Studholme Medical Centre

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• 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 inspection, we rated this key question as good. At this assessment, the rating remains the same. We assessed a total of 4 quality statements from this key question, Learning culture, Safe and effective staffing, Infection prevention and control and Medicines optimisation. The scores for the other quality statements are based on the previous rating for this key question.

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.

We received feedback from people who used the service who told us they experienced difficulties when trying to make a complaint and some of those that did tell us they were not satisfied with the response. Some people said they were discouraged from making a complaint and told that this could result in removal from the patient list.

Staff and leaders told us that they welcomed complaints and where they were appropriate or possible, they made improvements. The leaders assured us that they do not remove people from their practice list if they make a complaint. Staff described how patients were able to raise concerns and told us they were confident how to raise concerns themselves. Leaders in the service told us that there was an open and transparent culture, with informal and formal clinical discussions taking place.

The service kept a record of all formal complaints received and any action taken as a result of complaints. The service had received 23 complaints in the twelve months prior to our assessment. We saw that complaints received by the service were investigated and responded to in a timely manner but found in some cases further signposting could be included. Complainants were provided with an explanation as to the findings of any investigation. There had been 27 significant events recorded in the twelve months prior to our assessment and we saw incidents were investigated fully. We saw evidence where learning, including that identified from complaints and significant events, were discussed in staff meetings. We saw evidence that the service had actively reviewed feedback from patients and had implemented a strategy to make improvements. For example, further training for reception staff, introducing a capacity tracking tool and changing the ratio of appointments available to book on the day to book in advance, a new cloud-based telephone system and a new, easier to use website.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We received mixed feedback from patients. Most told us they were pleased with the care and treatment they received from staff and praised their kindness and professionalism. However, some patients told us that they found the attitude of some staff lacked compassion and people found them dismissive.

Staff and leaders in the service told us they wanted to provide excellent care. They recognised that further training was required and in response to patient feedback they had provided further training to their reception team.

There were a range of clinical and non-clinical roles within the practice. We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. However, we reviewed medicines available to support medical emergencies within the service and found that although a medicine to support advanced resuscitation was held alongside other emergency medicines, it was not clearly understood within the service which staff were trained to administer this. Since the site visit the service has provided evidence of training for two members of staff can administer this medicine. 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.

We received feedback from 91 patients and the vast majority of people who commented on cleanliness told us they found the practice clean.

Staff described appropriate infection prevention and control procedures. Leaders in the service told us they had identified areas of cleaning that they were not satisfied with and had taken action to remedy this and described how they were monitoring this on an ongoing basis.

We found that although generally the cleaning was of a good standard, there were a few areas that were missed, such as dust on the frames of examination couches. We also observed that there were cluttered surfaces in one room and in this room a box of gloves was inappropriately stored on a sink draining board. We found that the external clinical waste bin in the car park was not locked. We brought this to the attention of the practice manager who investigated and took action to rectify this immediately.

The service assessed and managed the risk of infection. There was a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place, risk assessments and audits were completed, and actions taken to mitigate risks.

The National GP Patient Survey does not include questions specific to this statement. We received feedback from 91 patients in the last 12 months but very little feedback related to medicines. Patients told us that they were able to access repeat prescriptions in a timely way.

Staff were knowledgeable about systems and processes within the service which supported medicines optimisation. Staff described processes to ensure appropriate clinical oversight of test results. Regular searches and audits were in place to ensure the practice delivered timely reviews of patients requiring repeat prescriptions. We interviewed the practice manager and registered manager who told us how the service monitored patients’ health in relation to the use of medicines including high risk medicines.

As part of the assessment, we conducted remote searches on the practice’s clinical system and reviewed a selection of patients’ clinical records. Our review of patient clinical records showed that patients were being effectively and safely managed. However, we found there were some areas the service could improve, for example clear recording of the reason why a medicine was prescribed. Our review of patients’ clinical records showed staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring, however we found there were a small number of patients for whom monitoring blood tests were overdue. We raised this with the provider who assured us they would take action to address this.

Staff managed prescription stationery appropriately and securely. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Medicines were stored securely and at appropriate temperatures, however we found there were some inconsistencies in the recording of fridge temperatures. The service had systems to manage and respond to safety alerts and medicine recalls. However, our review of patients’ clinical records identified that advice recommended by a drug safety alert issued in 2020 had not been implemented by the service. This was additional information that should be included on the prescription for a specific once-weekly medicine used to treat autoimmune conditions and some cancer therapies.

Prescribing data reviewed as part of our assessment demonstrated good practice. For example, the average daily quantity of hypnotics and the number of antimicrobials prescribed were significantly lower than local and England averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.