Rushden 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.We rated this key question as Good.

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.

The practice had a good learning culture, and processes were in place to support staff to report incidents, near misses and safety events. Managers investigated incidents thoroughly. Learning from incidents and complaints was discussed in meetings and resulted in changes that improved the service.

Leaders were committed to learning, and we discussed some examples of significant events and the actions the practice had taken in response to the learning identified. One incident related to childhood immunisations where an incorrect immunisation was administered. Upon realising the error, staff informed the senior staff and made contact with the pharmaceutical organisation. Staff applied the Duty of Candour and informed and apologised to the patients. No harm resulted to patients as a result of this incident however lessons were learned by staff which included a secondary check by staff of immunisation batches when collecting from the immunisation and vaccination refrigerator. This learning was shared with staff at a clinical meeting.

The practice worked with patients and healthcare partners to establish and maintain safe systems of care. Staff worked to facilitate continuity of care, including when patients moved between services. There were protocols in place for managing incoming correspondence into the patient’s medical records.

Patient referrals to specialist services were documented in the referrals systems and patient record. We found patient referrals were managed in a timely manner including 2- week wait referrals. A 2-week wait referral is an urgent NHS pathway where a patient is referred to see a hospital consultant within 14 days for symptoms that indicate cancer.

Safeguarding policies and procedures were in place to keep people safe and safeguarded from abuse. The practice had a nominated GP and Administrator as safeguarding leads for safeguarding adults and children. Staff had completed the relevant safeguarding training for their role and shared concerns quickly and appropriately. We saw safeguarding posters located in various places around the practice to promote safeguarding and clarify the systems in place.

The practice maintained a list of vulnerable adults and children and acted on concerns working in partnership with other organisations. Clinical system alerts were used to identify people who were at risk of harm or abuse including household contacts. There were systems in place to respond to concerns and act on correspondence. For example, they followed up children who failed to attend their appointments or were frequent attenders to the accident and emergency department. Safeguarding was discussed regularly at safeguarding meetings held every month.

Staff could recognise a deteriorating patient and knew what action to take. Staff had received sepsis and basic life support training. There were processes in place to ensure care was prioritised for the most clinically vulnerable patients. Staff had also received Care Navigation training. NHS Care Navigation training equips frontline general practice and primary care staff with the skills to assess patient requests safely and direct them to the most appropriate healthcare professional or community service.

Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

Emergency equipment was available and maintained. Systems were in place to check the emergency equipment and medicines regularly.

The practice facilities were fully accessible to patients. Consultation rooms were available on the ground floor. Leaders told us there were architectural plans in place for the practice premises to improve the facilities, and patient access and experience.

The practice detected and controlled potential risks. They made sure equipment, facilities and technology supported the delivery of safe care. Contracts were in place to ensure the premises were maintained. Systems were in place for the checks of fire alarms, fire extinguishers and fire evacuation procedures. Portable appliance testing was completed annually to ensure equipment was safe to use. The practice provided us with evidence of health and safety risk assessments which showed that risks were properly managed.

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

The practice made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

As part of our assessment, we reviewed staff personnel files and training records. We found safe recruitment practices were followed and appropriate checks had been completed. In addition, staff had completed required training according to their roles within the practice. Leaders were supportive of staff developing their skills and we found learning needs and development of staff was managed appropriately.

Staff were working within their agreed areas of competence and leaders explained they had mentoring and supervision systems in place for clinical staff. For example, dedicated time was allocated for supervision sessions and de-brief sessions for clinical staff. Prescribing tutorials were arranged and a random audit of prescriptions were reviewed to determine if clinician prescribing was in line with local and national guidance.

Leaders told us they had an ‘open door’ culture for all staff and encouraged good communication between staff for advice and support.

The practice 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 an infection control policy in place and a designated infection, prevention and control (IPC) lead. Staff had completed relevant infection control training. Risk assessments and audits were completed, and actions taken to mitigate risks. Clinical waste procedures were in place. The practice had effective oversight of the external cleaning company to ensure cleaning schedules were followed and cleanliness met the required standard.

The practice strived to make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved patients in planning, including when changes happened.

Staff involved patients in reviews of their medicines and helped them understand how to manage their medicines safely. Patients knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

Medicines were stored securely and at appropriate temperatures. Refrigerators used to store vaccines and medicines were monitored to ensure temperatures were maintained and products were appropriately stored within them. Staff regularly checked stock levels and expiry dates for all medicines, including emergency medicines. There were Patient Group Directions (written instructions to help specific healthcare professionals supply or administer medicines to patients) in place which relevant staff worked to.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. Prescribing data was reviewed as part of our assessment, and we found practice performance was in line with national averages for psychotropic medicines (used to treat various mental health conditions); and antibiotics.

As part of our assessment a Care Quality Commission GP Specialist Advisor undertook searches of patient records on the practice’s clinical system. Our clinical records review identified the following:

Azathioprine (a drug used to treat rheumatoid arthritis): We identified 10 patients prescribed this medicine and found no issues with the monitoring being provided for them.

Amiodarone (a drug used primarily for the treatment and prevention of life-threatening, irregular heartbeats): We identified 10 patients prescribed this medicine of which 3 had potentially not received the required monitoring. We reviewed in detail the clinical records of these patients. We found 1 patient was overdue by 6 days and a request for their blood test had already been made; and 2 patients overdue for monitoring had already been booked for an appointment.

Gabapentenoids (medication used to treat epilepsy and chronic nerve pain): We identified 79 patients out of 201 who had not had a review in the last 12 months. We reviewed in detail the clinical records of a sample of 5 of these patients and found 4 had not received a medication review. We discussed this issue with clinicians, and they took prompt action to address this and arranged for all patients to receive the necessary monitoring.

Safety Alerts: There was a process in place for recording and sharing medicine safety alerts. Safety alerts were discussed in clinical meetings. Our review of clinical records indicated that safety alerts were actioned in line with guidance. For example, we reviewed patients who were prescribed both an Aldosterone antagonist (a diuretic medicine which prevents potassium loss) and an ACE inhibitor (a medicine used primarily to treat high blood pressure and manage heart failure).The Medicines and Healthcare products Regulatory Agency (MHRA) advises close monitoring of patients prescribed these medicines as there is a risk to patients developing hyperkalaemia (high blood potassium) which could result in cardiac arrest. We identified 65 patients prescribed these medicines of which 5 patients were overdue blood test monitoring. We looked in detail at these 5 patients’ records and found 2 patients had already been booked in for an appointment; and 3 patients were overdue. Clinicians to prompt action to address this issue and provided evidence that all patients had appointments arranged to receive their blood test.

Medication reviews: We reviewed a random sample of 5 medication reviews out of a total of 245 reviews that had been completed for patients in the previous 3 months. We found no issues with any of these medication reviews and found they had been appropriately coded and contained necessary information.

As part of our assessment, we reviewed the processes in place for controlled drugs. Controlled drugs are medicines that are regulated by the government. This is usually because they are at higher risk of causing harm (such as dependence or misuse). Clinicians explained their systems and processes which included regular patient reviews; patient education including notes on prescriptions to alert patients of the risk of potential abuse; and a proactive approach to offering patients the opportunity to reduce their medication.