Swallowfield Medical Practice

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

Staff understood their safeguarding responsibilities and worked effectively with partner agencies to protect people from harm. The environment was clean and well-maintained, and risks were identified and managed appropriately. There were enough staff with the right skills, qualifications and experience and received training and regular appraisals to maintain high-quality care. However, we identified some areas requiring improvement, particularly in relation to governance of the dispensary, secure management of medicines and prescription stationery. The provider responded promptly and implemented actions to address these concerns.

At our last assessment in April 2016, we rated this key question as good. At this assessment, the rating remains the same because we found no issues with patient safety and clinical care.

This service scored 66 (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 demonstrated a proactive and positive culture of safety, underpinned by openness and honesty. Concerns relating to safety were actively listened to, with appropriate investigation and reporting of safety events.

People told us they felt supported to raise concerns and that staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) confirmed that the provider took feedback seriously and made proactive improvements in response.

The provider had established processes for staff to report incidents, near misses, and safety events. Incidents were recorded as either significant events or learning events; however, staff were not always able to clearly distinguish between the two. In response, the practice strengthened its Learning, Significant Event and Incident Policy and improved processes to ensure that minutes and key learning from meetings were consistently shared with all staff.

There was an effective system in place to record and investigate complaints. When things went wrong, staff offered appropriate apologies and provided support to those affected.

Representatives from the Patient Participation Group (PPG) shared that leaders took concerns, suggestions and ideas seriously and proactively made improvements to the service.

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.

There was a system in place to ensure referrals and test results were managed in a timely manner and that referrals, including urgent cancer referrals, were subject to regular monitoring.

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. 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.

All staff had completed safeguarding adults and children training to the appropriate level. Staff had also completed initial training to support interactions with patients with a learning disability or autism. We were advised further training would be undertaken when this was available.

There were dedicated leads for safeguarding adults and children. All the staff we spoke with or received feedback from knew who the lead was and what steps they should take if they had any concerns. The practice held regular multidisciplinary meetings (MDT) to discuss cases, referrals and ensure continuity of care.

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 maintained. 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.

We reviewed training records and noted all staff had completed basic life support training.

We noted some emergency medicines were not in stock at both sites and were not stored in tamper-evident containers or bags, in line with recommended guidance. However, following the onsite site visit, the practice shared the risk assessments for both locations and confirmed that appropriate tamper evident bags would be procured for both sites.

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. 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.

We noted the dispensary was located within a shared reception area, access was not consistently restricted to authorised staff, and doors were not always kept closed or securely locked. Door access codes were not regularly changed, and the same codes were used across the premises. Following the inspection, the practice has restricted access to the dispensary to authorised staff and introduced regular access code changes across the premises. These are recorded and audited, and a wider review of security arrangements were also underway.

During our site visit, we observed the premises to be clean and well-maintained. At the time of our assessment the provider was unable the obtain the cleaning logs for the two sites. However, these were subsequently shared following the onsite visit.

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.

We found that some non-clinical staff had not undergone Disclosure and Barring Service (DBS) checks at the time of the assessment. Reception staff had access to the dispensary area, despite not all having appropriate DBS checks. However, the practice had implemented plans to ensure that relevant staff would receive appropriate DBS checks from April this year and had introduced additional measures to strengthen governance arrangements in relation to recruitment and staff oversight.

There were processes for providing all staff with the development they need. This included appraisal, and career development conversations. Staff were supported to meet the requirements of professional revalidation where necessary.

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. We noted that cleaning schedules were in place, however improvements were required. These were subsequently addressed by the practice following the onsite visit, including the introduction of revised cleaning schedules and enhanced oversight. Risk assessments and audits were completed, and actions taken to mitigate risks.

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. However, improvements were needed for secure access of storage and of medicines.

As part of our assessment, a series of patient clinical record searches were undertaken by a CQC GP specialist advisor. This included a review of the management of patients on medicines that required monitoring. We found patients had received monitoring in line with guidance. The provider had effective systems to manage and respond to safety alerts and medicine recalls. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

The provider 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 received recommended monitoring. There were suitable processes for staff to follow when dispensing medicines. For example, prescriptions were always signed before being dispensed. The ordering and record keeping for medicines, was carried out appropriately. However, improvements were needed to ensure safe and secure storage in line with the requirements.

Prescription stationery was left in printers overnight within clinical rooms, creating a risk of unauthorised use. There was system in place for tracking and auditing prescription stationary, but it was not always effective. We noted that the storage arrangements did not align with national guidance, with stock not kept in locked cabinets within secure areas. Following the inspection, the practice implemented a revised process whereby all prescription stationery was removed from clinical rooms at the end of each session and securely stored and managed. Oversight and auditing arrangements had been strengthened to support compliance and reduce risk.

We noted that following our findings, the practice implemented a comprehensive programme of improvements to strengthen the security, governance, and management of the dispensary, medicines, and prescription stationery.