Larkside Practice

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 has changed to Requires Improvement. This is because we found areas for improvement in all the quality statements for the safe key question, with the practice not always providing care in a way that kept people safe and protected from avoidable harm. This included systems which were not always effective for assessing and monitoring patients and medicines. For example, clinical correspondence, monitoring patients’ health in relation to the use of medicines and safety alerts, in line with guidance. There were also shortfalls in safeguarding systems and processes for adults and children and staffing matters, such as, not all staff (clinical and nonclinical) had access to regular appraisals and were up to date with their training, as set by the practice. Additionally, systems and processes for ensuring safe environments and to assess and manage the risk of infection, were not always effective. We found breaches of regulation in relation to safe care and treatment. We have asked the provider for an action plan in response to these concerns.

This service scored 50 (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 receive patient feedback about the learning culture of the practice.

Staff knew how to report concerns, safety incidents and near misses.

The practice had a system for recording and acting on significant events, with 5 recorded in the year leading up to this inspection. We looked at 2 of these records and saw that they had been investigated and any actions carried out. However, we also noted that paperwork was not fully completed for all records. During the inspection, leaders took this feedback on board, recognising it as an area for improvement.

Leaders told us that significant events were discussed in practice meetings, with learning shared with the team when identified. However, some staff questionnaires highlighted that information about significant events and any learning, was not routinely shared. During the inspection, the practice showed us their November 2024 team newsletter that had been initiated to support staff communications. This included a significant events and learning points section.

The practice had a system for recording and acting on safety alerts received into the practice, such as those from the Medicines and Healthcare Products Regulatory Agency (MHRA). However, this system did not work effectively to make sure actions from them were embedded into routine practice, patients affected by them were always identified and actions taken to protect them from avoidable harm.

As part of our inspection, a series of patient clinical record searches were undertaken by a CQC GP specialist advisor. We ran a search to identify patients who were affected by a safety alert about taking the medicines: Simvastatin, Amlodipine, Diltiazem and/or Verapamil, at the same time. We identified 5 patients and found that 4 of them had not been made aware of the risks.

During the inspection, the practice took action to review and contact these patients and provided assurances of action plans and future monitoring of safety alerts systems.

People who provided feedback for this inspection told us the practice referred them to other services when needed in a timely manner, with a few people also sharing negative experiences.

Staff generally had the information they needed to deliver safe care and treatment.

There was a system for processing information relating to new patients including the summarising of new patient notes, with no backlog in this work. The few patients’ records that had been recently received and were awaiting summarising, were kept in an organised and secure way by the practice.

Positive feedback from the 2 care homes under the care of the practice, included staff’s responsiveness to refer residents to other services when needed. This was done in a timely manner.

Referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals. Administrative checks of referrals were also carried out by secretarial staff. A significant event had been raised by the practice, with regards to a patient referral for a specialist service.

Our search of the practice’s clinical records system showed that test results were generally managed in a timely manner and with appropriate clinical oversight.

However, we identified a backlog for the processing of tasks and correspondence, with the latter (approximately 2000), appearing to be related to coding matters. During the inspection, leaders told us they were aware of the backlog in coding correspondence and were taking steps to address this. They provided assurances of action plans and future monitoring of the processing of test results, tasks and correspondence, so that these were completed on schedule and with appropriate oversight from clinicians.

There was a clinical lead for safeguarding. Staff we spoke with were aware of the support available. This was reiterated in staff questionnaires, although some staff members commented that they did not have a good level of understanding of safeguarding and/or were not confident in responding to safeguarding concerns.

Practice records highlighted that 9 staff members (clinical and non-clinical) were not up to date with their safeguarding training. This included training in adults and children at the appropriate levels, in line with national guidance. During the inspection, leaders recognised the completion of staff training as an area for improvement and shared with us a plan and actions they were taking with regards to staff training matters. This included incentives to support staff with the completion of their training.

The practice had a safeguarding handbook and policy in place to support staff, with safeguarding listed as a regular agenda item, in clinical governance meetings.

During the inspection, leaders shared with us an audit tool they had completed on 16 December 2024 to monitor safeguarding children and adults at risk standards for general practitioners and GP practices. This audit had identified areas of improvement and actions to ensure that robust safeguarding systems and processes were in place and fully embedded by the practice. This included the development of a safeguarding children and adults at risk database and that patients’ clinical records were appropriately coded, maintained and updated. Leaders told us that they would start working in January 2025 on the development of the database and had requested support with this work, from their Integrated Care Board (ICB) Safeguarding Lead.

We did not receive specific examples from patients about how people were involved with managing risks.

Staff we spoke with were aware of actions to take if they encountered a deteriorating or acutely unwell patient.

However, training records the practice gave us for this inspection showed not all staff (clinical and non-clinical) were up to date with their training in emergency procedures. This included training in adult and child basic life support, 5 and 10 staff members respectively, with 5 staff members not up to date with Automated External Defibrillators (AED) training. Leaders had recognised the completion of staff mandatory training generally, as an area for improvement.

The practice was equipped to respond to medical emergencies. Medical oxygen and a defibrillator were kept on site, and there were systems to ensure these were regularly checked and fit for use. During the inspection, leaders told us they had ordered a suction machine.

The practice also held appropriate emergency medicines and had risk assessments in place that explained why medicines were, or were not, kept in the practice. During our site visit, we found emergency medicines to be in date.

There was a business continuity plan in place which was monitored and reviewed. There were systems to ensure that electrical equipment was regularly tested and medical equipment calibrated on a regular basis.

Staff were aware of the procedure for emergency evacuation, for example in the event of fire and knew who the fire marshals were for the practice. An internal fire risk assessment had been completed in August 2024.

However, according to practice records, 22 staff members (clinical and non-clinical) were not up to date with their annual fire safety training, with 16 members of staff not up to date with their annual evacuation chair training. Leaders had identified the completion of staff mandatory training generally, as an area for improvement.

Fire alarms were checked regularly by the neighbouring practice, and these were recorded by a fire marshal from Larkside Practice. However, these fire alarm checks did not necessarily include fire alarm points located within Larkside Practice’s premises. Additionally, fire drills were not regularly carried out by the practice with the last fire drill noted as July 2023. During the inspection, leaders told us that they would be reviewing and strengthening the monitoring of fire safety arrangements for the practice.

Additionally, an external legionella risk assessment had been completed in July 2023 and leaders told us that the practice had taken the actions identified in this risk assessment. While flushing areas with little water usage were completed on a regular basis, the practice had not regularly checked monthly tests of the water system. During the inspection, leaders told us that they had resumed monthly water testing and were following up on identified actions.

While there was some negative feedback about the approach of some staff members, patient feedback we received for this assessment was generally positive regarding staff.

During the inspection we found that the practice had a staff training programme in place. However, not all staff said they did not have protected time to complete mandatory training. Training records the practice gave us for this inspection showed that not all staff were up to date with their training. This included both clinical and non-clinical staff and across all mandatory training. Examples of these gaps in training have been highlighted in other parts of this report.

Some staff also said that they did not have access to regular appraisals, coaching or supervision. Records shared by the practice showed that not all staff had had an annual appraisal within the year leading up to this inspection. This included both clinical and non-clinical staff. During the inspection, leaders recognised staff training and appraisals as areas for improvement and shared with us assurances and a plan and actions they were taking with regards to these staffing matters.

Additionally, the practice could not demonstrate how they assured the competence of all staff employed in advanced clinical practice. For example, staff told us about systems in place for the supervision of the Primary Care Network’s (PCN) staff. However, there were no formalised systems in place for advanced nursing practitioners which included the prescribing competence of these non-medical prescribers through regular review of their prescribing practice, supported by clinical supervision and a systematic process. It was unclear how leaders monitored and assured themselves of nurses’ capability to practise at an advanced level. During the inspection, leaders took on board our feedback with regards to the lack of assurance of all staff employed in advanced clinical practice and recognised it as an area for improvement.

Feedback from people who use the service about the practice’s environment was positive, with people noting it was well maintained and tidy.

The practice regularly liaised with cleaning staff to address any concerns noted. However, room cleaning schedules were not in place for staff to follow and complete. During the inspection, leaders recognised this as an area for improvement and said that they would be introducing room schedules for cleaning staff.

The practice had a designated infection, prevention and control (IPC) lead. IPC audits were carried out, with the most recent audit carried out on 4 September 2024. The practice had acted on most issues identified in this audit and leaders shared with us a plan for the replacement of carpets in clinical areas, with a projected starting date of February 2025 and an estimated completion, within six months.

However, according to the information on staff mandatory training that was set and shared by the practice, 9 staff members (clinical/non-clinical) were not up to date with their IPC training. Additionally, 11 clinical staff and 7 non-clinical staff were not up to date with their annual hand hygiene training. Leaders had recognised the completion of staff mandatory training generally, as an area for improvement.

A staff handwashing audit had been carried out during March and April 2024, but according to information provided by the practice, 8 clinical staff and 5 non-clinical staff had not been involved in this audit.

During the inspection, the practice shared with us information about staff vaccinations. However, we found variations in how compliance was monitored and what records were held and where. Leaders told us that they were currently reviewing their systems for the monitoring and recording of staff vaccination compliance and for risk assessing non-clinical staff to identify vaccination relevant to their role, as per UK Health Security Agency (HSA) guidance.

Most feedback from people who discussed prescriptions noted the ease and convenience of ordering repeat prescriptions online. However, some people also reported issues with medicines, such as the practice being unable to locate their medicines request.

During our site visit and as per national guidance, we found that vaccines were appropriately stored and monitored, with blank prescriptions generally kept securely, and their use checked. Staff also had the appropriate authorisations to administer medicines.

As part of our inspection, a series of patient clinical record searches were undertaken by a CQC GP specialist advisor. This included a review of the management of patients on medicines that require monitoring, as well as the review of prescribing generally, including effectiveness and quality of medication reviews and usage.

We found no concerns in the monitoring of the patients’ records we looked at who were taking a disease-modifying antirheumatic drug (DMARD) and patients on oral non-steroidal anti-inflammatory drugs (NSAID) over 65 years or antiplatelet over 75 years and no proton pump inhibitor (PPI).

We also reviewed patients who were prescribed Angiotensin-converting enzyme (ACE) inhibitor or Angiotensin II receptor blockers and saw that 73 patients had not had the required monitoring. We looked at 5 these patients’ records and found that they were not engaging with the practice and been followed up appropriately.

We found 103 patients taking over 10 medicines with no medicines review in the last 18 months. We looked at 5 of these patients’ records and found that they had not been monitored appropriately or in line with guidance.

During the inspection, the practice took action to review and contact patients identified through our patient clinical record searches and provided assurances of action plans and future assessment and monitoring of management of patients on medicines that require monitoring, medicine reviews and usage.