Salters 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 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 practice had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and reported safety events. Leaders encouraged staff to raise concerns when things went wrong. There was a clear process for staff to report incidents, near misses and safety events. Staff were able to provide examples of incidents and could describe the process for reporting them. Learning from incidents resulted in changes that improved care for others. During staff meetings, the whole team discussed and learnt from clinical issues.

The practice 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 for new patients. There were protocols in place for managing incoming correspondence into the patient’s medical records. This included appropriate arrangements for the oversight and recording of laboratory results including when a clinician was absent. Patient referrals to specialist services were documented in the referrals systems and patient record. We found test results and referrals were managed in a timely manner.

The practice worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. There were appropriate systems in place for the management, oversight and review of lists of vulnerable people. Clinical system alerts were used to identify people who were at risk of harm or abuse including household contacts. 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 including dentist appointments. Safeguarding meetings were held on a regular basis to review people at risk which included external professionals such as health visitors.

The practice worked with people to understand and manage risk 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. Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take. The practice had an effective process for staff to respond to emergencies including if a clinician felt threatened.

The practice 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 maintained. Health and safety risk assessments had been undertaken and risk identified had been addressed. Systems were in place for the checks of fire alarms, fire extinguishers and fire evacuation procedures. Portable appliance testing was completed annually to ensure equipment was safe to use. There was a business continuity plan in place to provide guidance for dealing with a major disruption to the service, for example an IT failure.

The practice made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked well together to provide safe care that met people’s individual needs. We saw examples of phlebotomists being recruited to help reduce the workload on nurses. Safe recruitment practices were followed. They ensured staff employed through the primary care network (PCN) were suitably experienced, competent, and able to carry out their roles. For example, they were involved in PCN staff interviews, appraisals and leaders were mentors for them. There were a range of clinical and non-clinical roles within the practice. This was a training practice which supported medical students including nurses from the local universities. Learning and development were encouraged, and we saw many examples of staff undertaking additional training to progress within the practice and support colleagues. We found most training was up to date but found gaps in training for sepsis awareness (a life-threatening response to infection). The practice acted promptly to ensure all clinicians completed this training and added it to their annual training schedule.

The practice assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The practice had a designated infection, prevention and control lead and staff had completed their relevant training. Risk assessments and audits were completed, and actions taken to mitigate risks. Cleaning schedules were in place and followed. We found not all bins were operated with a foot pedal. The practice was responsive and took immediate action.

The practice 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. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely. 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. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

As part of our assessment, a series of patient clinical record searches were undertaken by a CQC GP specialist advisor. This included a review of the management of patients on medicines that required monitoring. We found most patients had received monitoring in line with guidance.

However, we did find that not all patients prescribed non-steroidal anti-inflammatory medicines (medicine for relieving pain, reducing inflammation and lowering a high temperature) or antiplatelet medicines (medicine which helps prevent blood clots forming) had been prescribed a protein pump inhibitor (a type of medicine that reduces stomach acid production). We discussed our findings with the practice, and they took immediate action to follow up on the gaps identified. This included a plan for future patients who are prescribed this medication. We reviewed a series of patients records who had a medication review in the past 3 months and found no issues with the monitoring of these patients.