Wheal Northey Also known as Wheal Northey Site

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 assessed all quality statements in the safe key question. Our rating for this key question remains good. The service took concerns seriously and regularly reviewed, analysed, and learnt from events and incidents. When things went wrong, staff acted to ensure people remained safe. Staff were knowledgeable within their role and shared experiences to support development. People were supported to live healthy lives and were provided with support and information on their care and treatment.

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.

Representatives from the PPG felt the practice took concerns seriously and proactively made improvements to the service. Complaints were shared with the PPG who told us they felt the practice was open and honest with them.

Staff understood how to raise concerns and report incidents both internally and externally. Some staff told us learning was not always shared with them. However, we saw evidence learning from events and incidents was shared in team meetings and available online. Leaders demonstrated they managed significant events and complaints appropriately and staff were involved in identifying learning. Staff and leaders felt there was an open culture where incidents could be discussed in a no-blame environment.

Policies and procedures were in place to support and encourage a learning culture. There was a process to record and review significant incidents and complaints. The practice learned and made improvements when things went wrong. Feedback and learning were shared in staff meetings. We saw evidence of this learning being shared with staff.

People had no specific feedback in this area.

Staff were aware of the systems and processes for sharing information to deliver safe care and treatment. Staff explained their understanding of the importance of continuity of care to ensure the right care at the right time. Staff we spoke with shared examples of how they work with other health providers and community services to support people in the best way possible.

Regular visits by the practice staff supported people living in local care homes. Partners were positive about how the practice worked with them. We were told ‘the practice works really well with our home, they are always courteous and obliging whenever we have to ring’.

There were appropriate referral pathways to make sure that peoples’ needs were addressed. A system for processing information relating to new patients including the summarising of new patient records was in place. There was a backlog of 692 patient records waiting to be summarised (approximately 2% of the patient list). The practice was aware of this and were in the process of developing an action plan to address the backlog. Referrals to specialist services were documented, contained the required information and were prioritised for routine or urgent action.

People had no specific feedback in this area.

Staff were trained to appropriate levels for their role and could identify vulnerable people easily. They were able to tell us about the systems and processes to keep people safe and safeguarded from abuse and felt confident in raising concerns. Staff knew who the safeguarding leads were.

Partners did not raise any concerns regarding safeguarding at the practice.

Systems, processes and practices were developed, implemented and communicated to staff. The practice had recently reviewed the level of safeguarding training that had been allocated to staff to ensure it was in line with the policy. There were regular discussions between the practice and other health and social care professionals such as social workers and children’s mental health workers to support and protect adults and children at risk of significant harm.

People had no specific feedback in this area.

Staff told us they informed people about risks and documented this on their patient record. Staff involved people in their consultations to ensure they understood the risks.

There were systems and processes in place to assess, monitor and manage risks to patient safety. Appropriately trained staff completed consultations and provided specific advice to people. Risks were recorded on patient records.

Staff knew their responsibilities to ensure the environment was safe for their patients such as their role to ensure equipment was cleaned at appropriate intervals in line with guidance. Staff had completed appropriate training including fire safety and information governance.

Equipment was fit for purpose and maintained to ensure it was in good working order. Environmental risks had been assessed and where necessary, appropriate actions taken. Clear signage around the building supported people and staff in the event of an emergency evacuation.

The practice made reasonable adjustments when people found it hard to access services such as level access to the building. Health and safety risk assessments had been carried out and appropriate actions had been taken. Systems and processes were followed to support a safe environment.

People had no specific feedback in this area.

Staff told us there were enough staff to provide appointments and prevent staff from working excessive hours. Staff were given protected time to complete mandatory training. Staff told us allocating people to the right clinician helped them get the right support at the right time. Leaders were aware of safe staffing levels and responded appropriately to meet demand.

Systems in place demonstrated appointments were allocated to appropriate clinicians. Staff had completed mandatory training, and some had also completed specific training in their specialist area. Staff had protected time for learning and development and where needed, were supported to meet the requirements of professional revalidation.

People had no specific feedback in this area.

Staff were aware of their infection prevention and control (IPC) responsibilities and were able to name the IPC leads. Staff raised IPC concerns in team meetings. Staff knew how to manage clinical waste and specimens.

The premises were visually clean. Sharps bins inside all premises were appropriately managed. Personal Protective Equipment (PPE) was available to staff. However, during the onsite visit, we found external clinical waste storage bins were not locked at several of the branch sites. During the onsite visit, the practice started to address this and following the onsite visit, they contacted the cleaning company to stress the importance of these bins being locked and this will now be regularly audited.

Staff had completed appropriate training in line with their role and responsibilities. Policies and procedures were available to staff. An up-to-date infection prevention and control audit had been carried out and an action plan had been completed. There was a process to record staff vaccinations in line with national guidance. However, we found there were gaps in the monitoring of staff vaccinations. The practice told us they were aware of this and had requested staff provide their missing data. The practice told us they were going to address this by completing a risk assessment for each member of staff with missing vaccine information. The practice told us they would update the recruitment process to include a request for staff vaccinations at the time of appointment.

We did not receive enough specific feedback in this area to rescore this evidence category.

Staff were aware of systems to identify people who required monitoring based on the medicines they were prescribed. Staff carried out regular checks on emergency medicines and equipment. Non-medical prescribers (healthcare professionals who can prescribe medicines but are not GPs) were able to discuss their prescribing each day if needed with a GP.

Staff managed medicines safely and regularly checked the stock levels and expiry dates for all medicines. Vaccines were appropriately stored and monitored in line with national guidance to ensure they remained safe and effective. Emergency medicines and equipment had been risk assessed and were checked regularly. Appropriate authorisations for staff to administer medicines were in place including Patient Group Directions (a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition) or Patient Specific Directions (a written instruction from a doctor or other independent prescriber for a medicine to be supplied or administered to a named patient).

Our remote clinical searches demonstrated mixed results in the review and monitoring of patients prescribed certain medicines. For example, our clinical searches identified 38 people prescribed azathioprine (used to treat inflammatory conditions and some cancers). We reviewed 5 patient records and found all 5 people had received the required monitoring in the last 6 months in line with guidance. However, we also identified 1140 people prescribed a direct oral anticoagulant (DOAC) (medicine that prevents blood clots). We found 825 of these patients had not been reviewed appropriately to ensure they were prescribed the correct dose of medicine. We reviewed 5 of these records and found all 5 had not been reviewed in line with guidance. Following our remote clinical searches, the practice reviewed, developed and strengthened their systems to ensure people received the appropriate monitoring or review. During the onsite visit, we found issues with the secure storage of blank prescription stationery and emergency medicines and equipment. The practice had non-medical prescribers who were healthcare professionals who can prescribe medicines but are not GPs. Although we did not find any patient harm, we found the practice could not demonstrate they had systems in place to review the prescribing of these members of staff. However, following our site visit, the practice acted swiftly and implemented new processes to address these risks.

We reviewed prescribing data which indicated the prescribing of some medicines was above the local and national expectations. For example, Pregabalin or Gabapentin (medicines prescribed for treatment of epilepsy, neuropathic pain or generalised anxiety disorder) were being prescribed at a higher rate than expected. Our clinical searches identified 750 people were prescribed these medicines of which, 313 had not been reviewed over the previous 12 months. We reviewed 5 of these patient records and found 3 people were overdue monitoring. The practice told us they were already carrying out a review of some of these people and would continue to review the other people we had identified. The service had appointed leads in various clinical areas to ensure regular updates were provided to staff such as changes in guidance or clinical processes.