Queensview Medical Centre

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• 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. The practice had systems to assess, monitor and continue to improve the quality and safety of service. There was a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. There were processes for monitoring patients’ health in relation to the use of medicines including medicines that require regular reviews. This key question has been rated as good.

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 practice 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. The practice had processes for staff to report incidents. There was an option for staff to open an incident directly from the clinical system, which leaders advised encouraged staff to report incidents more frequently and contemporaneously. Themes were identified and lessons were learnt to continually identify and embed good practice. Staff described a no blame culture and said they were encouraged to report incidents and share concerns.

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. Representatives from the patient participation group (PPG) felt the practice listened to their feedback and took appropriate action to make improvements where possible.

The practice worked with people and healthcare partners to establish and maintain 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 effective systems for the management of new patient registrations and summarising of records. Leaders advised there was dedicated staff to support timely registrations and review of new patient records to ensure clinical staff had up to date knowledge when reviewing patients. In addition, this ensured patients with long term conditions and those prescribed medicines that required regular review were seamlessly incorporated into the practice’s recall system. On the day of assessment, the practice was up to date with new patient record summarising.

The service worked with other providers to deliver shared care and when patients moved between services. There were systems in place for managing incoming correspondence for patients’ medical records. Referrals and test results were managed in a timely way.

The practice worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. They had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They always shared concerns quickly and appropriately. The clinical safeguarding lead and their deputy worked closely with the non-clinical safeguarding administrator. Staff were aware who the safeguarding lead was. The practice maintained oversight of lists of vulnerable people which were reviewed regularly. Vulnerable people were coded on the system and had alerts added to their records.

Staff knew how to identify, report and act when dealing with safeguarding concerns. They worked well with other healthcare professionals to ensure the concerns were addressed appropriately. An effective system was in place for the management, oversight and reviewing of safeguarding concerns. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice had worked with other practices in their primary care network (PCN) to develop a robust safeguarding training system for staff. They utilised a safeguarding tool developed by the Integrated Care Board (ICB) to assess staff competencies. A questionnaire was distributed for staff to complete at least annually. This was then used to identify gaps in knowledge and training priorities. We saw evidence that the effectiveness of training was also monitored through auditing of these questionnaires to check that staff competencies improved. Evidence reviewed demonstrated a correlation between targeted training and improved staff competence in relation to safeguarding.

Safeguarding meetings were held monthly, and regular communication was maintained in between these meetings. The practice acted on concerns and worked in partnership with other organisations. For example, they followed up children who attended AE and those that failed to attend their appointments.

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. The service managed significant events effectively. For example, leaders advised that following a significant event, improvements were made to the storage and accessibility of emergency equipment to ensure it was readily available in the case of an emergency. 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 practice was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care. Portable appliance testing and calibrations were completed. There was a business continuity plan in place which was monitored and reviewed. 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. Systems were in place to check safety equipment including fire alarms and emergency lighting. Fire evacuation drills had been completed. We observed fire exits were clear and fire safety equipment was easily available and regularly checked. Staff were aware of what to do in an emergency and where emergency medicines and equipment were stored. Temperatures of rooms where medicines were stored were monitored to ensure safety. Allocated staff also knew how to safely manage spillages of bodily fluids. We observed that the clinical rooms and offices used by the GP practice were fit for use and there were room checks undertaken.

Leaders made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked collaboratively to provide safe care that met people’s individual needs. The practice employed non-medical prescribers and had established formal processes in place to monitor and audit their clinical practice. This formal process included audits of their prescribing practice, regular appraisals, feedback and support. A sample of staff files we reviewed showed that all staff were suitably qualified, maintained their professional registrations and their continuing professional development (CPD) and had up-to-date specialist training appropriate to their role. All staff had appraisals, access to regular clinical supervision and protected time to complete their mandatory training. Leaders maintained effective oversight of staff completion of training. During our assessment, we found the majority of staff were up to date with their training. Those outstanding some modules included new staff still undertaking their induction. We reviewed evidence that demonstrated safe recruitment practices were followed.

The practice had developed systems to assess and manage the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Leaders ensured that facilities and equipment were safe, and that equipment was maintained according to manufacturers’ instructions. The practice had a designated infection, prevention and control (IPC) lead and all staff had completed relevant training. Cleaning schedules were in place and followed. The IPC lead had introduced digital systems to support effective oversight. For example, the use of QR codes linked to the practice’s digital management platform to complete room checks. Risk assessments and audits were completed, and actions were taken to mitigate risks.

The practice was able to demonstrate that it had an employee immunisation programme. Records of staff immunisation status were maintained. On the day of our assessment, we found records for 2 non-clinical members of staff were not available. Leaders were aware of this and advised results were pending for these 2 members of staff who had recently joined the practice.

As part of our assessment, a GP specialist advisor undertook a series of patient clinical record searches, to assess whether clinicians were prescribing a range of medicines safely and whether patients were being reviewed in line with national guidelines. The results of our searches were positive.

We reviewed patients prescribed a disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis and other inflammatory conditions by suppressing the immune system and reducing inflammation. The search identified 8 patients with 1 patient who may not have received the required monitoring. We found that although this patient was overdue their monitoring, there was evidence of efforts made by the practice to arrange an appointment for the patient. The practice took immediate action to arrange for the appropriate checks to be undertaken by the locality District Nursing team.

There was a process in place for recording and sharing Medicines and Healthcare Products Regulatory Agency (MHRA) safety alerts. Safety alerts were discussed in clinical meetings. Our clinical record review highlighted that safety alerts were actioned in line with guidance. Specifically, we reviewed patients prescribed a combination of medicines used to support patients with heart failure, to check they had received appropriate monitoring as required. Our search identified 5 patients who were overdue their monitoring. We reviewed records for all 5 and found that 2 were overdue but had been sent multiple reminders to book an appointment for review. The practice took immediate action to arrange blood test appointments for these patients.

We reviewed patients potentially at risk of having a missed diagnosis of chronic kidney disease (CKD) at stage 3, 4 or 5. Our search identified no patients at risk.

Our searches identified a total of 938 medication reviews that had been completed for patients in last 3 months. We reviewed a random sample of 5 of these medication reviews and found that all reviews had been completed appropriately.

We reviewed the prescribing of a medicine used to treat epilepsy and nerve pain to check that patients had been reviewed in the preceding 12 months. Our search identified 25 patients out of a total of 248 patients who appeared to have not received a review in that time. We reviewed a random sample of 5 of these patients and found only 1 patient was overdue a dose and medicines review but by just 6 days. Following our feedback, the practice contacted this patient and undertook an appropriate medicines review.

The practice adhered to an antibiotic stewardship policy that measures the appropriate use of antibiotics and optimises the use of antibiotics to improve patient outcomes. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. 

Staff regularly checked medicine stock levels and expiry dates, including emergency medicines and vaccines. Medical gases such as oxygen were stored safely. Fridge temperatures were monitored daily, and staff knew what action to take if the temperature was out of range. Similarly room temperatures where medicines were stored were monitored for safety. Staff managed prescription stationery appropriately and securely.