Olive Medical Practice

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• 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

At our last assessment, we rated this key question as inadequate. This rating remains in place, and all scores remain the same. This assessment only focused on the circumcision clinic aspect of the service, and only relevant quality statements were assessed.

The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We only assessed the circumcision clinic aspect of this quality statement.

Only 2 staff worked in the circumcision clinic, a GP partner and a nurse. Both had completed safeguarding training at the appropriate level in the previous 12 months.

The practice had a safeguarding policy in place, and the circumcision clinic also had a child safeguarding policy. The names of local safeguarding contacts were available.

The policy stated that the practice would organise at least annually a training session that all staff were expected to attend. It stated the training session would include updated training, discussion of any significant events relating to safeguarding, and a review of the policy. The GP and nurse confirmed that this annual session did not take place.

The GP and nurse told us that where only 1 parent brought their infant to the circumcision clinic, social services attended with them. There was no evidence of social services involvement for any of the records we checked where only 1 parent had been present. This meant the practice could not be assured the needs and safety of the infant had been fully considered.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We only assessed the circumcision clinic aspect of this quality statement.

Only 2 people ever worked at the circumcision clinic, a GP partner and a nurse. They always worked together.

The nurse was a practice nurse at a different GP practice and only attended this practice for the circumcision clinic. The practice held an employment history for the nurse, and evidence they were registered with the appropriate regulatory body. Photo identification and evidence of vaccinations and qualifications were also held. There was no evidence of the practice having sight of a Disclosure and Barring Service (DBS) check. The GP partner confirmed they had never requested a DBS check. They explained that the nurse signed an annual DBS disclaimer stating that since the last DBS check completed at the surgery, they had not received a conviction, caution, reprimand or warning recorded on a police central record. We saw that the last disclaimed had been signed in October 2022. The practice confirmed there was no contract for the nurse to work at the practice, and there was a verbal agreement only. The nurse stated they had worked at the circumcision clinic since 2019. The practice or GP had never carried out an appraisal or formal assessment of competency for the nurse working at the circumcision clinic.

The GP partner working at the circumcision clinic had been trained in the Plastibell Circumcision technique in August 2009, and a training certificate was held by the practice. They told us they had never had any updated training.

They said they had an informal support network but there were no formal training updates. The practice held evidence of their medical indemnity.

We only assessed the circumcision clinic aspect of this quality statement.

The circumcision procedures were always carried out in the same room at Olive Medical Practice. The room was visually clean and free from dirt and dust. We saw the room when it was set up for a clinic to commence. Sterile single use packs were used for each patient. The practice used a restraint board to secure an infant prior to the procedure starting. This was clean and the cover was intact. A new disposable cover was used for each patient.

The circumcision clinic did not carry out its own formal infection prevention and control audits, but used the ones used by the practice.

The GP and nurse had both been trained in infection prevention and control to the appropriate level.

The clinic gave each patient a pack on discharge, and this contained a bottle of disinfectant. Instructions on how to use this during bathing were provided. The disinfectant was labelled “Not suitable for babies under 9 months old”, and “Never use on broken skin”. The GP told us they supplied this as it had been used during their training, and they said they would ask for advice about this. We informed them that they should not supply this as it was against the directions stated on the bottle.

We only assessed the circumcision clinic aspect of this quality statement.

The practice administered Lidocaine to the infants as an anaesthesia prior to carrying out the procedure. Although there was a prompt to record the dose, it had not been recorded in 21 of the 22 records we examined. In addition, the weight of the infant was not recorded in any of the 22 records we examined. This meant there was no evidence a safe and appropriate dose was administered. The GP and nurse who ran the clinic told us they took the infant’s weight from the ‘red book’ (a personal child health record given shortly after birth to parents of babies, containing important health and developmental information). They did not confirm this by weighing infants and did not record the weight taken from the red book.

The time the Lidocaine was administered was recorded in 20 of the 22 records we examined, but in 2 it was left blank. The ‘time the procedure commenced’ was recorded in all records. This was the same time the Lidocaine was administered in all records, and the nurse told us the time the procedure commenced was always recorded as the time the Lidocaine was administered. This meant there was no evidence there had been time for the Lidocaine to take effect. In addition, records included a space to record 2 separate pain scores. These had never been completed in any of the 22 records so there was no evidence that levels of pain had been assessed.

The medicine store contained 2 unopened boxes and 1 opened box of Lidocaine. The opened box was for 5ml ampoules of the medicine. However, it contained 3 x 2ml ampoules, and these were a different batch number and expiry date than the box indicated.