Nork Clinic

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.

At our last inspection, we rated this key question as Good. At this inspection, 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 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.

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. During staff meetings, the team discussed and learnt from clinical issues. 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 patients support. Learning from incidents and complaints resulted in changes that improved care for others.

The practice worked with patients 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.

There were systems in place for processing information relating to new patients. Referrals and test results were managed in a timely way. Staff involved with referrals were able to explain the processes. The practice worked with other providers to deliver shared care and when patients moved between services. Staff told us there were regular multidisciplinary team meetings where patients who may be vulnerable or those receiving end of life care were discussed and actions agreed and put in place.

Safeguarding policies were in place and up to date. Staff were trained to appropriate levels for their role and could identify vulnerable patients easily. They were able to tell us about the systems and processes to keep patients safe and safeguarded from abuse and felt confident in raising concerns. The practice maintained a list of vulnerable patients and acted on concerns working in partnership with other organisations. The practice shared concerns quickly and appropriately. There were regular discussions between the practice and other health and social care professionals such as social workers and health visitors.

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

The practice maintained appropriate emergency equipment and medicines, which were regularly reviewed and kept in good working order. Emergency medicines and equipment were accessible. We noted that 2 expected items of emergency medicines were not stocked. The practice had discussed this decision at a clinical meeting but at the time had not created a risk assessment. The practice subsequently created a risk assessment outlining the rationale for their decision not to stock these specific items.A system had been implemented to ensure all staff knew their role within a medical emergency to ensure it was managed effectively. Staff could recognise a deteriorating patient and knew which actions to take. The practice had a duty doctor each day to support with any patients who needed urgent action. Staff had been trained to recognise symptoms which may need urgent medical attention. 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 care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

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. The premises were clean and equipped with suitable facilities to support effective infection prevention and control. However, we observed that storage arrangements for some cleaning equipment was inadequate. Specifically, mop heads had been left uncovered outside. This was addressed by the practice manager on the day of the inspection site visit and the practice manager also informed us that an enclosed cupboard would be used going forward to ensure appropriate storage.

There was adequate signage and clear fire escape routes. There was evidence of up-to-date medical equipment calibration and portable appliance testing (PAT) certificates were in place. We noted that two instruments stored in a doctor’s bag had not been calibrated or PAT tested since 2021. The practice acknowledged this as an oversight. We saw that before the end of our site visit the instruments had been removed from use, and new equipment was ordered. Following the site visit, the practice provided evidence confirming that the replacement equipment had been received and put in place.

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 patient’s 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. Clinical staff had easy access to informal and formal clinical supervision.

The practice had appropriate recruitment processes in place. Including disclosure and barring (DBS) checks, references, induction, and staff immunisation information.

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 all staff had had relevant training. We saw posters around the practice including information about managing sharps injuries, handwashing, and clinical waste to support good practice. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The practice made sure that medicines and treatments were safe and met patient’s needs, including where patients needed support due to their 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. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, and vaccines. The practice had effective systems to manage and respond to safety alerts and medicine recalls. 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 practice was lower than local and national averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

However, we found that prescription stationery was not appropriately tracked when used in individual rooms. After the site visit, the practice provided evidence that systems had been improved to ensure the appropriate security and tracking of prescription stationery. Prescription stationery had been removed from all clinical room printers and was stored securely in a locked cabinet. It was only issued when requested by a clinician. The practice had introduced a new logbook to record the serial numbers of prescription stationery issued to clinicians. Evidence showed that entries included the date, the clinician’s signature, and the corresponding serial numbers. Any unused prescription stationery was signed back in as returned to the locked cabinet.

We found that some Patient Group Directions (PGDs) had been incorrectly signed. Following the inspection, the practice provided evidence that new signing sheets had been completed for the affected PGDs, ensuring they were now correctly authorised in line with required governance processes. (PGDs are legal frameworks that allow certain qualified healthcare professionals to supply or administer specific prescription‑only medicines without a prescriber’s direct involvement).