The Avenues 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 did not consistently ensure safe care and treatment. While there was a positive learning culture and effective safeguarding processes, several key areas of safety required strengthening. These included systems for managing medicine alerts and monitoring certain high‑risk medicines. There were gaps in governance around patient group directions (PGDs) where required signatures were missing and vaccines had been administered under PGDs that had not been appropriately signed. Prior to our assessment a new Infection prevention and control (IPC) lead had been appointed. The practice had identified that historically audits and risk assessments were not completed to a high standard. We found that IPC audits and risk assessments had not always been completed in a timely manner.

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.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt 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, clinical and administrative teams discussed and learnt from issues that had been identified.

Staff felt able to report incidents and managers promoted an open culture, which was reflected by staff feedback. 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 and gave support.

Learning from incidents and complaints resulted in changes that improved care for others. For example, following an incident that was reported the practice changed how death certificates were managed. The duty GP was now responsible for handling these to ensure they were actioned efficiently. As a result of this, there had been no more delays due to having to wait for specific members of staff to return from absence or from non-working days.

The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. Clinical searches undertaken on the practice’s clinical system highlighted that systems required strengthening for dealing with Medicines and Healthcare products Regulatory Agency (MHRA Alerts). Searches identified 7 patients on aldosterone antagonist plus an ACE inhibitor, (medicine used to treat high blood pressure and heart failure) who had potentially not received the required monitoring within the last 6 months. A review of 5 patient records showed that 3 patients were overdue monitoring. Following the assessment, the service provided an action plan outlining a new system that was being set up for a GP to run searches for these patients quarterly and reviewing them appropriately.

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.

A review showed that test results were managed in a timely way, however a review showed that tasks, documents and letters referring to patients were sometimes left open longer than was necessary. Although systems were in place to manage these items, it was not always easy to identify which ones were still awaiting further action.

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 found that all staff were appropriately trained in safeguarding procedures. There was a safeguarding lead for adults and children.

Chaperones were available, clinical and non-clinical staff had received training in this area. There were posters on the notice board in the waiting room making patients aware they could request a chaperone. Following the assessment, the provider informed us they had also displayed chaperone posters in all clinical rooms.

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.

Staff had received training in sepsis awareness and basic life support and were able to explain how to act safely in an emergency.

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. Staff had completed mandatory training in fire safety.

The service made sure there were enough qualified, skilled and experienced staff. However, they did not always make sure staff received effective supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

A review of patient group directions (PGDs) showed that appropriate processes were not in place. We found that not all required members of staff had signed the appropriate PGDs. Following the assessment, the provider implemented an action plan to ensure appropriate supervision and oversight was given to this going forward. More details about PGDs are included in the medicines optimisation quality statement.

The practice held regular meetings for both clinical and non-clinical. These meetings were used to ensure staff were working towards the same goals with the aim of a consistent approach being made by staff.

We found that mandatory training was up to date, except for one member of staff. The provider had already identified this and had a plan in place to ensure all training would be completed as soon as possible.

A review of recruitment procedures showed that safe practices were followed. We reviewed 3 staff members recruitment files, this included administrative and clinical staff members. All files recorded that appropriate recruitment checks had been completed, and staff had received annual appraisals.

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share 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. A review showed that although there was an infection, prevention and control policy in place, risk assessments and audits had not been completed in a timely manner. We found that a room used primarily by the primary care network (PCN) for an art therapy area had not been risk assessed. We found items stored there that were not in line with the practice’s infection, prevention and control policy such as cardboard boxes. This was immediately addressed by the provider.

Following the assessment, an action plan was submitted to show how risk assessments and audits would be completed in a timely manner. Further infection, prevention and control training was also going to be provided to staff.

The service did not always make sure the systems for managing medicines were safe.

A review of patient group directions (PGDs) highlighted multiple occasions where staff members from the practice and Primary Care Network (PCN) had not signed forms authorising them to supply and administer medicines and vaccinations. We found that clinicians had administered vaccines under PGDs that had not been signed. We saw that although the provider had attempted to obtain signatures, assurance processes were lacking. Following the assessment, the provider submitted an action plan which showed that a significant event had been started and an audit to ensure that all patients that were vaccinated during the period the PGDs were not signed had received the correct vaccinations. The provider was also working with their PCN to put steps in place to manage the governance of staff working across different GP practices.

As part of our assessment, a series of patient clinical record searches were undertaken by a CQC GP specialist advisor. This included a review of the management of patients on a sample of medicines that require monitoring, as well as the review of prescribing, including the effectiveness and quality of medicine reviews and usage.

Our clinical searches highlighted that 158 patients who had potentially not received the required monitoring while on direct oral anticoagulants (DOACs, this is medicine used to thin blood). We reviewed 5 patients records, all 5 showed that patients had not had their creatinine clearance calculated, this is used to ensure patients are on the right dosage of medicine. We saw that 4 out of the 5 patients reviewed, did not have an accurate weight recorded recently which is required to calculate creatinine clearance. The review showed that these patients had been contacted to arrange for observations to be taken in the near future. Following the assessment, measures were put in place to ensure more oversight was given for monitoring these patients.

As highlighted in the earlier section of safe systems, pathways and transitions. Clinical searches undertaken on the practice’s clinical system highlighted that systems required strengthening for dealing with MHRA Alerts. Following the assessment, a named GP would be responsible for running searches on the clinical system to ensure that MHRA Alerts were being actioned.

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.

Our clinical searches looked at the quality of medicine reviews, we looked in detail at 5 records with no issues or concerns noted.

Staff managed prescription stationery appropriately and securely. 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.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. This included a 2 cycle audit on chronic kidney disease (CKD) which showed positive improvements had been achieved.