Monkwearmouth Health 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. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues.

Staff told us of an open and honest working environment, where leadership provided guidance and encouraged open communication. They felt confident raising concerns, knowing their feedback was valued and acted upon, with safety remaining a key priority. The records we looked at showed teams were reviewing and learning from incidents. Employees reported an open culture, with management actively promoting continuous learning from events.

The provider 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 people support. We saw 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 effective 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 for example adult’s referrals to secondary care or community 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 GP safeguarding lead worked closely with staff to share concerns quickly both internally and externally as appropriate.

Staff were able to tell us who the safeguarding lead was and how to raise concerns. They told us they received training in both safeguarding adults and children and had a clear understanding of their safeguarding responsibilities for reporting concerns.

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.

The practice had a chaperone policy in place, ensuring that chaperones were available to provide comfort and to help mitigate risk for both patients and staff. We saw staff who required a Disclosure and Barring Service (DBS) check had one recorded, including those acting as chaperone.

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 received annual training in cardiopulmonary resuscitation (CPR), basic life support, and management of anaphylaxis. Staff could recognise a deteriorating patient and knew of action to take. We saw examples of where this had been the case for both adults and children where appropriate action was taken by staff without delay.

Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Staff would use alternative methods of communication where needed and had access to interpreters.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There was a business continuity plan in place which was monitored and reviewed.

Contracts were in place to ensure the premises were maintained. Staff told us the maintenance team attended upon request to resolve any issues or necessary repairs.

Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. Appropriate emergency equipment and medicines were in place and accessible to staff. Clinic rooms had appropriate flooring and equipment. However, we found some small defects in the plaster and décor of the clinic room we assessed. We saw staff had recently highlighted this to the maintenance team and this was being followed up.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The practice employed a variety of clinical and non-clinical roles. We found that staff learning needs and development were managed effectively, and individuals were working within their agreed areas of competence. However, our review of mandatory training revealed that some staff were not fully up to date. This was promptly addressed within a few days, and the practice manager is now reviewing the oversight process within the computerised system to prevent future occurrences.

Safe recruitment practices were followed. We sampled recruitment checks for staff and saw that checks had been undertaken prior to employment. For example, proof of identification, references, qualifications, registration with the appropriate professional body and a contract of employment was in place for staff.

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 who was the practice nurse and all staff had had relevant training. Cleaning schedules were in place and followed.

Risk assessments and audits were completed, and actions taken to mitigate risks. The practice was inspected for IPC by a local NHS trust infection prevention and control lead resulting in an overall score of 94%. Any issues were addressed, and the process will be undertaken again within a 6-month timescale.

The service made sure that medicines and treatments were mostly safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

We carried out clinical searches as part of the assessment and found that the practice mostly had effective systems and manage potential risks related to medicines well. For example, there were no patients with a potential misdiagnosis of diabetes as all were diagnosed correctly and there were no patients with prescribed disease modifying anti rheumatic drugs that required monitoring. We did identify some issues with patients who required additional monitoring, such as blood tests.

In our clinical searches there were 727 patients prescribed medication for conditions related to cardiovascular and kidney health to regulate blood pressure and fluid balance. Of these, 34 patients identified by the search had not had the required monitoring. We reviewed 5 of these records and all 5 were confirmed as overdue for monitoring. We noted patients were being contacted however no further action such as issuing shorter prescriptions to encourage patient compliance. The risks to patients include electrolyte balance, unoptimized blood pressure control and renal failure.

There were 37 patients prescribed medication for the treatment or prevention of bone related conditions for 5 years or over. The search showed 33 of these patients had not had a scan that measures bone mineral density. We looked further at 5 patients and found there were 3 who were overdue a scan. The risk was that patients may be taking the medication unnecessarily and may become unwell as a result. Since the assessment the practice had reviewed all 37 patients. They found 7 scans had already been completed so were recorded on the system, 3 were exempt so were recoded and 17 patient scans were requested.

National Institute for Health and Care Excellence guidance recommends that patients should be reviewed within 48 hours following an acute asthma exacerbation, that requires oral steroids, and their regular treatment should be adjusted if necessary to improve symptom control. For our clinical searches, this timeframe was extended to 7 days. There were 400 patients registered with asthma of which 20 had been prescribed 2 or more courses of rescue steroids. Among these 20 patients, we found follow-up after steroid treatment was inconsistent. This poses a risk of deterioration due to asthma and delays in timely review. Following the assessment the practice had implemented a new Asthma Telephone Review Protocol for staff to follow. They also reviewed the relevant patients from the previous few days.

There were 200 patients overall with hypothyroidism, of which 22 (or 11% of) patients had not had a thyroid function test monitoring for 18 months. Of the 5 patients we looked at, 4 were overdue a Thyroid-Stimulating Hormone test, and 4 were overdue a medication review. We saw patients were being contacted however no further action such as issuing shorter prescriptions, had occurred to encourage compliance. Infrequent reviews can risk patients being under or over treated for their hypothyroidism.

We identified 63 out of 354 patients with diabetes whose most recent blood test, which reflects average glucose levels over the past 2–3 months was above the expected range. Of the 5 patient records we examined in detail, 3 were overdue for a medication review only. While patients had been contacted by letter, no further action such as issuing shorter prescriptions to encourage compliance had been taken. This posed a risk of deterioration or complications related to diabetes, and their treatment may be suboptimal. The practice has since reviewed these three patients and updated the clinical system accordingly.

We reviewed a sample of authorisations for staff to administer medicines under Patient Group Directions (PGD) and noted that some authorising signatures were dated before the second member of staff was added to the document, meaning the authorisation was not valid. This issue was resolved by the end of the assessment day.

Staff did not manage the storage of prescription stationery in line with current guidance, as measures to ensure security and restrict access to authorised individuals were not consistently in place. Procedures were changed to comply with the updated guidance immediately.

However, 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. 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 medicines safely and worked to ensure people received 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. Waste medicines were recorded and disposed of appropriately including medicines returned by patients. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff mostly followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed during our assessment supported this. For example, the number of antimicrobials issued by the provider was 2.4%, significantly lower than the 8% national average.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.