Saltley Centre for Health Care

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

The service had a proactive learning culture, within which people could raise concerns and learn from them. Staff understood and managed risks. There were sufficient staff with appropriate skills and qualifications. Overall staff managed medicines safely and involved people in planning any changes.

We assessed a total of 8 quality statements from this key question. We found there was evidence to demonstrate specific action taken to address the issues identified at the last inspection. Policies and procedures reviewed were updated to reflect any changes and provide clear guidance to staff and outline roles and responsibilities to keep patients safe. Overall, the provider was able to demonstrate effective systems were in place for identifying and managing incidents to support learning and improvement.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff understood the requirement of the duty of candour. The practice had systems in place to support an effective learning culture and we were told that people could raise concerns.

At this inspection staff told us that they found clinical and non-clinical leaders approachable and the practice team supportive. We found evidence to show that, monitoring and auditing of clinical and operational performance had been formally implemented to provide learning for staff and support with making improvements to services. This included staff supervision and annual appraisals.

Staff we spoke with told us that there were processes for reporting, recording and acting on incidents and significant events. Significant events and incidents were recorded and sent to the management team for analysis of risks and themes. Quarterly meetings were held and the minutes showed that significant events and incidents were a standing agenda item. The minutes contained details of the discussion and learning.

Complaints records showed that complaints received in the last 12 months had been acknowledged and acted on. Staff told us that they were aware of the complaint procedure and were confident that they knew how to support patients if they needed to make a complaint. There were complaints leaflets in reception to let patients know what they need to do should they wish to raise a complaint. Evidence we examined showed that practice staff carried out audits of complaints and compliments received to analyse and review themes. An action plan was developed to support improvements and learning at the practice.

We found instances where patients presenting with symptoms suggesting serious illness were assessed appropriately and referred to secondary care using appropriate pathways. For example, patients with suspected cancer were referred to secondary care via the 2 week wait referral pathway in a timely manner. The referral activity was audited and multidisciplinary team meetings held to discuss outcomes.

We found that not all guidance as followed by the practice ensured structured plans and processes were effectively implemented to support the safe delivery of care for specific conditions. For example, our review of patients with the potential of a missed diagnosis of diabetes identified 35 patients. We had concerns about the number of patients with a potential missed diagnosis of diabetes. These were discussed with the practice GPs at the remote interview. Discussions included the delays in following up patients with raised HbA1C (blood sugar levels) above 47 within 2 to 12 weeks in line with guidance, processes in place for following up patients who failed to attend appointments and the timely coding of a diagnosis for patients with a potential missed diagnosis of diabetes. During the remote interview GPs were able to provide assurances that these issues were being managed. Audits were completed every quarter to review patients with a potential diagnosis of diabetes. The practice staff had identified that one of the main reasons for the high number was due to patients failing to attend appointments. Evidence of the audits were shared at the site visit. Other actions taken to improve outcomes for these patients included identifying a dedicated team led by a diabetes specialist nurse, increasing appointment availability and improving the patient call and recall systems.

During our inspection we identified that systems were in place to support the ongoing care and treatment of patients who used the service. Our clinical system searches showed that care templates were used to formulate a treatment and follow up plan to support patients individual needs. The GPs worked with other health and social care professionals to deliver a coordinated package of care for patients with the most complex needs.

We found instances where patients presenting with symptoms suggesting serious illness were assessed appropriately and referred to secondary care using appropriate pathways. For example, patients with suspected cancer were referred to secondary care via the 2 week wait referral pathway in a timely manner. The referral activity was audited and multidisciplinary team meetings held to discuss outcomes.

The management team had safeguarding systems and processes in place, these were up to date and in line with local guidance. All staff received up-to-date safeguarding training appropriate to their role and knew how to identify and report concerns. Information on the local safeguarding processes and who to contact was available to staff should they have a concern.

One of the GPs at the practice was the designated safeguarding lead for adults and children. All staff were aware of who this was. Regular safeguarding multidisciplinary meetings were held to discuss safeguarding concerns. Safeguarding registers for both children and adults were maintained and there was evidence of reconciliation of the registers.

There were detailed safeguarding registers for adults and children, which administration staff managed and reported updates to the relevant GPs. Alerts were put on the records of patients identified as being at risk from abuse. This included children on the child protection register, children of concern and looked after children. Families of patients identified as at risk were linked and had alerts on their records.

We saw that Disclosure and Barring Service (DBS) checks were undertaken for all staff, in line with the practice policy. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.

Arrangements were in place for planning and monitoring the number and mix of staff needed. Staff told us that they worked flexibly and additional hours to cover each other if needed.

Staff were aware of their responsibilities if presented with an emergency. Non-clinical staff had access to a RAG (Red, Amber, Green) rating system to support them in identifying the level of risk a patient may be presenting with. Where staff had concerns about a patient health when they present at the practice, they used the system to assign a colour coded criteria to indicate the severity or level of concern. The criteria also indicates the action that needs to be taken for example, Red indicates a high level of risk, requiring immediate action or attention.

Staff records showed that newly appointed staff had an appropriate induction period.Basic life support and sepsis training were part of the practice’s mandatory training requirements.
 

The facilities and premises were appropriate to meet the safe care and needs of patients. We saw that health and safety risk assessments had been completed in all areas for example, safe management of substances, such as cleaning products used at the practice. The practice had safety policies, which were regularly reviewed and communicated to all staff.

Training records showed that staff had received training related to health and safety and fire safety. The practice had three named fire marshals who had completed the required training.

There was a comprehensive business continuity plan in place, detailing procedures to be followed in the event of major incidents such as power failure or building damage. The plan also provided staff with emergency contact numbers and was easily accessible.

Systems were in place to check, maintain and calibrate equipment used to support patient care and treatment at the practice. Equipment was checked annually to ensure it was safe to use. The last checks were completed on the 29 August 2024.
 

Staff told us that additional staff had been recruited following the change in provider. Staff reported that they received support, supervision and development opportunities and that they worked together to provide safe care that met people’s individual needs.

There was a varied skill mix of clinical and non-clinical roles within the practice that worked together to support patients. Systems were in place to ensure staff training was up to date, learning needs and development of staff was managed appropriately. There was a process for ensuring staff were working within their agreed areas of competence. The practice completed regular consultation audits on all patient facing roles to ensure competency of staff. A clinical supervisor undertook, one to one reviews of clinical cases, documentation, prescribing and treatment plans. The outcomes of the reviews were clearly documented and where learning was identified this was shared with relevant staff and other practice staff where appropriate. The practice also completed regular audits on non-clinical staff such as administration staff to ensure that staff remained competent in their role.

We examined 5 staff records these showed that safe recruitment practices were followed for all staff.

At our site visit of the practice, we observed the premises to be visibly clean and tidy. Cleaning schedules were in place for the practice cleaner and other staff to follow. The schedule included checks and audits of the standard of cleaning carried out.

As part of our inspection, we looked at the management of medicines through clinical searches and reviews of a sample of patient records. We identified a number of patients prescribed high-risk medicines and found that most patients had received all recommended and required monitoring. There were some gaps however, which identified that full reviews were not always completed. We looked at patients on a Disease-modifying antirheumatic drugs (DMARDs) which has the potential for serious side effects. DMARDs are commonly used to treat inflammatory conditions such as rheumatoid arthritis. We saw that 24 patients had been prescribed this medicine, 9 of whom had not had all the required monitoring in the last 3 months. We examined 5 of the 9 patient records, which showed a good level of clinical oversight. Patient reviews showed that patients who had not had blood tests had their medicines stopped where appropriate, an explanation given and appointments made. The gaps in patient records showed that 2 of the patients did not have the underlying problem for prescribing the medicine linked in their clinical records and 2 patients did not have the day of the week they should take the medicine stated on their clinical records or prescription. These actions had been taken in most cases but not all partly because they were hospital issued medicines. Hospital correspondence we saw did show that they had made the request for the day of the week the medicine should be taken to be included on the prescription. It was also noted that the practice had not consistently downloaded blood test results for these patients from the hospital ICE test request data system. These issues were discussed with the GPs during the remote interview with the GP SpA. We were assured by evidence the provider shared with us at the site visit that appropriate action had been taken to address the issues discussed above.

Staff we spoke with were aware of the importance of maintaining a cold chain for vaccinations. Records seen showed that the temperatures of the medicine fridges were regularly monitored to ensure the effectiveness of the medicines stored in them, which included vaccines.

Staff had access to emergency medicines and equipment in the event of a medical emergency and knew where to find them when needed. Records available showed that practice staff checked the medicines and equipment daily. Recommended medicines were available.

As part of our inspection, we looked at the management of medicines through clinical searches and reviews of a sample of patient records. We identified a number of patients prescribed high-risk medicines and found that most patients had received all recommended and required monitoring. There were some gaps however, which identified that full reviews were not always completed. We looked at patients on a Disease-modifying antirheumatic drugs (DMARDs) which has the potential for serious side effects. DMARDs are commonly used to treat inflammatory conditions such as rheumatoid arthritis. We saw that 24 patients had been prescribed this medicine, 9 of whom had not had all the required monitoring in the last 3 months. We examined 5 of the 9 patient records, which showed a good level of clinical oversight. Patient reviews showed that patients who had not had blood tests had their medicines stopped where appropriate, an explanation given and appointments made. The gaps in patient records showed that 2 of the patients did not have the underlying problem for prescribing the medicine linked in their clinical records and 2 patients did not have the day of the week they should take the medicine stated on their clinical records or prescription. These actions had been taken in most cases but not all, partly because they were hospital issued medicines. Hospital correspondence we saw, showed that they had made the request for the day of the week the medicine should be taken to be included on the prescription. It was also noted that the practice had not consistently downloaded blood test results for these patients from the hospital data system. These issues were discussed with the GPs during the remote interview. We were assured by evidence the provider shared with us at the site visit that appropriate action had been taken to address the issues discussed above.

National prescribing data showed that the practice prescribing was in line with other practices locally and nationally in 4 of the 6 medicine prescribing indicators. The remaining 2 indicators showed positive variations. The positive variations showed the practice had lower prescribing rates of the following medicines when compared to other practices locally and nationally:

o broad spectrum antibacterial medicines
o hypnotic medicines, used to improve the quality of sleep