Dr VK Dewan

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.

Systems were in place to protect individuals from abuse and avoidable harm. We found safeguarding procedures were in place to ensure those at risk were regularly reviewed and their safety was clearly prioritised across the service.

Health and safety procedures were regularly monitored, and the premises were appropriately maintained. Any actions identified were acted on to reduce potential risks.

We found safety incidents were investigated to identify shortfalls and prevent recurrence and regular practice meetings were in place where learning was shared with the practice team to mitigate any future risks.

This service scored 72 (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.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. 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.

The practice had a significant events policy, and a reporting form was in place, which was accessible to all staff members.

Information reviewed demonstrated that people had opportunities to provide feedback and they knew how to make a complaint. Lessons were learnt from individual complaints and shared with the practice team to improve the quality of care. Feedback and information were available in the practice and on their website.

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.

Effective systems were in place for processing information relating to new people including the summarising of new records. We found clinicians made appropriate and timely referrals in line with protocols and up to date evidence-based guidance. This was supported by a system in place to ensure all patient information including laboratory test results and referrals were reviewed and actioned in a timely manner.

The provider told us that there were processes in place that was monitored and managed to keep people safe. For example, the provider was part of the primary care network (PCN) and attended regular meetings with other agencies across the locality to share and discuss information relating to patient care and treatment.

There were a range of structured meetings in place. These included safeguarding and practice team meetings.

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.

There were processes in place to follow up children and young people who were not brought to their appointments with the provider and for secondary care appointments and safeguarding meetings were held on a regular basis to review people at risk. Community teams were invited and attended on occasions; however, they ensured information was shared appropriately for the care of people with safeguarding and vulnerable concerns.

There was a policy in place for the renewal of DBS checks. Records we examined showed that all staff had a DBS check in place. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.

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.

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.

Leaders told us that they worked with services locally to understand and manage risks. The practice also had registers in place to support those patients who were vulnerable or who had mobility or communication needs.

All staff were trained in basic life support and receptionists were aware of actions to take if they encountered a deteriorating or acutely unwell patient and had been given guidance on identifying such patients.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. Staff had been provided with training in health and safety related topics such as fire safety, infection control and manual handling. Staff reported during discussions that they had no concerns regarding the arrangements in place to ensure health and safety.

There were policies and procedures in place for the management of health and safety. Fire safety policies were in place and staff were aware of how to access these. Fire marshals had undertaken additional training for the role. Systems were in place for the regular checks of fire alarms, extinguishers and fire evacuation procedures.

The practice had completed assessments in place for the control of hazardous substances. Evidence provided by the practice showed equipment was regularly calibrated and electrical items were PAT (portable appliance testing) tested.

There was a business continuity plan in place which was monitored and reviewed. Reception and administration staff who handled calls to the practice and arranged appointments with the clinical team were aware of potential red flag symptoms. Staff knew when to notify a GP or other clinicians with concerns about a patient who may be acutely unwell and/or deteriorating.

During our site visit we found the premises were well maintained. The provider detected and controlled potential risks in the environment. They made sure equipment, facilities and technology supported the delivery of safe care. Regular checks were carried out on the premises, facilities and the equipment provided. Contracts were in place to ensure the premises were clean and well maintained. Clear signage around the building supported people and staff in the event of an emergency evacuation.

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 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.

The practice had recruitment policies in place, and all staff had completed disclosure and barring checks. All newly employed staff had completed an induction to ensure they were competent in carrying out their role. We reviewed 3 personnel files and found appropriate checks such as previous employment record and proof of identity checks had been completed. Personnel folders were well organised and there was a systematic approach to ensure that personnel folders were managed appropriately. We found staff immunisation status records 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 completed training relevant to their role. Staff were aware of the systems and processes to follow to ensure clinical specimens were handled safely.

The practice had policies in place for infection, prevention and control which was accessible to staff and staff were aware of the action to take. For example, in the event of a sharps or contamination injury.

Cleaning schedules were in place and followed. Risk assessments and audits were completed and actions taken to mitigate risks. The practice had achieved 100% in a recent infection control audit.

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

As part of the assessment, we carried out remote clinical searches. We reviewed the number of people who had been prescribed ACE inhibitors and angiotensin II receptor blockers (ARBs), medicines used to control blood pressure. The search identified a potential of 25 people who had not had regular monitoring. We reviewed a random sample of 5 records and found no evidence in the clinical records that the prescriber had checked monitoring was up to date prior to issuing a prescription. We spoke with the lead clinician following the clinical search who was aware of the outstanding monitoring for this group of patients and action had been taken prior to the assessment to remind patients to attend their appointments. A second search showed the number of people on medicines used to treat anxiety, mental health conditions and conditions like seizures who had been prescribed more than 10 times in the past 12 months. The search identified potentially 21 people on these types of medicines. On discussing the findings with the clinical lead, we were told that an audit had been completed and patients were currently being reviewed. The audit also reviewed patients on a medicine called Zopiclone, used for sleeping problems. The audit showed 38 people had been prescribed this medicine. Following the assessment we received assurances, that 14 people were on long term prescriptions, 9 of these patients had been started by community mental health team and 5 people had been started by the practice. The remaining 24 patients patients were being prescribed this medicine in line with clinical guidelines. Medicine reviews had been completed for 2 of the 5 patients in the past 6 months and the practice planned to complete a medication review with each person to ensure they were receiving the appropriate treatment. Further reviews showed the number of people who had been over prescribed SABA inhalers used for the treatment of asthma in the past 12 months. The search identified 3 patients. We reviewed each clinical record and found 2 patients had no evidence of a medication review and 2 patients’ prescriptions were on repeat instead of being assessed when they required an inhaler. We received assurances that the pharmacist would take action to change all prescription requests to ensure patients were not receiving repeat inhalers and inhalers would be issued as required.

We reviewed a random sample of records in relation to safety alerts issued by the Medicines and Healthcare products Regulatory Agency (MHRA) and found all the appropriate monitoring had been completed.

Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Systems for maintaining the cold chain were also effective with data loggers in place. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely. 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 in line with local and national averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.