Hartshill Medical Centre

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 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 service 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.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider would listen to their concerns. Staff felt there was an open culture, and that managing patient safety was a primary concern. We saw the leaders’ investigated incidents and these were documented. The ones we reviewed showed a lack of a detailed route cause analysis and risk mitigation; however, staff told us these were discussed in meetings. There was a system to record and investigate complaints. We saw complaints were responded to and when things went wrong, staff apologised. However, when we reviewed their complaints responses we saw the service not always document the next steps, and responses were not always timely. The leadership team in response to our feedback updated the complaints leaflet whilst on site to include timelines for acknowledgement and responses. Staff told us learning from incidents and complaints resulted in changes that improved care for others.

The service 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 people moved between different services.

There were systems in place for processing information relating to new patients. The service worked with other providers to deliver shared care and when patients moved between services. Referrals and test results were managed in a timely way.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. During our clinical searches we identified the potential for the practice to miss opportunities to identify vulnerable patient family groups. The provider stated they would rectify this issue.

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.

Emergency equipment was available and maintained. Staff 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 service 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.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider would listen to their concerns. Staff felt there was an open culture, and that managing patient safety was a primary concern. We saw the leaders’ investigated incidents and these were documented. The ones we reviewed showed a lack of a detailed route cause analysis and risk mitigation; however, staff told us these were discussed in meetings. There was a system to record and investigate complaints. We saw complaints were responded to and when things went wrong, staff apologised. However, when we reviewed their complaints responses we saw the service not always document the next steps, and responses were not always timely. The leadership team in response to our feedback updated the complaints leaflet whilst on site to include timelines for acknowledgement and responses. Staff told us learning from incidents and complaints resulted in changes that improved care for others.

The service did not always make sure recruitment processes were followed correctly. Staff received effective support, supervision and development.

There were a range of clinical and non-clinical roles within the practice. We reviewed five recruitment files. We found there were gaps in recruitment process. These included immunisation history, employment history and health checks. We fed this back to the leadership team, who stated they were aware of the issues around the gaps in the employment history and had been trying to address this when recruiting new staff. They stated they would follow this up with previous employees as well. The leadership team stated that health checks had been completed with previous employees. However, since the closure of the local occupational health team these had not been undertaken. A new occupational health service had been commissioned for the local area and the leadership team told us that moving forward they would be using this service to support with health checks. From the files we saw, not all staffs' immunisation status were held in the files reviewed and no risk assessments had been completed in their absence to identify potential risks to staff and patients. We discussed this with the leadership team who stated they would gather the routine immunisations information for all staff and put a risk assessment in place for other selected vaccinations.

We found the majority of training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence.

The service 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 staff had completed relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed. Infection prevention and control had been identified as an area for development in the practice development plan and on-going progress was being made.

Medicines were stored securely and at appropriate temperatures. Where the practice did not hold recommended emergency medicines, risk assessments had been completed and reviewed. Staff regularly checked the stock levels and expiry dates for all medicines.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Prescribing data reviewed as part of our assessment showed some medicines were prescribed appropriately. For example, the number of hypnotic drugs issued by the provider was lower than local and national averages. The provider undertook clinical audits of prescribing that focused on improving care and treatment.

We found prescription stationery was not secured in a way that could be audited, so that every prescription could be accounted for. The provider took action to rectify this whilst we were onsite.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. Our clinical searches however identified areas to strengthen. This included ensuring people were made aware of the day of the week they should be taking a particular immunosuppressant, in line with current guidance. Also ensuring they were following current guidance when prescribing medicines in relation to asthma for the small number of people who were prescribed this. Medicine reviews were being completed satisfactorily; however, we found the provider needed to ensure they were addressing alerts which appeared on their system and one medicine review had been coded by a person who was not authorised to do so.