Archived: Triangle Group Practice

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• 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 has changed to Good. The service was in breach of Regulation 12 (Safe care and treatment) in relation to medicines optimisation and safe & effective staffing. This was because not all prescribed medicines were being monitored in line with national guidelines, and the practice did not always hold records of the immunisation status of both non-clinical and clinical staff members.

This service scored 68 (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. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues, and we saw evidence of this from documented staff meeting minutes. Staff felt there was an open culture, and that safety was a top priority. 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 people support. Learning from incidents and complaints resulted in changes that improved care for others. The practice had a dedicated learning day they held monthly for all staff members.

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 service worked closely with members of the wider multi-disciplinary team, including health visitors and social services. On a monthly basis, clinical staff held a multi-disciplinary team meeting which included healthcare professionals from the wider community, such as the district nursing and palliative care teams.

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. Referrals and test results were managed in a timely way. The practice had a designated member of staff who monitored those on a 2 week wait pathway for suspected cancers, checking every week to see if the patients had received their appointments. This staff member also took a proactive role in monitoring if patients had not received their results in a timely manner, and would liaise with the hospitals or laboratories as needed to ascertain the reason for any delays.

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. At the time of the site visit, we did not see evidence of one of the clinical staff member’s safeguarding adults training at a level applicable to their role. Since the site visit, we have been provided with evidence of the completion of this training. All staff members at the practice knew who the safeguarding leads were and how to escalate any potential safeguarding concerns accordingly. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

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. All staff members received sepsis training, and we observed several posters within the practice to alert both patients and staff of the associated warning signs. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

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. We saw evidence the practice had completed regular checks of fire safety equipment and Legionella water testing. The practice completed yearly fire drills.

Whilst the service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development, they did not always complete the necessary checks to ascertain immunisation status of the staff members they employed. For example, non-clinical staff completed a self-declaration form of what immunisations they had received as opposed to providing evidence of this. This was the case in both of the 2 non-clinical staff member files we reviewed. Of the 2 clinical staff member files we reviewed, we found that both staff members were missing their immunisation status of tetanus, diptheria and polio (as per the guidelines set out in “The Green Book: Immunisation of healthcare and laboratory staff”). 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.

The service largely made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. However, some patients did not always receive the required monitoring. Although we received an immediate response from the practice to report that the issues we found had been rectified with the affected patients, we did not find sufficient evidence at the time of our clinical searches that risks to patients had been appropriately mitigated.

Data reviewed as part of our assessment showed that the provider was prescribing medicines safely in most cases. However, we noted that not all prescribed medicines were being monitored in line with national guidelines. We reviewed clinical records for patients who had been prescribed medicines which required routine monitoring. We identified 598 patients who were prescribed an angiotensin converting enzyme (ACE) or angiotensin receptor blocker (ARB) medicine, of which 71 patients had not received the required monitoring. ACE and ARB medicines are used to treat patients experiencing high blood pressure or heart failure. We reviewed 5 patient records and found that all of these patients were overdue monitoring. Whilst the practice had documented efforts to contact 4 of these 5 patients, we did not see evidence the practice had contacted the remaining patient.

30 patients were prescribed an aldosterone antagonist (a medicine used to treat heart failure or high blood pressure) and an ACE/ARB medicine, of which 6 had not received the required monitoring. When prescribed together, there is a risk of patients developing hyperkalaemia (increased levels of blood potassium). We reviewed 5 patient records and all of these patients were overdue monitoring. Whilst the practice had documented efforts to contact all of these patients within the past 3 months, prescriptions had continued to be issued despite not having up-to-date monitoring completed.

During our remote clinical records searches, we identified 2 out of 139 elderly patients who were prescribed a non-steroidal anti-inflammatory (NSAID) or antiplatelet (blood thinning) medicine without a proton-pump inhibitor (PPI) medicine. A PPI medicine should be used alongside NSAID and antiplatelet medicines to prevent the likelihood of gastric bleeding in this patient group. Following the assessment, we were advised the 2 patients identified had now been commenced on appropriate protective medication.

We identified 30 patients with chronic kidney disease (CKD) stage 4 or 5. CKD is graded on a scale from 1-5, with stage 1 being kidney disease with normal renal function, and stage 5 being the most severe form of kidney disease. Out of the 30 patients with CKD 4 or 5, we identified and reviewed 4 patients. Whilst the practice had documented efforts to contact 3 of these patients within the past 3 months, we did not find evidence the remaining patient had been invited for the required monitoring. Prescriptions had continued to be issued despite these patients not having up-to-date monitoring completed.

The practice told us that they would address these omissions following the assessment.

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