St Martin's Gate Surgery

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 practice 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. People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt that if they were to raise concerns, they would be dealt with in a timely manner. There was a process for staff to report incidents, near misses and safety events. During staff meetings, the whole team discussed and learnt from clinical issues. Learning from incidents and complaints resulted in changes that improved care for others. Staff felt there was an open culture, and that safety was a top priority.

The practice 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. Patient referrals to specialist services were documented in the referrals systems and patient record. Patients were positive about referrals being managed in a timely manner. There were protocols in place for managing incoming correspondence into the patient’s medical records. This included appropriate arrangements for the oversight and recording of laboratory results.

The practice 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 practice shared concerns quickly and appropriately. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. There was appropriate management with oversight and review of safeguarding, including registers, meetings and alerts on records. There were appropriate processes in place to respond to concerns and correspondence such as when children missed their appointments.

The practice 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 what action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The practice detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of care. Health and safety risk assessments had been undertaken and risks identified had mostly been addressed. Portable appliance testing and calibration of equipment was completed annually to ensure equipment was safe to use. However, we did find equipment at their branch site that had not been calibrated. Leaders told us they had a plan in place for this to be completed.

The practice made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked well together to provide safe care that met people’s individual needs. They ensured staff employed through the PCN (Primary Care Network) were suitably experienced, competent and able to carry out their roles. For example, they were involved in their appraisals and PCN staff were given an induction pack when starting their role. We reviewed a range of personnel filesand found some gaps for staff immunisation status records. Leaders were able to show evidence of this being chased up following a change in management. We found training was up to date. Learning needs and development of staff was managed appropriately. Leaders told us they made changes to the appraisal process following staff feedback. Feedback we received from staff was very positive about this change.

The practice 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 the relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

As part of our assessment, a Care Quality Commission GP Specialist Advisor undertook searches of patient records on the practice’s clinical system. Our clinical records review identified some gaps for medicines management.We found the following:

Non-steroidal anti-inflammatory drugs (NSAID - medicine for relieving pain, reducing inflammation and lowering a high temperature) prescribed to patients over 65 years of age; and antiplatelet drugs (used to inhibit the formation of blood clots) prescribed for patients over 75 years of age: We identified 140 patients out of 342 who had not been prescribed the recommended Proton Pump Inhibitor (PPI) drugs and reviewed the care records for 5 patients. PPIs are a group of medicines that reduces stomach acid production. National Institute for Care and Health Excellence (NICE) guidance recommends prescribing PPI drugs for elderly patients taking NSAID or antiplatelet drugs to reduce the risk of gastrointestinal bleeding. Of the 5 patient care records reviewed, we found all 5 patients had not been prescribed PPIs and had not declined being prescribed these drugs or been identified as not being able to tolerate the drug.

Methotrexate (an immune system suppressant drug): We identified 65 patients that were prescribed this medicine. We found for all 5 patient records we reviewed; the day of the week the medicine should be taken was not indicated. As the prescribed dose of Methotrexate should be taken once weekly on the same day each week, this day should be documented and clearly communicated to the patient.

Staff managed prescription stationery appropriately and securely. 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.