Cam & Uley Family Practice Also known as The Orchard Medical 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. The practice had a 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. Staff had the right skills, qualifications, and experience. Staff managed medicines well and involved people in planning any changes. There were systems and processes to monitor prescribed medicines which required additional monitoring. However, we noted some gaps in this monitoring during our clinical searches. The practice addressed these immediately and instigated further systems and processes to reduce the risk of this reoccurring.

This service scored 62 (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 safety culture based on openness and honesty. Concerns related to safety were actively listened to, thoroughly investigated, and appropriately reported. The practice continually identified areas for improvement and embedded best practices through lessons learned. Members of the Patient Participation Group (PPG) commented that the practice responded to concerns with seriousness and took constructive steps to implement changes. Complaints were shared with the group, who described the process as transparent, honest, and open. People felt encouraged and supported when raising issues, and staff were recognised for their compassion and understanding. Management promoted a culture where reporting concerns was welcomed; staff were aware of how to escalate incidents both internally and externally. Learning from incidents and events was consistently shared during clinical and team meetings with the wider staff teams. Staff said that leaders were accessible and promoted an open, non-blame culture. Policies and procedures reinforced a commitment to continuous learning and improvement. Significant events and complaints were regularly reviewed in meetings, and a system was in place to track and monitor them. However, we identified some inconsistencies in the recording process. While some actions related to significant events had been completed, others remained partially completed or not formally closed. In response to this feedback, the practice took steps to strengthen and improve in this area. Investigations were carried out to determine the root causes, and appropriate measures were implemented to address the issues.

The practice worked with people and healthcare partners to build and sustain safe systems of care, ensuring safety was actively managed and monitored. Staff supported continuity of care, particularly when people transitioned between services. Referrals to specialist services were clearly documented, included all necessary information, and were prioritised appropriately based on urgency. A tracking system was in place to monitor referral progress and follow up on any delays. Partner organisations shared positive feedback about the practice’s commitment to people of local care homes for example: “They respond to calls within the same day and are prompt in coming out to the service. The staff are friendly and understanding, making sure to allow extra time for individuals who need it.” Staff provided examples of coordinated efforts with other healthcare providers to meet individuals’ clinical requirements. There were systems in place to manage information for newly registered patients. At the time of this inspection, there were 178 new patient records waiting to be summarised. The practice had a plan in place, to manage and mitigate the backlog, with consideration given to identify and reducing any risks to people’s safety and wellbeing and were in the process of reviewing staff skills and experience in this area.

The practice collaborated with people and healthcare partners to explore what safety meant to them and determine the most effective ways to achieve it. Their focus remained on enhancing lives while upholding each person’s right to live safely, free from bullying, harassment, abuse, discrimination, preventable harm, and neglect. Concerns were promptly and appropriately shared with relevant agencies. Staff received role-specific safeguarding training and were equipped to identify individuals at risk. They understood the systems, processes and procedures in place to protect people from abuse and felt confident raising any concerns. Everyone knew who the safeguarding lead was and how to access them. We observed the practice had developed robust policies and procedures reflecting strong partnerships with external agencies and local safeguarding teams. Clinical staff were supported by electronic systems that flagged potential safeguarding issues during patient record reviews. There were regular meetings and discussions between the practice and other health care professionals, such as social workers, to support and protect vulnerable adults and children from risk of harm.

The practice worked with people to understand and manage risks effectively. Care was delivered in a manner that was safe, supportive, and responsive to people’s needs, empowering them to engage in activities that mattered to them. People were informed about condition-related risks and advised on appropriate actions should their health decline. Systems were in place to assess, monitor, and manage patient safety risks, and these protocols were clearly communicated to staff.

The practice had made reasonable adjustments to improve accessibility for individuals who found it difficult to access services, such as providing ground floor rooms and step-free access and offering appointments. Staff understood their responsibilities in maintaining a safe environment, including how to respond in emergencies. They had completed relevant safety training, including health and safety, fire safety, and information governance. All equipment was suitable for its intended use and regularly maintained to ensure it remained in good working condition. Clear signage throughout the building supported both staff and people in the event of an emergency evacuation. A business continuity plan was in place and reviewed as needed. Health and safety risk assessments had been conducted, with appropriate actions taken in response. During our onsite visit to the main practice, we observed the layout of the reception and waiting room meant that staff would not be able to observe a deteriorating patient. Staff reported that they often had to rely on other people or staff to raise concerns in such situations. The practice addressed our concerns and confirmed that an action plan had been implemented to address this issue and enhance the visibility of people in the waiting area by reception staff. We also observed that clinic rooms were not secured with locks, despite containing potentially hazardous items such as needles and syringes. There was no evidence that a risk assessment had been conducted to address this. However, following our visit, the practice took action and submitted evidence demonstrating planned improvements to the safety and security of access to such equipment. Additionally, we identified that the accessible toilets at both the main site and the branch surgery were missing emergency pull cords. At the branch location, there were also no grab rails to support individuals with limited mobility. Once these concerns were brought to the practice’s attention, steps were being taken to rectify the issues.

The practice made sure there were enough qualified, skilled, and experienced staff, who received effective support and development. Some staff told us they had not received an annual appraisal. The practice told us they were aware of this and had a scheduled plan to ensure everyone does receive an appraisal in the near future. The staff worked well together to provide safe care and treatment that met people’s individual needs. Most staff feedback expressed the current staffing levels met patient needs. However, some staff told us there had been periods when the practice was short staffed due to sickness absence and this had resulted in not being able to complete workflows. Leaders were in the process of reviewing the staffing model, following the planned implementation of the new electronic triaging system (systm connect). Recruitment checks had been completed for all newly appointed staff prior to commencing in their roles. However, we found that one staff file did not contain references from previous employment. There was no evidence a risk assessment had been completed. Following the on-site visit the practice provided assurances that a risk assessment had been implemented. A process was in place to record staff immunisation status in accordance with national guidance. However, we identified gaps in staff files regarding the monitoring of immunisations. Following the on-site visit, the practice provided assurances that staff had been asked to supply the missing information, and where this was not possible, a risk assessment had been completed. In addition, they had updated the recruitment process to include a request for staff vaccinations at the time of appointment. Staff had completed both mandatory and role-specific training, which was centrally monitored to ensure timely completion and alignment with their areas of competence. However, some training was overdue. At the time of the inspection, the practice had already taken steps to address this and was actively strengthening its systems and processes to ensure that all future training, including role specific modules, was completed before the current certificates expired. There was a system to ensure triaging of people was carried out by suitably qualified and trained staff and appointments allocated to appropriate clinicians.

Staff demonstrated awareness of their responsibilities regarding infection prevention and control (IPC) and knew who to contact for additional support if needed. The practice had systems in place to assess and manage infection risks, effectively identifying, controlling, and reporting concerns to relevant agencies in a timely manner. Cleaning schedules were established, and the premises were visibly clean. Personal Protective Equipment (PPE) was readily available to staff. However, during the onsite visit, we observed that the storage of clinical waste bins at both Cam and Uley practices was not secure. The practice responded promptly and began taking steps to enhance the safety and security of these bins. Staff had received IPC training, and risk assessments and audits were conducted, with actions taken to mitigate identified risks. An up-to-date IPC audit had been completed.

The practice strived to make sure that medicines and treatments were safe and aligned with people’s needs and preferences however, this was not always effective. Staff were familiar with systems used to identify individuals requiring monitoring based on their prescribed medications. Non-medical prescribers’ (healthcare professionals trained to prescribe medicines without being a GP) had daily opportunities to discuss their prescribing decisions with a GP. An audit was carried out by a GP on a selection of clinical records, followed by discussions which focused on clinical decisions and prescribing practices. Regular checks were conducted on emergency medicines and equipment. However, we found some equipment had expired and the practice could not initially provide evidence of the rationale for not stocking certain emergency medicines in accordance with national guidance. The practice responded promptly, supplying evidence of a completed risk assessment regarding the omitted medicines and actions taken regarding the out-of-date equipment. Staff also routinely checked medicine stock levels and expiry dates. The practice had not considered the security and access arrangements for the dispensary. The dispensary door was unsecured, allowing easy access from the waiting area, with no locked barrier separating people from the dispensary. Furthermore, no risk assessment had been carried out to evaluate the potential risk of external cleaning staff accessing the dispensary, where confidential patient medication records were stored. Following the onsite visit, the practice provided assurances they had plans in place to address the safety and security of the access to the dispensary. There was a system and process in place for the safe storage and management of prescription stationary. Printers containing prescriptions were locked, however we found there was no process in place to review, audit or spot check prescriptions once placed in printers. A review of Patient Group Directions (PGDs) written instructions for supplying/administering medicines for specific conditions and Patient Specific Directions (PSDs) instructions for individual patients confirmed they were completed correctly and in line with guidance. Cold chain processes were observed at both sites, and we found the recording of fridge temperatures were well documented. Staff were knowledgeable regarding actions to take should the cold chain be compromised. The vaccine fridges had multiple items touching the back and side of fridges, this was highlighted to staff on the day of the onsite visit. The practice provided assurances this would be addressed immediately.

The practice had systems to manage and respond to safety alerts and medicine recalls however, these were not always effective. Our clinical searches identified 2 people aged 65 and over on a high dose of citalopram or escitalopram (medicines to treat low mood and panic attacks). These people had not been fully informed of the risks of taking higher doses of these medicines. Our clinical searches also identified 3 people prescribed Topiramate (medicine used to treat seizures and to prevent migraine headaches in adults and teenagers). These people had not received appropriate monitoring. The practice took immediate action to review these people and remind clinicians of these medical alerts. Our clinical searches also identified that 762 people had received a medication review in the previous 3 months. We reviewed 4 of these records and they lacked structure, quality and content. Following our remote clinical searches, the practice reviewed, developed and strengthened their systems to ensure people received the appropriate monitoring or review.