Spring Gardens Group 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 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 meant people were safe and protected from avoidable harm.

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. Leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Leaders shared this learning with staff to support improved practice.

Most people who gave feedback to CQC felt supported to raise concerns and said staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. Staff felt there was an open culture, and safety was a top priority. There was a robust system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes which improved care for others.

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.

The service worked closely with people and healthcare partners to understand what safety meant to them and how best to achieve it. The focus remained on improving people’s lives while protecting their right to live safely and free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Staff shared concerns promptly and appropriately when issues arose.

Clear safeguarding policies were in place and well understood by staff, all of whom had received appropriate training. The practice maintained a register of vulnerable adults and children and took timely action on any concerns, working in partnership with other organisations to ensure coordinated support.

Safeguarding leads held regular meetings to keep information current. These included internal meetings with administrative staff who supported safeguarding processes, as well as broader discussions with health visitors and professionals involved in children’s safeguarding. The safeguarding leads and administrators also carried out routine audits to ensure information was accurate and correctly coded within people’s records.

Leaders and staff worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs which was safe, supportive and enabled people to do the things which 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.

The service had systems in place to identify, assess and manage risks within the care environment. Staff ensured equipment, facilities and technology were suitable and supported the delivery of safe care. While parts of the building required refurbishment, leaders told us they were unable to proceed with internal improvements until a roof repair, which was the responsibility of the landlord, had been completed.

There were appropriate contracts in place to ensure the premises were maintained. Health and safety risk assessments and audits had been carried out, and actions arising from these had been addressed. A business continuity plan was in place and was regularly reviewed and updated.

Leaders 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 which 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. Non-clinical staff were trained in a variety of administration roles so they could provide cover when required. Nursing staff were supported in their careers. For example, they were training to become Advanced Nurse Practitioners. Robust safe recruitment practices were followed. Leaders used an external human resources organisation for additional advice and guidance when needed. The practice had an employee immunisation programme. Records of staff immunisation status were maintained.

The service assessed and managed the risk of infection appropriately. Staff identified and controlled potential sources of infection and escalated concerns to the relevant agencies in a timely manner. However, the service had not completed actions from its most recent audit. For example, some hand soap dispensers had not been replaced. We also found several bins in clinical areas did not have lids, although these were not used for clinical waste. External clinical waste bins were chained, but one was not locked and was therefore accessible to the public. Leaders told us this was due to a faulty bin which had not been collected despite their request. They ensured it was secured and addressed the other concerns while we were still onsite.

Medicines management systems were safe, effective and well governed. The practice ensured medicines and treatments met people’s needs, capacities and preferences. People were involved in planning their care and were supported by staff when changes to their medicines were required. Staff involved people in medicines reviews and helped them understand how to manage their medicines safely. People knew who to contact if their condition worsened or if they experienced unexpected symptoms.

Staff were trained and competent in medicines optimisation. They received regular training and competency assessments and told us they felt confident managing the storage, administration and recording of medicines. Prescription stationery was managed securely. Staff followed established protocols to ensure prescribing was safe, and people received recommended reviews and ongoing monitoring.

Medicines were stored safely. Storage areas were secure and temperatures were monitored. Staff routinely checked stock levels and expiry dates for all medicines, including emergency medicines, vaccines and controlled drugs. Waste medicines, including those returned by patients, were recorded and disposed of appropriately. Medical gases, such as oxygen, were stored safely and supported by completed risk assessments.

Prescribing was safe and appropriate. Staff took steps to prescribe medicines optimally, including antibiotics. The practice had a programme of regular clinical audits designed to improve prescribing quality, such as audits of repeat prescribing and antibiotic use.

Clinical record searches showed safe prescribing and monitoring. As part of our assessment, a Care Quality Commission GP Specialist Advisor completed searches of patient records. The review identified very few issues in prescribing or the management of long‑term conditions. For example, a sample of 5 patients (from 94) prescribed immune‑suppressant medicines for conditions such as rheumatoid arthritis showed no concerns or missed monitoring. A similar review of 5 patients (from 1,992) taking Angiotensin‑Converting Enzyme (ACE) inhibitors found no issues.

A further review of 4 patients (from 466) prescribed SGLT‑2 inhibitors used to help lower blood sugar by increasing glucose excretion via the kidneys found all had been given information on expected risks and side effects, including Fournier’s gangrene. Three of the 4 had also been provided information on the risk of chronic kidney disease. Leaders took immediate action on missed blood tests and results to ensure patients were safe from harm.