Hendford Lodge 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 assessed all quality statements in the safe key question.

At our last assessment, we rated this key question as requires improvement. At this assessment, the rating has changed to good. The service regularly reviewed, analysed and learnt from events and incidents. The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse.There were systems and processes to monitor patients prescribed medicines which required additional monitoring. However, we noted some gaps in this monitoring during our clinical searches. The practice addressed these immediately and instigated further systems and processes to reduce the risk of this reoccurring.

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 service had a proactive and positive culture of safety, based on openness and honesty.

Staff understood how to raise concerns and report incidents. Staff told us there was an open culture, and that safety was a top priority. 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. Significant events and complaints were included in the agenda at governance meetings and learning was discussed and shared to improve care for others. A member of the PPG said the provider engaged fully with the PPG and took on board their advice. The practice shared lessons learnt openly with the PPG and discussed this during their meetings.

The service worked with people and healthcare partners to maintain safe systems of care. They made sure there was continuity of care, including when people moved between different services.

There were systems for processing information relating to new patients. There was a documented approach to the management of clinical correspondence including test results, and this was managed in a timely manner. Staff had clear responsibilities and followed systems to ensure continuity between secondary and primary care. For example, handling referrals to other healthcare providers and updating patient records with hospital discharge information. However, at the time of the inspection the practice did not have a system to monitor whether urgent referrals had been processed in an appropriate timescale. The practice provided assurances that this would be promptly addressed by monitoring patients had been referred appropriately and had received their appointments. The service worked with other providers to deliver shared care and when patients moved between services. Community and out-of-hours services had read-only access to the clinical record system.

The service concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Staff had undertaken up-to-date safeguarding children and vulnerable adults training at the appropriate level for their roles. They could identify the practice’s safeguarding leads and knew how to raise concerns. The practice had a safeguarding policy which was accessible to all staff on the practice’s computer system. The practice regularly discussed safeguarding concerns within the practice at bi-weekly clinical meetings and externally with a multidisciplinary team at monthly safeguarding meetings. The practice told us that some external stakeholders could not regularly attend the safeguarding meetings due to capacity issues. After discussing the issue with the local Integrated Care Board (ICB), the practice registered for access to a database provided by the local authority which included personal details regarding children and families. The practice used this additional information to review safeguarding concerns and provide the necessary support to their patients. Any actions discussed during safeguarding meetings were recorded in individual patient records on the electronic records system. Staff were made aware of patients with identified safeguarding concerns together with their household members, by the use of an alert on their clinical records. The practice maintained a list of vulnerable people and acted on concerns by working in partnership with other organisations.

The service worked with people to understand and manage risks. They provided care to meet people’s needs that was safe and supportive.

All the staff were up-to-date with their basic life support training. Staff could recognise a deteriorating patient and knew of actions to take. Receptionists received training on emergency symptoms and the actions to take. The duty GP was available to provide support to the receptionists. The practice had an emergency incident procedure covering situations such as verbal and physical violence and deteriorating patients. Staff we spoke with provided examples of a coordinated response between clinical and non-clinical staff to manage such circumstances. People received advice on risks related to their condition and the actions to take if their condition deteriorated. Emergency medicines and equipment were available, maintained and with regular checks at the main site. However, the emergency medicine box at the branch site was not tamperproof at the time of inspection. The emergency medicines and equipment check at the branch site was performed by staff from the local Primary Care Network (PCN) (a group of general practices who works together to provide integrated services to the local population) working there with oversight by the provider. The practice investigated and explained that it was a one-off situation, and a tamperproof tag was reinstated to the emergency medicine box. Following the assessment, the practice implemented a competency checklist and induction plan for staff working at the branch site to ensure checks were completed correctly. During the inspection, we noted that the lists of emergency medicines were different at the main and the branch sites which could present a risk if GPs visiting the branch site were not aware of these differences. Following the assessment, the practice reviewed its processes and immediately implemented the same checklist of emergency medicines for both sites.

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

The main location and the branch site were well-maintained and free from clutter. The practice carried out a range of health and safety risk assessments. For example, regarding fire, electrical system, Legionella bacteria (an organism that can cause severe chest infection through contaminated water sources such as water outlets) and asbestos. The risks identified from these assessments had been addressed. Fire equipment checks and fire drills were documented. Electrical equipment was tested to ensure it was safe to use and equipment, such as scales, were calibrated for accuracy.

All staff were up-to-date with fire safety and health and safety training. Lead roles for health and safety were clearly defined. The practice had a health and safety policy and business continuity plan detailing what actions were to be taken in the event of any incident which would hamper the running of the services. There was a lone working policy and risk assessment to promote staff safety.

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.

There were a range of clinical and non-clinical roles within the practice. Staff told us there had been times when the service was short staffed, but this had improved over the past few months after the successful recruitment of GPs and administrative staff. Most staff feedback expressed that the current staffing level was enough to provide safe care.

Safe recruitment practices were followed in line with the provider’s recruitment policy. We reviewed 4 recruitment files during the site visit and found appropriate recruitment checks had been carried out. We reviewed training records and found all staff were up-to-date with their mandatory training in line with the practice policy. Staff received induction appropriate for their roles and staff were working within their agreed areas of competence. They had regular appraisals and were able to discuss their development.We saw evidence of staff being upskilled to support the practice and their professional development. For example, the practice supported their staff by giving protected time and funding for clinical and non-clinical apprenticeships and prescribing courses.

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 (IPC) lead, and all staff were aware of who it was. All staff had received relevant IPC training in line with their roles and responsibilities. The IPC policy was accessible to all staff and was under regular review. Staff knew how to manage clinical waste and specimens. Up-to-date IPC risk assessments and audits were completed, and actions were taken to mitigate risks.

We observed the practice was visibly clean and tidy on the day of inspection. Cleaning schedules were followed and the practice met with the external cleaning company regularly to review the completed cleaning audits and discuss any issues. Personal Protective Equipment (PPE) was available to staff and there were hand washing facilities in all clinical areas.The disposal of sharps equipment, such as needles, was managed safely. External clinical waste bins were locked and stored in a secure area. We saw posters around the practice including sharps injury, handwashing and clinical waste to support good practice. An isolation room was available if a patient was suspected of having an infectious disease.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

The practice had a pharmacist and a pharmacy technician who supported the GPs in the practice. The practice regularly audited non-medical prescribers (healthcare professionals who can prescribe medicines but are not GPs) to ensure medicines prescribed were necessary, correctly prescribed and followed up when needed. The practice had a policy for the management of medicines including repeat prescribing. The practice had a process for authorising staff to administer medicines including Patient Group Directions (PGDs - a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition) or Patient Specific Directions (PSDs - a written instruction from a doctor or other independent prescriber for a medicine to be supplied or administered to a named patient). However, we reviewed a sample of PGDs during the site visit and found they had not been completed correctly in line with guidance. The practice took immediate action, and we saw evidence to show this was rectified during the inspection. Blank prescription stationery was securely stored in a locked cupboard. However, we found some historically missing personalised paper prescriptions. Following the assessment, the practice took action to investigate this as a significant event, notified relevant third parties and reviewed their process for handling paper prescriptions. We found 2 unlocked vaccine fridges in an unlocked room at the branch site which could impact the security of the vaccines. The room was used by a nurse from another practice. A significant event analysis was raised and discussed in a meeting with services that use the branch site. The practice was in the process of developing a new policy to lay out staff responsibilities, implementing competency checks and induction for new staff working at the branch site.

Our clinical searches identified shortfalls in the review and monitoring of patients prescribed certain medicines. For example, our clinical searches identified 175 out of 456 patients who were on a direct oral anticoagulant (DOAC) (medicine that prevents blood clots) had not received appropriate monitoring. We also found 151 out of 431 patients who were prescribed non-steroidal anti-inflammatory drugs (NSAID) (medicines that increase the risk of bleeding in digestive tract) without also prescribing a proton pump inhibitor (PPI) (medicines that protect the digestive tract from bleeding). This was not in line with national guidance. The practice reviewed all these patients and managed them appropriately within a reasonable timeframe. The practice developed a new protocol and implemented new processes to regularly monitor these specific patient groups.

The staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials and hypnotics (medicines that promote sleep) issued by the provider was lower than the national average.