Peak & Dales Medical Partnership Also known as Bakewell 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 requires improvement. At this assessment, the rating remains the same. The service was in breach of the legal regulation in relation to safe care and treatment.

This service scored 56 (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 mostly 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.

There was a system to record and investigate complaints. When things went wrong, staff apologised and gave people support. We looked at 7 complaints and found they had all been acknowledged by the provider. The provider told us they had responded to all of the complaints. However, they could not evidence that a formal written response had been provided to 4 out of the 7 complaints or, that these complainants had been signposted to the Parliamentary and Health Service Ombudsman (PHSO).

The provider had processes for staff to report incidents, near misses and safety events. Managers encouraged staff to raise concerns when things went wrong. Significant events and complaints were standard agenda items at practice meetings. Staff were able to give examples of learning from significant events and felt there was an open culture, and that safety was a priority. Learning from incidents and complaints resulted in changes that improved care for others. There were systems in place to summarise and analyse trends in significant events and complaints to monitor that changes had been effective.

The service mostly 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. Systems were in place to summarise people’s records. Referrals and test results were managed in a timely way. The service worked with other providers to deliver shared care, however it was difficult to find shared care agreements in people’s records.

We received feedback from 3 care homes where the service provided care and treatment. Feedback from 2 care homes was very positive. They told us they were kept up to date with information, there was a good working relationship between the homes and the practice and they had a dedicated GP who provided weekly ward rounds to the homes. They told us the service were very responsive to the needs of people living in the home. Feedback from another home was less positive and they expressed concerns that staff were not listened to and end of life care was not always supportive.

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. Multi-disciplinary team and safeguarding meetings were held to review this group of people on a regular basis. Staff told us if they had a safeguarding concern, they added the person’s name to the list of people to be discussed at the safeguarding meetings and made the safeguarding lead, or their deputy, aware of any concerns immediately.

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. Systems were in place to follow up children who were frequent attenders to AE or failed to attend appointments within secondary or primary care settings.

The service mostly 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.

Staff could recognise a deteriorating patient and knew of actions to take. People were advised on risks related to their condition and actions to take if their condition deteriorated.

Emergency equipment was available and maintained however, monthly checks had been ineffective because they had failed to identify there were no self-inflating bags with reservoirs for adults or children at the Bakewell practice. The bags had been ordered and delivered to the branch practice but not transferred to the Bakewell practice. The provider transferred them on the day of our assessment. Eye protection and a pocket mask were not available on the resuscitation trolley at the branch practice. Staff were unable to locate these elsewhere within the practice on the day of our assessment.

The service did not always detect and control potential risks in the care environment.

At the Bakewell site, we found that a cleaner’s room was over cluttered, inaccessible and a potential hazard risk. Following our assessment, the provider sent us photographic evidence that this had been tidied up. At the branch practice, the floor in the room where the immunisation fridges were kept was uneven and in a poor state of repair due to missing carpet tiles. At both practices we found that the hoops attached to blinds were not always secured to the wall in line with a Central Alerting System (CAS) alert. Following our assessment the provider sent us details of the actions they had arranged to address these issues.

Some staff told us they did not have all the required equipment, such as enough electronic blood pressure machines and thermometers and had to purchase their own. The provider told us that manual blood pressure machines were available in all clinical rooms.

Some of the issues identified in the fire risk assessment had not been completed within the timeframes specified. The provider showed us evidence that they were working with the company that carried out the fire risk assessment to address the remaining issues. The service carried out fire drills at both the main and branch location. Fire wardens and responsible people had been appointed to ensure that in the event of a fire the practices were safely evacuated. The service ensured that fire equipment was regularly checked and monitored by specialist services.

Risk assessments to monitor safety within the practice had been completed. For example, a legionella risk assessment had been completed and regular water temperature checks were in place. Two members of staff had completed City and Guilds training in water safety to provide additional support to the service. The practice had carried out all of the required remedial work to rectify electrical faults identified in their 5-yearly periodic electrical safety inspections. Control of Substances Hazardous to Health (COSHH) risk assessments were available in the practices. Contracts were in place to ensure the premises were maintained. 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. Staff told us that teams 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, learning needs and development of staff was managed appropriately, and staff worked within their agreed areas of competence. Most staff had received an appraisal in a timely manner. Safe recruitment practices were followed. All of the required recruitment documentation was not readily accessible on the day of our assessment due to an issue with the electronic systems used to store the information. The day after our assessment the provider forwarded to us the missing information.

The service assessed and managed the risk of infection. They mostly detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The practice had a designated infection, prevention and control (IPC) lead and staff had received relevant training. Policies were in place to support IPC and clinical waste was stored securely. Staff vaccination was maintained in line with current UK Health and Security Agency (UKHSA) guidance. To mitigate any potential risks to staff and patients, risk assessments had been completed when staff immunisation had not been completed.

IPC audits had been completed and the required actions identified had been completed. However, the IPC audit had failed to identify the risk of carpet in the waiting rooms, non-wipeable chairs in some of the consultation rooms and carpet tiles on the floor at the branch practice. Following our assessment, the provider sent us details of the actions they had arranged to address these concerns and timeframes of completion. Completed cleaning schedules were available at the Bakewell practice but not at the branch practice. The provider informed us they would introduce the same system in the branch practice as they had in place at the Bakewell site.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Systems were in place for monitoring people prescribed high risk medicines, however we found a small number of people where this had not been effective because people were not always compliant with their review dates.

Medicines used in the treatment of rheumatoid arthritis were managed well although it was difficult to find shared care agreements in people’s records. Following our assessment, the provider sent us evidence that clinical staff had been made aware not to prescribe these medicines if a shared care agreement was not in place. The service planned to write to all consultants to arrange for the shared care agreements to be sent to the practice with a completion date of 30 September 2025. We found a very small number of patients who had not received all of the required monitoring for high risk medicines. Recalls had been put in place to follow up their blood test monitoring.

We found examples where medicine reviews were coded as being completed however, there was little or no text to demonstrate what had been reviewed. The provider told us that going forward they would add a summary to peoples’ records and sent us evidence that this had been shared with clinicians.

We found examples where people had been prescribed the incorrect dose of steroids for the treatment of their asthma. Following our assessment the provider sent us evidence that showed clinicians had been made aware of the most therapeutic dose to prescribe. We reviewed the records of a person with asthma that had been provided with repeat prescriptions of a medicine that was contraindicated in the treatment of asthma. When we highlighted this to the provider, they cancelled the repeat prescriptions and called the person in for a medicine review.

Appropriate emergency medicines and medical oxygen were stored safely and appropriate risk assessments completed. Staff told us they regularly checked the stock levels and expiry dates for all medicines. However, there were no records to demonstrate that regular checks of emergency medicines were carried out, only records of items nearing their expiry date were maintained. This meant the practice could not provide assurance that emergency medicines were consistently monitored to ensure they were safe and fit for use.

Staff did not fully manage prescription stationery appropriately and securely. Blank prescriptions were not recorded upon receipt into the practice or when they were transferred from the main practice to the branch practice. Prescriptions were tracked throughout the practice although an up to date audit trail of prescriptions left in unlocked printers overnight was not in place. A log of prescription pads found at the main site was not in place which increased the potential risk of prescription abuse or fraud. Following our assessment, the provider sent us an updated policy describing how they would change their processes going forward. They told us they had made the decision that prescriptions would only be printed in the dispensary where secure arrangements were in place.

Systems for monitoring uncollected dispensed prescriptions within the dispensary were not effective. We found 16 uncollected prescriptions at the branch practice, some had been dispensed up to 9 months before our assessment. A delivery service was in place to deliver prescriptions to housebound people. However, there was no audit trail to confirm receipt of the dispensed medicines by the driver upon collection from the branch practice or when delivered to the people. The practice updated their policy to ensure this would be done.

Staff had the appropriate authorisations to administer medicines. Appropriate systems were in place for the safe management of controlled drugs. The practice monitored the prescribing of antibiotics to reduce the risk of antimicrobial resistance. Prescribing data reviewed as part of our assessment confirmed this. For example, the overall volume of antibiotics prescribed by the practice was comparable with local and national averages. The practice’s IT system flagged when someone was due a medicines review or when additional monitoring was required. Vaccines were stored and managed in line with national guidance. Medicines and Healthcare products Regulatory Agency alerts were handled effectively.