Gosberton 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

We looked for evidence that people were protected from abuse and avoidable harm. At our last assessment, we rated this key question as good but found that learning from significant events was not always shared with all staff and systems and processes were not consistently in place to ensure patient’s medicines were well managed.

At this assessment the rating remains good, we found the previously identified issues had been addressed and resolved. Safety was a priority, and people were protected from abuse and avoidable harm. The service had a strong 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. Managers made sure staff received training and appraisals to maintain high-quality care.

Staff managed medicines well and involved people in planning any changes.

This service scored 75 (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.

We found that changes had been made since our last assessment. Systems and processes relating to incidents and complaints had been reviewed and there was a new lead for significant events and complaints. Learning from complaints and events was shared effectively with all staff. Managers encouraged staff to raise concerns when things went wrong. The practice held meetings where events including clinical issues were discussed and learnt from. Information was disseminated to those who were not present at the meeting.

Staff felt there was an open culture, and that safety was a top priority. The provider had clear 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. For example, following a complaint relating to a breach of confidentiality we saw that an apology had been made to the patients concerned and evidence that changes had been made to avoid a repetition.

We saw that the systems and processes in place included revisiting changes that had been made as a result of learning from events to ensure that changes had been effective and were embedded.

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.

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.

We saw there was a range of multidisciplinary meetings within the practice to support safe pathways. Leaders told us this included active engagement from community mental health teams, specialist neighbourhood nurses and health visitors.

To support safe transitions the practice used comprehensive written care plans following chronic disease reviews and “grab and go” forms and hospital passports for patients with learning disabilities. We were told Dementia care plans were completed during annual reviews.

The service worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. They had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They 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 collaboratively with other organisations.

The service worked with people to understand and manage risks using a holistic approach. 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 were trained to 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.

The service had systems and processes in place to ensure detection and control of potential risks in the care environment. The practice had oversight to ensure equipment, facilities and technology supported the delivery of safe care.

Staff completed fire training, there were designated fire marshals and the practice conducted regular documented fire drills. The fire alarm was tested on a weekly basis.

Contracts were in place to ensure the premises were maintained and monitored. 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.

The service made sure there were enough qualified, skilled and experienced staff, who received effective induction support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There was a satisfactory skill mix at the practice which included a range of clinical and non-clinical roles. 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. Safe recruitment practices were followed and evidenced in staff files.

Staff were supported to develop and were positive about the training and development opportunities given. We found that staff had received regular appraisals.

Processes had been established to ensure staff working for, but not directly employed by the practice, were recruited safely, had received appropriate and up to date training and were working within their agreed areas of competence.

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.

Since our last assessment the practice had implemented the NHS standards of healthcare cleanliness in order to ensure they proactively assessed, controlled and mitigated infection control risks.

Staff had received relevant infection prevention and control training, and the practice had a designated infection, prevention and control lead who had been recently appointed to the role. They were due to undertake additional training to support them in their lead role.

Cleaning schedules were in place, followed and monitored. Risk assessments and audits were completed, and actions taken to mitigate risks.

The staff records we reviewed showed that the practice held relevant information relating to the immunisation status for staff.

At our last assessment we found that medicines were not always suitably managed, and patients were not always informed of associated risks. At this assessment we saw evidence that the issues identified had been addressed and new systems and processes introduced to improve safety.The practice had implemented a clinical IT system to improve efficiency and safety, supporting proactive identification and prevention and automating alerts and monitoring

The service 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 managed prescription stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received recommended medicines reviews and monitoring.

However, as a result of our clinical searches we found that the follow up of patients after an acute asthma attack within an appropriate timeframe was inconsistent. Immediately after our assessment the provider told us that in order to improve this, they had introduced a pop-up box in the clinical records system to remind clinicians to arrange a follow up 48 hours after a steroid has been prescribed to an asthmatic patient.

Also, as a result of our clinical searches we identified 3 patients who had received more than 10 prescriptions of opioid medicines where there was no evidence of discussions with the patient regarding addiction and weaning off these medicines. We raised this with the practice who evidenced that they had taken immediate action to address this and to ensure this was not an issue going forward.

Medicines including controlled drugs were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs.

At our last assessment we found that emergency medicines were available in two locations in the practice and within a GP emergency medicine bag, but appropriate risk assessments and monitoring were not in place in respect of the doctor’s bag.

At this assessment we found that emergency medicines were still available on the ground and first floor of the practice and the necessity for the doctor’s bag had been assessed and the doctor’s bag was no longer used.

Dispensary staff had received appropriate training and regular checks of their competency. Dispensing incidents and near misses were recorded and reviewed regularly.

The dispensary was clean, tidy and well organised with only authorised people having access.

Medicines stocks within the dispensary were secure, managed well, and expiry dates regularly checked.

Standard Operating procedures were in place for all the dispensary activities.

Waste medicines were disposed of appropriately including medicines returned by patients. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

Since our last assessment the provider had reviewed and amended their systems to manage and respond to safety alerts and medicine recalls and we found they were now well managed and responded to appropriately.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. There were suitable processes for staff to follow when dispensing medicines. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics.

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