain care and treatment that met people’s needs. Staff managed medicines well and involved people in planning any changes.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and leaders told us they were a learning organisation based on openness and honesty however learning from some incidents and complaints was not alwaysidentified. Concerns about safety were investigated but areas of concern were not always identified. For example, an incident had occurred where the sign out sheet to track blank prescription stationery through the practice had gone missing. A new sign out sheet was printed but there was no investigation to check if any blank prescription stationery had gone missing. During the onsite visit, another incident occurred where a whole box of prescription stationery had been removed from secure storage not following the protocol of only taking a small number for what was needed. Following the site visit, we received a significant event analysis of this event but it did not reference any steps taken to provide assurance no blank stationery was missing. Lessons were not always learnt from these incidents to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from some clinical issues. Staff felt there was an open culture, and that safety was a top priority. There was a process for staff to report incidents, near misses and safety events.

There was a system to record and investigate complaints. We viewed a sample of complaints and saw they were managed inconsistently. For example, we viewed a complaint that had been emailed in. There was no record the complainant received a complaints outcome letter from the service with a reference to the Parliamentary and Health Service Ombudsman for escalation if they were unhappy with how their complaint was managed. We viewed the response to another complaint, but a copy of the original complaint was not kept so were unable to see if their complaint was fully addressed.

The practice worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Referrals were managed appropriately.

There were systems in place for processing information relating to new patients. The practice worked with other providers to deliver shared care and when people moved between services. Some people that had regular contact with the practice were allocated a named GP to support them with the management of their health conditions.

During the inspection process, we identified test results were not always processed in a timely manner in line with policy. For example, test results flagged as urgent had been received 5 days before our clinical searches but had not been viewed. Following the inspection, the practice reviewed their protocol to ensure test results were viewed and processed timely, in order of urgency.

The practice 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 practice 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.

The practice 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. People were advised on risks related to their condition and actions to take if their condition deteriorated.

Contracts were in place to ensure the premises were maintained. The practice had policies and procedures to detect and control potential risks in the care environment. There were systems and processes in place to support the health and safety of everyone who visited the practice; both staff and people using the service. There was a Health, Safety and Risk Management policy related to minimising risks in the premises. The practice had completed an ‘External Inspection of Premises risk assessment’ which identified risks and added a comment to reach risk. However, the risk assessment tool contained within the policy had not been used to review the risks, both internal and external, to identify risks, consider who was at risk and what actions were needed to reduce or eliminate harm.

There was a business continuity plan in place which was monitored and reviewed.

The practice made sure equipment supported the safe delivery of care by ensuring electrical appliances had been tested, and equipment had been serviced and calibrated.

The practice had enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked 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. We found training was up-to-date. Staff had completed training and added the date they had completed it to the online system but had not consistently uploaded their completion certificate in line with policy as evidence.

Learning needs and the development of staff was managed appropriately, and staff were working within their agreed areas of competence. Non-medical prescribers had regular supervision with a named supervisor, and their prescribing was audited to ensure it was in line with guidance.

New recruitment processes had recently been implemented but were not yet embedded. We viewed a sample of staff files and found some were missing references and gaps in employment histories had not been explored. One of these staff members had not undergone a Disclosure and Barring Service (DBS) check since 2017 and had not completed the self-declaration to confirm no changes in convictions. The policy stated the self-declaration form was not required for a GP if they were on the GP Performer’s List but there was no evidence this had been checked.

Staff files did not contain evidence of routine vaccinations in line with guidance. The practice was aware of this issue and had requested this evidence and they had risk rated staff to consider the risk this posed to them. However, this was done by allocating a risk of low, medium or high on a spreadsheet and did not consider the specific risks individual members of staff may encounter. The deadline for staff to provide evidence had passed and the practice had not taken any further steps to gain assurance they had done everything practicably possible to protect staff and their patients from vaccine-preventable diseases.

Cleaning schedules were in place. Clinicians were responsible for cleaning equipment in-between patients.

The practice had a designated infection, prevention and control (IPC) lead and all staff had completed relevant training. The practice had not carried out any handwashing audits. Plans were in place to complete these in the following 3 months. An annual infection prevention control audit had not been completed in line with the provider’s policy in the last 12 months. This means the practice had not assessed and managed the risk of infection. We requested a copy of the last IPC audit that had taken place, but it was not provided. Following the onsite visit, the practice immediately addressed our concerns and submitted a completed audit which identified actions that needed to be taken.

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

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. We reviewed a sample of Patient Group Directions (PGDs) (a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition by named registered health care professionals without them having to see a prescriber) and found they had been completed correctly in line with guidance.

Policies and processes were in place to manage blank prescription stationery but there was no audit process in place, and this had not been identified during investigations following incidents where secure storage had been compromised. Following the onsite visit, the practice told us they would take action and review these processes.

Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. During the onsite visit, we did not see some of the recommended emergency medicines. Following the site visit, the practice told us these missing medicines were in a different cupboard and had now been placed with the other emergency medicines.

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. 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. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.