The Mill 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 patients were protected from abuse and avoidable harm.

The practice had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. Staff understood and managed risks. The facilities and equipment met the needs of patients, they were clean and well-maintained, and any risks had been 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. Staff managed medicines well and involved people in planning any changes. There were systems in place to ensure that Medicines and Healthcare products Regulatory Agency (MHRA alerts) were followed. Patients on high-risk medicines were recalled for monitoring in a timely manner

At our last inspection, we rated this key question as good. At this inspection, the rating remains the same.

This service scored 81 (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. Lessons were learnt to continually identify and embed good practice.

Leaders were committed to learning and organised educational meetings for all staff during which educational presentations were provided, and guest speakers were invited to talk with staff. We noted that lunch time clinical meetings would include external partners and stakeholders such as local pharmacists, community mental health teams, community services, and charitable organisations. Topics recently covered as part of the breakfast clinical meetings included a menopause masterclass.

The lead Infection prevention and control (IPC) nurse organised training for staff within the practice. They had proactively developed and produced bespoke IPC training, including videos featuring themselves, to enhance staff knowledge and compliance. They had also developed a series of games which covered IPC. These were developed in line with popular TV quiz shows. Staff told us this kept the subject fun whilst also re-enforcing required learning.

Patients felt supported to raise concerns and felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong. Clinical issues were discussed during staff meetings for shared learning. Staff felt there was an open culture, and that safety was a top priority. The practice had processes for staff to report incidents, near misses and safety events. 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 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 patients moved between different services.

There were systems in place for processing information relating to new patients. The practice worked with other providers to deliver shared care and when patients moved between services.

The practice worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.The practice shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. Staff we spoke with were aware of the safeguarding leads and the process to follow if they had any concerns. Safeguarding registers for children and vulnerable adults were maintained and staff acted on concerns by working in partnership with other organisations. Patient records contained pop-up alerts and alerts were also visible in the Summary Care Record.

The practice had a chaperone policy in place to maintain patient privacy during intimate examinations. Posters were displayed in consultation rooms and waiting areas.

The practice held internal yearly safeguard training which was attended by all staff. Staff we spoke with referred to this training as invaluable and felt that it allowed for greater understanding and discussion about the topic.

The practice worked with patients to understand and manage risks by thinking holistically. They provided care to meet patients’ needs that was safe, supportive and enabled patients to do the things that mattered to them.

National GP patient survey data highlighted 89% of patients felt that, during their last appointment, the healthcare professional was very good or fairly good at listening to them (national average 87%). In addition, 95% of patients stated they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment (national average 91%).

Emergency equipment was available and maintained. Staff training meant they 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 detected and controlled potential risks in the practice 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 and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed.

We saw that the practice had effective systems to monitor and comply with risk assessments, including fire safety and legionella testing (legionella isa type of bacteria naturally found in water, but can becomes a health risk if it grows in man-made systems) to ensure that patients and staff remained safe. Electrical equipment had been calibrated and tested.

Fire alarms were regularly tested, and routine fire drills were conducted across the practice. All staff received fire marshal training and understood their responsibilities. This included ensuring the building was fully evacuated of both staff and patients. Staff described planned fire drills where managers positioned themselves in various rooms to confirm that fire wardens checked all designated areas on each floor before exiting the building. Feedback from these drills was shared with staff to promote learning and continuous improvement

The practice made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met patients’ individual needs.

There were a range of clinical and non-clinical roles within the practice. 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. Safe recruitment practices were followed. Checks were in place to confirm nursing staff renewed their registration with their professional body annually. The practice also conducted General Medical Council (GMC) checks for doctors.

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 (IPC) lead and all staff had had relevant training. Cleaning schedules were in place and followed. Clinical rooms had adequate provision of personal protective equipment (PPE) and handwashing facilities. IPC policies were in place and IPC audits were completed regularly and the appropriate actions were taken when necessary to mitigate any risks.

The practice used digital technology to improve their IPC standards. Each clinical staff member was responsible for carrying out IPC checks in their clinical rooms at the end of every session and this was recorded using a QR (Quick Response) code. Responses were monitored to check these had been completed, or if anything needed addressing.

The lead IPC nurse had created a training programme for new starters and for refresher training. This incorporated videos of procedures relevant to the practice and allowed for staff who preferred different learning techniques. Topics covered included a video explaining and showing hand washing techniques as well as donning and doffing of PPE.

The practice made sure that medicines and treatments were safe and met patients’ needs, capacities, and preferences. They involved patients in planning, including when changes happened.

Staff involved patients in reviews of their medicines and helped them understand how to manage their medicines safely. Patients 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.

Staff followed protocols to ensure they prescribed all medicines safely, and ensured patients received all recommended medicines reviews and monitoring.

Medicines were stored securely and at appropriate temperatures. Refrigerators used to store vaccines and medicines were monitored to ensure temperatures were maintained and products were appropriately stored within them. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

We found there was established and effective systems in place to ensure appropriate Medicines and Healthcare products Regulatory Agency (MHRA) alerts (providing alerts, recalls and safety information on drugs and medical devices) were consistently reviewed and actioned. Staff followed established processes to ensure patients prescribed medicines with related risks received recommended monitoring.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. For example, hypertension, contraceptive implants and chronic kidney disease.

Patient Group Directions (PGDs) were in place which relevant staff worked to, (PGDs are written instructions to legally authorise specific healthcare professionals supply or administer medicines to patients).