Dr Heath Prescot Medical Centre

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 75 (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.Leaders encouraged staff to raise concerns when things went wrong. The provider had systems for staff to report incidents, near misses and safety events. The practice had recorded 18 significant events in the last 12 months. People felt supported to raise concerns and felt staff treated them with compassion and understanding. Staff felt there was an open culture, and that safety was a top priority. Analysis was undertaken and learning from incidents and complaints resulted in changes that improved care for others. When things went wrong, staff apologised and gave people support.

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 to specialist and urgent services, including urgent referrals, were managed through a clear process.The provider was part of a PCN and participated in meetings across the locality to share information relating to patient care and treatment. These included safeguarding and multi-disciplinary 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. The practice had a safeguarding lead and staff received safeguarding training appropriate to their roles. Recruitment procedures including the necessary pre-employment checks were in place to ensure staff were suitable to work within the service. Patient records included clinical codes to identify safeguarding concerns, supporting effective monitoring and 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.Leaders told us they worked with services locally to understand and manage risk. The practice had registers in place to support patients who were vulnerable or had mobility or communication needs.Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of the action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

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 clean and well 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.

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.A recruitment policy was in place, and a review of personnel files confirmed safe recruitment was consistently followed. New staff participated in a structured induction and were required to complete mandatory training that was regularly refreshed.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared any concerns with appropriate agencies promptly.The practice had a designated infection, prevention and control lead and all staff had received relevant training. Staff were aware of the systems and processes required to ensure clinical specimens were handled safely. Cleaning schedules were in place and followed. 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.We carried out a random selection of clinical searches to review how patients’ medicines were monitored and if the appropriate care and treatment was being received. For example, clinical searches identified 23 patients prescribed methotrexate, an immune suppressant medicine, within the previous 6 months who may be overdue monitoring. However, we found that appropriate monitoring was in place in line with guidance for all records reviewed.We carried out a search to identify the number of patients with a potential missed diagnosis of diabetes. The review of HbA1c results (HbA1c is a blood test that shows the average level of blood glucose) demonstrated that patients had been appropriately reviewed and acted upon in line with clinical guidance.

We reviewed 5 clinical records of patients over the age of 65 who had been prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Long term use of these drugs can cause gastrointestinal side effects and are prescribed alongside proton pump inhibitors (PPI) to reduce this side effect. We found no evidence on patient records we reviewed to establish if the risk of gastrointestinal protection omission had been discussed. We raised this during our assessment. The provider conducted a rapid investigation to identify all patients registered at the practice who may have been affected and took immediate action to contact the patients and remedy this shortfall.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. 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 followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. However, the procedure for recording and monitoring paper prescriptions were not effective. This was discussed during our assessment. The provider was receptive to our feedback and during our assessment we received assurance that action had been taken to mitigate any risk.

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. Waste medicines were recorded and disposed of appropriately including medicines returned by patients. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure those people prescribed medicines with specific risks received recommended monitoring. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.