Great Ayton Health 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 66 (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 had processes for staff to report incidents, near misses and safety events. Lessons were learnt to continually identify and embed good practice.

In feedback, all staff confirmed that they knew how to report a significant event.

Most staff also stated that they were invited to discuss significant events, with others stating that they would be if they had been involved or if it was relevant to their job role.

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 PPG felt the provider took concerns seriously and proactively made improvements to the service.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and 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 and test results were managed in a timely way.

We found that there were systems and processes in place to deal with Medicines and Healthcare products Regulatory Agency (MHRA) alerts. These alerts are followed to ensure that medicines and medical devices are safe.

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.

Safeguarding policies were in place and were known to staff, who were appropriately trained in safeguarding. One of the GP Partners was the safeguarding lead for the practice and all staff knew who to report safeguarding concerns to.

Chaperones were available and both clinical and non-clinical staff had received training in this area. There were posters on noticeboards advising patients that they could request a chaperone should they wish to do so.

All staff had received training in safeguarding adults and children at a level relevant to their role. However, the most recent safeguarding children training was not recorded on the monitoring system so the provider would not know when staff were due their refresher training. This was immediately rectified by the practice manager.

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. However, the system for managing emergency equipment required review.

All staff had completed Sepsis training, training in basic life support and anaphylaxis training and could recognise a deteriorating patient.

Patients were advised on risks related to their condition and actions to take if their condition deteriorated. For example, patients identified as being at risk of SGLT2 Ketoacidosis and Fournier gangrene had been informed of the risk and had their records appropriately coded.

Emergency equipment (such as a defibrillator and emergency medicines) was available on-site and maintained. We saw during our site visit however, that the practice did not stock some emergency medicines as per national guidance recommendations and there was no evidence that an appropriate risk assessment had been conducted or documented for the medicines that the practice did not stock.

We also saw that some items on the practice checklist for the crash trolley were missing and that checks were being carried out monthly (as per their Emergency Equipment policy) rather than weekly as per current national guidance.

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 practice was situated in an NHS Property Services building and contracts were in place to ensure that the premises were well maintained.

The practice provided us with evidence of a recent environmental risk assessment and health and safety risk assessment and there were clear action points to address any risks that had been identified.

There was a business continuity plan in place which was monitored and reviewed on an annual basis.

Regular fire safety checks were carried out and all staff had completed mandatory training in fire safety.

The service made sure there were always enough qualified, skilled, and experienced staff, who worked well together to provide safe care that met people’s individual needs.

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. However, the practice was not following its own clinical supervision policy which stated that clinical staff should receive supervision at least quarterly.

Some clinical staff stated in feedback that they did not receive formal supervision between their appraisals (held annually). Others highlighted that supervision only took place whilst they were training for certain qualifications or more advanced roles.

Supervision for clinical staff appeared to be ad-hoc, although staff confirmed that the practice had an open-door policy and that support was available should they need it.

GP Registrars were being appropriately supervised and reported that they had a face to face/telephone debrief at the end of each clinic with their named supervisor, during which prescribing medication was also discussed.

Safe recruitment practices were being followed which included appropriate levels of Disclosure and Barred List checks made pre-employment.

The service 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 (IPC) lead and all staff had completed relevant training. Cleaning schedules were in place and were being followed.

A recent IPC audit had been conducted by the IPC Lead, and no areas of non-conformity were identified.

During our visit, we observed the practice to be clean and tidy throughout.

The service mostly ensured that medicines and treatments were safe and met people’s needs, capacities, and preferences.

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.

Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines and vaccines. Waste medicines were recorded and disposed of appropriately.

Staff stored medical gases, such as oxygen, safely and the provider had effective systems to manage and respond to safety alerts and medicine recalls.

Patient Group Directions (written instructions allowing non-prescribing health professionals to administer specified medicines to a specific group of patients without a specific prescription) were in place and up to date.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. For example, audits of medicines used for treating epilepsy to ensure patients had received appropriate monitoring and had been advised about the risks associated with them.

Staff followed established processes to ensure that people prescribed medicines with specific risks received recommended monitoring. Findings from clinical searches showed generally good oversight and monitoring of patients prescribed high risk medicines. For example, those on anti-rheumatic medicines and those prescribed medicines to treat high blood pressure. However, we identified 40 patients on a medicine to treat pain had potentially not received the appropriate monitoring. We found 3 of the 5 records we reviewed required action. The provider carried out a review of all these patients immediately following the assessment and took appropriate action where required.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was in line with the national average.

Processes were not in place to manage blank prescription stationery and track them throughout the practice. Although prescriptions were stored securely on receipt, we observed they were left in printers in clinical rooms that were accessible to the public. This was immediately addressed by the practice and a system put in place to ensure their security.