Hockley Farm 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

We looked for evidence that people were protected from abuse and avoidable harm.At our previous comprehensive assessment, we rated this key question as Requires Improvement. At this assessment, the rating has changed to Good.

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 processes for staff to report incidents, near misses and safety events. The practice had a positive culture of safety and leaders encouraged staff to raise concerns when things went wrong. Staff felt there was an open culture, and that safety was a top priority.

Lessons were learnt to continually identify and embed good practice. Learning from incidents and complaints was discussed in meetings and resulted in changes that improved the service.

Leaders were committed to learning, and we discussed an example of a significant event and the actions the practice had taken in response to the learning identified.

For example, one incident related to a patient who presented at reception experiencing chest pain, requesting an appointment. The patient was informed by a receptionist that there were no available appointments. The patient returned home and telephoned for an ambulance. The patient was admitted to hospital and found to have experienced a heart attack. The patient subsequently complained to the practice and this incident was investigated. Leaders explained this incident should not have happened, and the patient should not have been turned away from the practice. This incident was discussed at a practice governance meeting and leaders arranged for reception staff to receive refresher training on medical emergencies. In addition, the practice policy was updated to ensure no patients are turned away from the practice as a result of no available appointments if they present at the practice with an emergency. Leaders informed us they had sent a written apology letter to the patient involved in this incident.

The practice worked with patients and healthcare partners to establish and maintain safe systems of care. Staff worked to facilitate continuity of care, including when patients moved between services. There were protocols in place for managing incoming correspondence into the patient’s medical records. Patient referrals to specialist services were documented in the referrals systems and patient record. We found referrals were managed in a timely manner.

Safeguarding policies and procedures were in place to keep people safe and safeguarded from abuse. The practice had a GP safeguarding lead and a deputy safeguarding lead. Staff had completed the relevant safeguarding training for their role and shared concerns quickly and appropriately. We saw evidence of a training session organised for staff on the practice standard operating procedure for domestic abuse.

The practice maintained a register of vulnerable adults and children and acted on concerns working in partnership with other organisations. Clinical system alerts were used to identify people who were at risk of harm or abuse including household contacts. There were systems in place to respond to concerns and act on correspondence. For example, they followed up children who failed to attend their appointments or were frequent attenders to the accident and emergency department.

Regular monthly safeguarding meetings with the practice safeguarding lead and multidisciplinary healthcare professionals took place where safeguarding risks and patient care was discussed. Safeguarding was discussed with all staff in practice meetings to keep staff informed as appropriate.

The service did not always work well with people to understand and manage risks. They did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

As part of our assessment, we checked the emergency equipment and medicines available and reviewed the processes to maintain these. We found emergency medicines were located in a locked room in the practice. Emergency medicines, except those subject to additional storage requirements, should be readily accessible and not stored within locked cupboards or rooms as this can cause an unacceptable delay in the event of an emergency. We raised this concern with leaders who took immediate action to address this issue and relocated the emergency drugs grab bag to reception.

Following our site visit, leaders also arranged for coloured bags to be used to identify more easily which drugs may be needed in an emergency. Refresher training on basic life support had been scheduled for a protected learning time session for all staff. In addition, updates were made to the practice Resuscitation Risk Assessment to make the assessment more comprehensive.

There were triage processes in place to prioritise care for the most clinically vulnerable patients. Staff explained the ‘Rapid Health’ triage and on-call GP process which ensured acutely unwell patients were identified and managed safely. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The practice facilities were fully accessible to patients. The building was step-free for patients, with full access for wheelchair users. Consultation rooms were located on the ground floor. The practice had recently made improvements to the signage for the corridors and the consultation room numbers to make it clearer for patients to navigate. In addition, in response to feedback from the practice Patient Participation Group (PPG), pickets were installed for the disabled parking bays so bay locations were still visible in the event of bad weather and snow. At the time of our assessment, leaders were in the process of requesting from the building landlord the installation of power-assisted doors for the practice corridors to further improve ease of access within the building for patients.

The practice detected and controlled potential risks. They made sure equipment, facilities and technology supported the delivery of safe care. Contracts were in place to ensure the premises were maintained. Systems were in place for the checks of fire alarms, fire extinguishers and fire evacuation procedures. Portable appliance testing was completed annually to ensure equipment was safe to use. The practice provided us with evidence of health and safety risk assessments which showed that risks were properly managed. There was a business continuity plan in place which was monitored and reviewed.

The practice made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

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.

The lead pharmacist was an independent prescriber and leaders explained they held monthly meetings with nurse leads and pharmacists to discuss patient cases.

Leaders were enthusiastic about the development of their workforce and encouraged staff to learn new skills. For example, multiple staff had been upskilled to be able to undertake the task of summarising patient records which involved extracting key clinical information and organising it on the clinical system.

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 (IPC) lead and staff had completed relevant training. Risk assessments and audits were completed, and actions were taken to mitigate risks. Clinical waste procedures were in place. The practice had effective oversight of the external cleaning company to ensure cleaning schedules were followed and cleanliness met the required standard.

The practice strived to make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved patients in planning, including when changes happened.

Staff involved patients in reviews of their medicines and helped them understand how to manage their medicines safely. Patients knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

Medicines were stored securely, however during our onsite visit, we found refrigerators used to store vaccines and medicines, were not monitored effectively to ensure temperatures were maintained. We raised this issue with leaders who took immediate action to address this issue. ‘Cold Chain’ training was arranged for all nursing staff as part of a protected learning time meeting. In addition, a new escalation sheet had been added to each of the refrigerators to ensure staff were aware of what to do in the event of a temperature breach; new fridge temperature data loggers were installed; and each of the health care assistants and nursing team were assigned a refrigerator each to monitor daily.

There were Patient Group Directions (written instructions to help specific healthcare professionals supply or administer medicines to patients) in place which relevant staff worked to.

There was a programme of regular clinical audits that focused on improving care and treatment. This included audits on antibiotic prescribing, diabetes and chronic kidney disease.

Prescribing data was reviewed as part of our assessment and found that practice performance was in line with national averages for Pregabalin and Gabapentin medicines (primarily anticonvulsant drugs, also prescribed for pain); psychotropic medicines (used to treat various mental health conditions); hypnotic drugs (used for the management of severe insomnia); and antibiotics.

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 the following:

Methotrexate (an immune system suppressant drug): We identified 33 patients prescribed this medicine in the last 6 months and reviewed a sample of 5 patient records. We found 2 patients had not received the required monitoring however, we found these 2 patients had already been booked in for appointments for these tests at the practice.

Aldosterone Antagonist (a drug used primarily for the treatment of high blood pressure and heart failure): We identified 61 patients prescribed this medicine of which 19 patients had potentially not received the appropriate clinical monitoring. We reviewed in detail a random sample of 5 of these patients’ records and found 2 patients were overdue monitoring however, we found these 2 patients had already been booked in for appointments for these blood tests at the practice.

Bisphosphonate (medicines that strengthen bone density): National guidance recommends that after a patient has been taking this oral medicine for 5 years, the need for continuing treatment should be reassessed and consideration should be given to providing a Dual Energy X Ray Absorptiometry (DEXA) scan. DEXA scanning offers a non-invasive and highly accurate method for evaluating body composition, including bone mineral density. We identified 26 patients who had been prescribed this medicine for over 5 years. We reviewed in detail the records of 5 patients. We found 2 patients were overdue a DEXA scan and medication reviews. The practice took immediate action in response to our feedback and undertook an audit of all of these patients. Learning from this audit involved implementing a 6-monthly recurring audit to proactively identify and follow up patients due a DEXA review, alongside a process to actively capture privately performed investigations at routine patient reviews.

Safety Alerts: There was a process in place for recording and sharing medicine safety alerts. Pharmacists monitored all alerts and maintained a register. Safety alerts were discussed in clinical meetings. We undertook a clinical records review to assess if safety alerts were actioned in line with guidance. For example, we reviewed patients who were prescribed both an Aldosterone antagonist (a diuretic medicine which prevents potassium loss) and an ACE inhibitor to assess if these patients had received appropriate urea and electrolyte blood test monitoring in accordance with national Medicines and Healthcare products Regulatory Agency (MHRA) drug safety alert guidance. We identified 28 patients prescribed these medicines and reviewed in detail a sample of 5 patient clinical records. We found 2 of these patients were overdue their blood test monitoring, however these patients had already been booked in for appointments for these blood tests with the practice.

Medication reviews: We reviewed a random sample of 5 medication reviews out of a total of 734 reviews that had been completed for patients in the previous 3 months. We found no issues with any of these medication reviews and found they had been appropriately coded and contained necessary information.

As part of our assessment, we reviewed the processes in place for controlled drugs. Controlled drugs are medicines that are regulated by the government. This is usually because they are at higher risk of causing harm (such as dependence or misuse). Clinicians explained their systems and processes which included no more than 28 days of medicine prescribing, regular patient reviews, audits, and a proactive approach to offering patients the opportunity to reduce their medication.