Pathfields Medical Group

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. We assessed all quality statements in the safe key question. At our last assessment, we rated this key question as requires improvement. At this assessment, we rated the key question as good. We found the service now had a good learning culture and people could raise concerns. The service took concerns seriously and regularly investigated, reviewed, analysed, and learnt from events and incidents. When things went wrong, staff acted to ensure people remained safe. Staff were knowledgeable within their role and shared experiences to support development. The facilities and equipment met the needs of people, were clean and well-maintained and any identified risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training, regular supervision and appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.

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. They listened to concerns about safety and investigated and reported safety events. Policies and procedures supported and encouraged a learning culture. Staff understood how to raise concerns and report incidents both internally and externally. Leaders demonstrated they managed significant events and complaints appropriately and staff were involved in identifying learning. Some staff told us learning was not always shared with them. However, we saw evidence where learning from events and incidents had been shared in team meetings and made available online. The patient participation group (PPG) felt the service took concerns seriously and proactively made improvements. Managers encouraged staff to raise concerns when things went wrong. Staff felt there was an open culture, and that safety was a priority. There was a 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 that improved care for others and embedded good practice.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff were aware of the systems and processes for sharing information to deliver safe care and treatment. Staff explained their understanding of the importance of continuity of care to ensure the right care at the right time. Referrals to specialist services were documented, contained the required information and were prioritised for routine or urgent action. There were systems for processing information relating to new patients. The service worked with other providers to deliver shared care and when people moved between services. Partner organisations shared positive feedback with us about how the service supported people living in local care homes. They told us they received a ”weekly call from [the] practice where we can discuss any concerns, service users have a yearly health check at [the] surgery and we have a medication review yearly”.

Staff were trained to appropriate levels for their role and could identify vulnerable people easily. They were able to tell us about the systems and processes to keep people safe and safeguarded from abuse and felt confident in raising concerns. The service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. The service shared concerns quickly and appropriately. There were regular discussions between the service and other health and social care professionals such as social workers and health visitors. A GP at the service had recently taken on the safeguarding lead role and was being supported in their new role by the GP who was previously in the role. They had time allocated each week to review any safeguarding concerns and attend multi-disciplinary meetings as and when they were required.

The service worked with people to understand and manage risks by thinking holistically. There were systems and processes to assess, monitor and manage risks to patient safety. Appropriately trained staff completed consultations and provided specific advice to people. Staff told us they informed people about risks and documented this on their patient record. They provided care to meet people’s needs in a way that was safe, supportive and enabled people to do the things that mattered to them. People were advised on risks related to their condition and actions to take if their condition deteriorated. People said they were involved as much as they wanted to be in decisions about their care and treatment. Our clinical searches identified 5 patients of child-bearing age who were prescribed teratogenic drugs (medicines that can cause birth defects or developmental disorders) and found 4 did not have a pregnancy prevention plan in their patient record. We reviewed these records and saw evidence people had been informed of the risks and had been sent an annual risk acknowledgement form to sign. These forms had not been signed and returned and the service had recently sent an SMS message to follow up on the return of these forms.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The service made reasonable adjustments when people found it hard to access services such as having step-free access and ground floor level rooms. Staff had completed appropriate training including fire safety and information governance. Equipment was fit for purpose and maintained to ensure it was in good working order. Clear signage around the building supported people and staff in the event of an emergency evacuation. There was a business continuity plan which was monitored and reviewed. Contracts with external companies ensured all premises were maintained. Health and safety risks assessments had been carried out and where necessary, appropriate actions taken. However, during the onsite visit, we found radiators dangerously hot to touch. There was no signage to indicate this risk, even though this was documented in the risk assessment, as an action to reduce risks to people. We also found some paper patient records were not stored securely and some reception areas for staff were not always secure. The service immediately addressed our concerns and provided us with evidence to demonstrate they had taken action.

The service ensured 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 at the service. Systems demonstrated appointments were allocated to appropriate clinicians. Staff had completed mandatory training, and some had also completed specific training in their specialist area. 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 processes were in place.

The service had a designated infection, prevention and control lead and all staff had completed relevant training. Policies and procedures were available to staff. Cleaning schedules were currently under review with the contracted company. The premises we visited were visually clean. Sharps bins inside premises were appropriately managed. Personal Protective Equipment (PPE) was available to staff. However, during the onsite visits, we found some external clinical waste storage bins although locked, were not stored securely at several of the branch sites. The service provided evidence they addressed this issue immediately. Risk assessments and audits were completed, and actions taken to mitigate risks. For example, in some premises, sinks did not have an elbow operated tap to turn them off after hands had been washed. A risk assessment to mitigate any risks of cross-contamination had been completed. However, the service was aware they had not carried out regular hand washing audits which would support the mitigation of the risks relating to the use of the non elbow operated taps. The service was in the process of implementing a schedule of hand washing audits to coincide with annual appraisals. There was a process to record staff vaccinations in line with national guidance. However, we found there were some gaps in the monitoring of staff vaccinations. We saw evidence the service had requested missing information from staff, and they told us they would be completing a risk assessment for those with missing vaccine information.

The service ensured medicines and treatments were safe and met people's needs. Clinical searches identified gaps in medicines optimisation, which were promptly addressed. People were involved in planning their care, including when changes happened. Staff followed protocols for safe prescribing, medicine reviews and monitoring. Emergency medicines and equipment were checked regularly and stored safely, but not always easily accessible. Inconsistencies in stocked medicines posed a risk during emergencies. This was immediately addressed. Effective systems managed safety alerts and medicine recalls. Clinical searches found 262 patients over 65 on NSAIDs or antiplatelets, or over 75, should have been prescribed stomach-protecting medication. We viewed 5 records that showed this wasn’t considered, increasing risk. The service reviewed risks for these patients and offered additional medication where necessary. Staff ensured monitoring for medicines with specific risks. Clinical searches identified 143 patients prescribed 10 or more medicines had received a medication review over the last 18 months. Five patient records we viewed showed appropriate review. Regular clinical audits of prescribing focused on improving care and treatment. Blank prescription stationary was stored securely. However, stationary was not always tracked meaning the service would not know if prescriptions went missing. A new process to manage this stationary was implemented immediately. We reviewed Patient Group Directions (written instructions for the supply and/or administration of a named licensed medicine for a defined clinical condition by named registered healthcare professionals without them having to see a prescriber) and Patient Specific Directions (written instructions from a GP or other independent prescriber for a medicine to be supplied or administered to a named patient) and found they had not been completed in line with guidance. The service provided evidence they addressed this issue.