Marine Medical Group

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. At this assessment, the rating remains the same.

This service scored 69 (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. The PPG were informed of complaints about the practice to provide further input or suggestions for improvement.

Managers encouraged staff to raise concerns when things went wrong. Staff told us of an open and honest working environment, where they were supported by leadership. They felt they were able to raise concerns and that their views were listened to and acted upon, with safety a top priority. During staff meetings, the clinical team discussed and learnt from clinical issues. There was also a daily less formal clinical meeting to share learning.

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. From the sample of complaint records we reviewed, we found the practice responded to people’s complaints in a timely manner.

Learning from incidents and complaints resulted in changes that improved care for others. For example, the practice strengthened its systems and processes for managing patient samples, resulting in safer and more reliable handling procedures.

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. For example, adult’s referrals to secondary care or community services.

Referrals and test results were managed in a timely way. The administrative team developed a detailed spreadsheet outlining the referral pathways and the specific information required for various conditions and specialists, helping to improve both accuracy and timeliness.

The practice ensured effective management and oversight of triage by having a duty doctor available each day to handle urgent patient issues throughout surgery opening hours.

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.

Staff were able to tell us who the safeguarding lead was and how to raise concerns. They told us they received training in both safeguarding adults and children and had a clear understanding of their safeguarding responsibilities for reporting concerns. However, we found that although nursing staff had completed children’s safeguarding training to Level 3, they had only completed training for adults safeguarding to level 2. Managers were already aware of this and awaiting the next available course in adults safeguarding level 3.

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 had a chaperone policy in place, ensuring that chaperones were available to provide comfort and to help mitigate risk for both patients and staff. We saw staff who required a Disclosure and Barring Service (DBS) check had one recorded, including those acting as chaperone.

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 well maintained. Staff could recognise a deteriorating patient and knew of action to take. Staff received annual training in cardiopulmonary resuscitation (CPR), basic life support, and management of anaphylaxis. We saw examples of where appropriate action was taken by staff without delay.

Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Staff met with patients, their families and carers to discuss their care and treatment. Staff would use alternative methods of communication where needed and had access to interpreters.

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. Staff told us the maintenance team attended upon request to resolve any issues or necessary repairs.

Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. Clinic rooms were all on the ground floor and had appropriate flooring and equipment. Appropriate emergency equipment and medicines were neatly stored and easily accessible to staff.

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 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 learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Staff told us they had received relevant training for their role, and they had access to clinical supervision where appropriate. Staff reported that they receive regular appraisals in which their training and development needs are routinely discussed. They also described an open‑door culture within the practice, enabling them to raise learning needs at any time.

Safe recruitment practices were followed. We sampled recruitment records for staff and saw that checks had been undertaken prior to employment. For example, proof of identification, references, qualifications and registration with the appropriate professional body. Staff had a contract of employment and relevant vaccinations were in place.

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.

The practice had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and followed.

Risk assessments and audits were completed, including an annual infection prevention and control audit and hand hygiene audit and actions taken to mitigate risks. There had also been a recent audit on the management of urine samples with actions taken to streamline the process further.

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

In our clinical searches we found 116 patients were identified out of 441 patients prescribed blood thinning medication who had potentially not had the required monitoring. Of the 5 cases reviewed in detail, 1 was excluded. In the remaining 4, weight and blood pressure had been documented, but the CRC1 (Cockcroft–Gault creatinine) clearance had not been calculated in line with guidance. This calculation is essential to confirm that the patient is receiving the correct dose. The practice confirmed they were aware of the issue due to pharmacy staffing shortages. Since the assessment the practice have confirmed the 4 patients’ clearance has been calculated and documented. The practice has also reviewed all but 6 of the 116 patients within this search and taken the required action.

Our search identified 397 patients who were prescribed medication primarily used to treat type 2 diabetes by preventing the reabsorption of glucose back into the blood stream. Of the 5 records reviewed in detail, 3 patients had only received partial updates or annual reminders relating to the medication concerns, and 2 had not received any of the recommended updates or reminders as advised by the Medicines and Healthcare products Regulatory Agency (MHRA). Following the assessment, the practice confirmed that all 397 patients have all been informed of the medication concerns. The practice has also introduced an automated 6 monthly medication update reminder to keep patients informed in line with guidance.

The clinical search identified 97 patients who may have an undiagnosed case of chronic kidney disease (CKD) at stages 3–5. Of the 5 records reviewed, 3 represented missed diagnoses of stage 3 CKD, while the remaining 2 were not missed diagnoses; however, 1 of these required an updated blood test. Since the assessment the practice confirm all 97 patients have been reviewed with those requiring a further blood test have been contacted and blood testing has been arranged. The practice has also introduced new protocols to improve accurate coding and to produce a monthly report highlighting any potential missed diagnoses for GP review.

The clinical searches identified 2,703 patients who had a medication review recorded within the past 3 months. Of the 5 records examined, 1 contained evidence of a completed review, while 4 showed no context as to what happened in the medication review. The clinician we spoke with explained that when a medication review is completed and no issues are identified, no formal entry is made in the patient record; instead, the clinician clicks away from the review to indicate completion. As a result, it may be difficult for another clinician to determine whether a full medication review has taken place. Since the assessment the practice have introduced a new process in which GPs document the checks completed within the patient record and apply the appropriate coding.

Our clinical searches identified 40 patients who appeared to be over‑prescribed rescue asthma inhalers. Of the 5 records reviewed, one patient was educated about inhaler overuse and 2 patients showed repeated attempts to engage the patient in a medication review. The practice confirmed that staff have already undertaken significant work in this area to improve the situation. However, since the assessment, the practice have asked all 40 patients to book in for a review with their GP. They have also introduced a new protocol within the long‑term condition review process to help reduce over‑prescribing.

National Institute for Health and Care Excellence (NICE) guidance recommends that patients should be reviewed within 48 hours following an acute asthma exacerbation, that requires oral steroids, and their regular treatment should be adjusted if necessary to improve symptom control. For the purpose of our clinical searches, this timeframe is extended to 7 days. There were 1,890 patients registered with asthma of which 95 had been prescribed 2 or more courses of rescue steroids. Among these 95 patients, we found follow-up after steroid treatment was inconsistent. This poses a risk of deterioration due to asthma and delays in timely review. Following the assessment, the practice had implemented a new post-acute asthma exacerbation review protocol for staff to follow.

There were 609 patients overall with hypothyroidism, of which only 4 patients had not had a thyroid function test monitoring for 18 months. We saw patients were being contacted, however no further action such as issuing shorter prescriptions, had occurred to encourage compliance. Infrequent reviews can risk patients being under or over treated for their hypothyroidism. Since the assessment 3 of the 4 patients reviewed have appointments booked. The practice also confirmed that a new protocol has been introduced: patients who repeatedly fail to attend their reviews, or do not book at all, will now have their medication supplies reduced if they continue not to attend.

We identified 119 out of 1,152 patients with diabetes whose most recent blood test, which reflects average glucose levels over the past 2–3 months was above the expected range. Of the 5 patient records we examined in detail, 1 patient was overdue a full review. While the patient had been contacted by letter on numerous occasions, no further action such as issuing shorter prescriptions to encourage compliance had been taken. This posed a risk of deterioration or complications related to diabetes, and their treatment may be suboptimal. The practice has since reviewed this patient and advised them that failure to attend a review will result in their prescription being shortened.

However, 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. The practice had personalised patient lists for continuity of care which worked well for both staff and patients.

Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. We saw staff had the appropriate authorisations to administer medicines under Patient Group Directions (PGD). Staff managed prescription stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

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. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

Staff followed established processes to ensure people prescribed medicines with specific risks generally 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. For example, the number of antimicrobials issued by the provider was lower than local and national averages.

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