East Park 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 63 (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 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 identify and embed good practice.

The service provided people with several ways to raise concerns, including both verbal and written methods. Staff were able to clearly explain the process and gave examples of how they had supported people to voice their concerns when needed. Leaders were visible and approachable when people wanted to raise concerns. All concerns, verbal or written, were recorded and used for learning where appropriate. Incidents or events that could be learnt from or improve future service provision were documented, discussed openly with the appropriate staff roles and learning implemented. Staff we spoke to demonstrated a good understanding of duty of candour.

The service worked with people and healthcare partners to provide safe care pathways. Staff managed treatment plans and ensured information was shared appropriately to make sure people received continued support when they moved between services.

The service worked effectively with other organisations, including the local hospice and care homes, to ensure people experienced a clear and coordinated pathway of care. Feedback from organisations that worked closely with the practice was consistently positive; describing clear, open, and effective communication and reported strong working relationships with the service.

Systems were in place to support the timely and safe processing of referrals, with checks in place to ensure all information was accurate and complete. Staff demonstrated a clear understanding of their roles and responsibilities and were able to explain the processes followed for referrals, correspondence, and the registration of new patients. We reviewed the timescales for completing tasks and found they were managed effectively. Urgent matters were dealt with on the same day, and routine correspondence was usually processed within a few days. This ensured information was shared promptly and actions were completed in a timely manner to ensure a safe pathway of care.

The service worked with people and healthcare partners to understand what being safe meant to them and how best to achieve that. Staff promoted people's wellbeing while protecting them from abuse, discrimination, neglect, and avoidable harm. The service had a system in place to ensure concerns were quickly and appropriately shared.

Staff demonstrated a good understanding of safeguarding and were able to identify the safeguarding lead and explain their own responsibilities within the process. Appropriate safeguarding policies and procedures were in place, and staff had completed training relevant to their role and level of responsibility. Systems were established to help protect people from harm, including safeguarding registers and electronic alerts that highlighted important information about individuals when required. The service also had processes in place to monitor and support vulnerable people, including following up on those who did not attend appointments, helping to ensure risks were identified and managed appropriately.

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.

The service maintained an appropriate range of emergency equipment and medicines, which were stored in accessible locations and subject to regular checks to ensure they were available and ready for use when needed.

Staff demonstrated an awareness of symptoms that may indicate serious health conditions and were supported by electronic and visual prompts to help identify and respond to risks effectively. Effective communication processes were in place, and non-clinical staff could quickly access clinical support when they identified concerns about people's health.

The practice also recognised the needs of vulnerable groups and could demonstrate a range of measures to support them, including access to interpreters, longer appointments where required, and signposting to local support services.

The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

During the onsite assessment, an oxygen cylinder was found to be stored next to paper materials and electrical equipment, which presented a potential fire risk. In addition, there was no signage in place to indicate that oxygen, a potentially combustible substance, was being stored in the area. The provider took immediate action to address the concern by relocating the oxygen cylinder to a more suitable location within the designated room and ensuring appropriate warning signage was displayed.

Cleaning products were stored securely and safely, with clear documentation available to support the safe management of hazardous substances, including risk assessments and safety information. However, there was no signage in place to indicate the presence of substances covered by the Control of Substances Hazardous to Health (COSHH) regulations. This meant staff and visitors were not clearly alerted to the storage of potentially hazardous materials. The provider was made aware of this and following on from the onsite assessment we have received evidence that this has been rectified.

There were regular fire safety checks in place ensuring fire extinguishers, fire exits and signage were in place. There was no evidence of fire drills being completed to ensure staff were confident and understood what to do in the event of a fire.

We reviewed a sample of equipment to confirm that the required annual testing and servicing had been completed to ensure equipment was safe to use and provided accurate readings. This included equipment such as the defibrillator, blood pressure monitors, and electrical equipment. During the onsite assessment, it was identified that stickers used to indicate testing dates had become detached from some items, making it difficult to verify testing had occurred. Further evidence was requested, and a subsequent review by the provider identified that the external contractor responsible for equipment testing had not completed the required annual check of the defibrillator. The provider took immediate action to rectify this and worked with the contractor to ensure all outstanding testing was completed. Although the annual servicing had not been undertaken as required, the defibrillator had an inbuilt system designed to alert staff of any fault.

The service had risk assessments and control measures in place to help protect people from potential hazards. These included arrangements for managing risks associated with Legionella, fire safety, and COSHH. We also saw risk assessments that were completed based on emerging risk and events.

The service had a business continuity plan in place which had been reviewed, and staff were aware of how to access it and their responsibilities in the event of a disruption to services. Maintenance checks and testing were completed by external contractors, and records demonstrated that outcomes were reviewed and any required actions were addressed. At the time of the assessment, ongoing building works required the use of an alternative entrance to the premises. The practice had implemented measures to ensure access routes remained safe, clearly signposted, and accessible for people using the service.

The service did make sure there were enough qualified and experienced staff. Staff received support, supervision and development. The recruitment process was not consistent, and measures were not in place to ensure risk and peoples safety were taken into account.

The service had a recruitment process in place, and a sample of staff records demonstrated that checks, including qualifications, references, and right to work documentation, were completed as part of recruitment. Disclosure and Barring Service (DBS) checks were evidenced for some staff. Records of the original DBS checks completed at recruitment were not available for all staff files reviewed. There was a lack of consistency in the approach to DBS monitoring, and no risk assessments were in place, where checks were not available.

The service employed a good mix of clinical and non-clinical staff, ensuring a broad range of skills and expertise were available to meet people's needs. Staff demonstrated appropriate knowledge and competence in their roles and held the relevant qualifications, training, and experience required to carry out their responsibilities effectively.

Staff worked within the scope of their roles and held the relevant qualifications and skills required for their positions. Records showed that induction programmes were completed, and mandatory training was monitored to support compliance. A sample of training records demonstrated good levels of compliance with mandatory and role-specific training requirements. The service had effective systems in place to monitor training completion and ensure staff remained up to date.

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Evidence of staff immunisation status was only available for one of the records reviewed, and there was no clear or consistent process for assessing and managing any risks associated with missing immunisation information. This meant the service could not fully demonstrate how it assured itself that people were protected from potential risks relating to staff immunisation status. Following the on-site assessment, the provider confirmed that its recruitment policy and procedures had been reviewed. The provider confirmed that immunisation status was being obtained and that staff were provided with appropriate information to support informed decision-making regarding immunisations.

The premises were visibly clean, tidy, and well maintained. Although additional risks were present due to the temporary arrangements required during ongoing building works, and some areas of the original premises were showing signs of wear, the cleanliness and safety of the environment had not been compromised. This was due to the diligence of staff and the additional control measures implemented to minimise risks and maintain standards.

Equipment was visibly clean, and infection prevention and control (IPC) records were well organised and easily accessible. Processes, procedures, and environmental checks were routinely monitored through audits to ensure standards were maintained. Clear guidance and instructions were in place for the handling and disposal of waste and clinical specimens, and staff were able to demonstrate a good understanding of these procedures.

Cleaning schedules were clearly documented, and completed records provided evidence that required tasks had been carried out. The cleaning records folder was comprehensive, containing clear documentation, risk assessments, and defined responsibilities, demonstrating a structured approach to maintaining a safe and clean environment.

The service did not always ensure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

We reviewed records for patients aged over 65 years who had been prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Current guidance recommends that many patients in this age group are also prescribed a proton pump inhibitor (PPI) to help reduce the risk of stomach irritation and gastrointestinal complications associated with NSAID use. Of the 151 patients identified, 45 did not appear to have been prescribed a PPI or have documented evidence of a discussion regarding the associated risks. A sample of five patient records found that all five required further review and actions. The provider was informed of the findings and had started a review of these patients.

We completed a review of the service's response to Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts relating to females of childbearing age prescribed valproate, a medicine that can be used for treating epilepsy but carries a significant risk of birth defects and development disorders if taken during pregnancy. The records reviewed showed appropriate action had been taken in line with current guidance. Annual reviews had been completed, and there was evidence that individuals had been informed of the risks associated with the medication.

A review of the service's response to an MHRA safety alert relating to mirabegron, a medicine used to treat an overactive bladder, found that 2 of the 31 patients prescribed the medicine had not received the recommended monitoring and review in line with the safety alert guidance. The practice was made aware of the findings and completed a review to ensure actions were taken where required.

We reviewed a sample of records for people prescribed methotrexate, a disease-modifying anti-rheumatic drug (DMARD) that can be used to treat rheumatoid arthritis and certain types of cancer. The records demonstrated that appropriate monitoring and regular reviews were being completed by the relevant hospital consultant team. Information relating to ongoing specialist oversight and treatment reviews was available within the patient records.

We completed a review of records relating to people prescribed ACE inhibitors, medicines that can be used for high blood pressure and heart failure. Of the 622 patients identified as receiving these medicines, 26 were flagged as not receiving the required monitoring and review. A sample of five patient records were reviewed, and, in each case, the practice had taken appropriate action to contact the individual and advise them of the blood tests required to support the safe use of the medication. Records demonstrated repeated attempts to contact patients where there had been no initial response, showing that the service was actively monitoring outstanding reviews and taking steps to ensure patients received the necessary safety checks.

Non-medical prescribers had access to a duty doctor to discuss their findings and support clinical decisions as well as a clinical pharmacist who supported best practice prescribing.

Medicines were stored in designated cupboards and refrigerators, with appropriate security measures in place to restrict unauthorised access. The service completed routine temperature monitoring of both medication fridges and the rooms where medicines were stored to ensure medicines remained safe and effective for use. We saw evidence that temperatures were recorded daily and were regularly reviewed. Staff demonstrated a good understanding of the actions required if temperatures fell outside the accepted range.