Tredegar 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 last assessment, we rated this key question as Good. At this assessment, the rating remains the same.

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 service fostered a strong learning culture where staff felt safe to raise concerns. Staff followed processes for reporting incidents, near misses, and safety events. Leaders listened to safety concerns, investigated issues, and reported safety events. Lessons were learnt to continually identify and embed good practice.

The whole team discussed and learnt from clinical issues. The service had daily clinical huddles to discuss any cases of concern. 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. The service had a duty of candour policy in place.

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. The service had robust systems in place to ensure information was effectively shared across teams and agencies, enabling the delivery of safe, coordinated care.

Clinicians followed established care pathways for diagnosis, treatment, and referral to specialist services. There was a system to ensure referrals to specialist services were documented and contained the required information. The service had processes in place to monitor urgent (2 week wait) referrals and there were effective safety netting processes to ensure all patients were followed up. Communications from secondary care, such as discharge summaries, were processed efficiently to ensure continuity of care.

Clinicians processed test results daily and we saw most test results were managed promptly. However, we found a small number of pathology results had not been marked as reviewed. Leaders addressed this immediately and following our inspection, took action to improve oversight.

The service was proactive in safeguarding people from the risk of abuse, working closely with partner agencies to ensure a coordinated approach. Clear systems and processes were in place to respond promptly when concerns arose about abuse or neglect. The service had leads for safeguarding adults and children. All staff we spoke with were aware of who the lead was and how to escalate any concerns they had. They demonstrated how they would act if they suspected a patient’s safety was at risk. Training records we reviewed showed most staff had received safeguarding training appropriate to their roles and responsibilities.

Staff reviewed and maintained safeguarding registers for both children and adults. Safeguarding alerts were added to the clinical record system when relevant, ensuring that all team members could identify any ongoing concerns and could act accordingly.

There were effective arrangements for supporting people to identify manage and mitigate risks. The service was equipped to deal with medical emergencies (including suspected sepsis) and staff were suitably trained in emergency procedures. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. The service operated an online consultation service to help triage patient queries and appointment requests. The service had developed an on-call duty GP list to enable the prioritisation of patients with urgent needs.

Staff effectively identified and managed risks within the care environment, ensuring equipment, facilities, and technology supported delivery of safe care. Although the surgery building was over 30 years old and required refurbishment, it was clean and tidy. There were maintenance contracts to uphold safety standards.

Comprehensive health and safety audits and risk assessments, including electrical, gas, and Legionella had been completed within the past 12 months, with all identified risks addressed.The service had a business continuity plan which was regularly reviewed to manage major service disruptions. Staff reported no concerns regarding health and safety arrangements.

Although the provider used computer software to track mandatory staff training, some staff had not completed training. For example, one GP and one nurse’s training records were incomplete. Following this assessment, managers sent us evidence of completed mandatory training.

Clinical staff and non-medical prescribers received support and supervision, but meetings and prescribing parameters were not routinely documented. We saw that where clinical consultations had been discussed with a GP, this was recorded in the patient record. We reviewed a sample of consultation notes of non-medical prescribers and we found the consultations were of good quality and appropriate.

Managers had not consistently followed recruitment check processes. For example, we checked 5 staff files and found 3 staff files lacked immunisation history. In addition, managers had not undertaken risk assessments for those staff who declined vaccination. We saw all staff whose files we reviewed had a DBS check recorded.

Some staff had not received an annual appraisal, though managers had identified this and were committed to addressing it. There was monthly protected learning time which supported professional development. The service had enough staff. The leaders told us staff always worked within their job description and competency. Where people had specialist needs, such as, a learning disability, and autism, leaders told us staff had begun the Oliver McGowan mandatory training online, and the practice was seeking a provider to deliver the second part of the training.

The facilities and premises were clean, and systems were in place to prevent the spread of infection. Personal protective equipment (PPE) was well stocked and placed appropriately throughout the building. The provider assessed and managed infection risks, with clear roles assigned, including a dedicated lead for infection prevention and control. Staff had received training relevant to their roles.

Cleaning schedules were in place, and regular infection control and cleaning audits were conducted to maintain standards. The provider had created a new purpose-built storage space so cleaning equipment could be stored safely and according to best practice. Waste, sharps, and clinical specimens were managed carefully to keep everyone safe. Staff vaccinations were kept up to date in line with the latest UK Health Security Agency (UKHSA) guidance. There was a clear system for reporting infection concerns to the relevant agencies, such as for notifiable diseases.

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. In the main, staff followed prescribing protocols, ensuring safe practice and timely reviews. The service carried out regular prescribing audits which supported continuous improvement in care.

As part of our assessment a number of set clinical record searches were undertaken by a CQC GP specialist advisor. These searches were completed with the consent of the provider, and to review if the service was assessing and delivering care and treatment in line with current legislation, standards and evidence-based guidance.

We reviewed clinical records for patients who had been prescribed medicines which required monitoring. Our review showed that regular medicines reviews were carried out for people who used the service to ensure their medicines were safe and appropriate to their needs.

There was evidence that most people taking medicines with specific risks that required monitoring, were appropriately monitored before their medicines were prescribed.Where more frequent monitoring was required, there were a small number of patients who had not always had appropriate monitoring. The service had a shared care policy which stated that where a specialist prescribes a medicine requiring ongoing monitoring, responsibility for both prescribing and monitoring would remain with the specialist service. The clinical searches identified 4 patients whose prescriptions for lithium (a medicine to treat depression) were commenced in hospital. However, we noted that 2 of these patients were discharged with a letter requesting their GP to do blood monitoring but there was no record of up-to-date monitoring We did not see digital flags on their records highlighting the need for Lithium blood tests for these patients. The risk of prescribing Lithium without monitoring is side effects including Lithium toxicity, thyroid disturbance and renal function impairment. We asked the provider to review these patients during the assessment process.

The provider had systems to manage safety alerts, but these were not always effective. For example, the Medicines and Healthcare products Regulatory Agency issued alerts in 2016 which warned against combining certain medicines due to risks of severe hyperkalaemia (high potassium levels) and acute kidney injury. The clinical searches identified 4 patients who were overdue monitoring. All of these patients last blood tests were normal and only one of these patients was significantly overdue required monitoring. Leaders acted quickly to resolve this concern and improve oversight, following assessment.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. The service had taken steps to ensure appropriate antimicrobial use to optimise patient outcomes and reduce the risk of adverse events and antimicrobial resistance.

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 systems to manage and respond to safety alerts and medicine recalls.