St Georges Medical 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 remains the same. This meant safety was a priority, and people were protected from abuse and avoidable harm. The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and generally any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff generally managed medicines well and involved people in planning any changes.

This service scored 66 (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. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Forum felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong. Incidents were discussed and learning disseminated through staff meetings. Staff felt 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. Learning from incidents and complaints resulted in changes that improved care for others. For example, improved labelling on emergency bag following a patient collapse.

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.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. However, the safeguarding policies did not highlight the risks associated with female genital mutilation (FGM), radicalisation or human trafficking. Following our assessment, the provider forwarded to us an updated policy and other associated policies. Multidisciplinary team meetings were used to raise awareness of potentially vulnerable groups of people. The service had systems in place to generate and corroborate the children’s register with health visiting services and relevant cases were discussed at the monthly meetings. There were systems in place to follow up people who failed to attend appointments in primary and secondary care or, were frequent attenders to the emergency department. We saw an example to support the service had followed the ‘child not brought’ and safeguarding policy.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Emergency equipment was available and maintained. Systems were in place to check emergency medicines held by the GPs. Staff could recognise a deteriorating patient and knew of action to take. People were advised on risks related to their condition and actions to take if their condition deteriorated.

The service detected and controlled the majority of potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Staff completed online fire training, there were designated fire marshals and the service organised walk through fire drills. The fire alarm was tested monthly. Following the assessment the service advised that in future the fire alarm would be tested on a weekly basis. Electrical and medical equipment had been tested and calibrated. The service had not acted on a previous safety alert as we identified 3 slatted window blinds in the waiting room which were a potential risk as the loose pulley was not fixed to the wall to prevent potential strangulation of children. The service provided evidence following the assessment that these blinds had been removed. There was a business continuity plan in place which was monitored and reviewed.

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 service. 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. Staff were positive about the support, training and development they received. All nursing and non-clinical staff had received regular appraisals. Safe recruitment practices were followed. We discussed that any verbal information obtained as part of the recruitment process needed to be recorded and kept on file. Systems were in place to ensure staff working on behalf of but not directly employed by the service were recruited safely and working within their agreed areas of competence.

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 service had a designated infection, prevention and control lead and all staff had had relevant training. Whilst cleaning schedules for the practice premises were in place and followed, there were no cleaning schedules for staff and practice nurses who used equipment. Staff told us they cleaned equipment down before and after use but this was not recorded anywhere. Risk assessments and internal audits were completed, and actions taken to mitigate risks. However, the action plan developed following the external infection prevention and control audit required updating to reflect action taken and a number of actions remained outstanding. Clinical waste procedures were in place. Staff provided information about their immunisation status as part of the recruitment process either through documentary evidence or completing and signing a declaration. We discussed including dates of immunisations on the declaration form.

Systems to manage and respond to MHRA alerts needed reviewing especially in relation to women of child bearing age on teratogenic drugs. The service had recently sent text messages to people with a link to an NHS leaflet on the specific drug. The information for pregabalin was quite detailed in relation to pregnancy risks, however the carbimazole leaflet was nonspecific with the pregnancy advice contained within the main text. One person appeared to be a non-English speaker. The service had not established contraceptive usage and evidence of effective contraception was recorded for 1 of the 5 people reviewed.

The service told us they had aligned their medicine policies to follow the guidance outlined in the Repeat Prescribing Toolkit produced by the Royal College of General Practitioners. Monthly searches were completed to identify those people who required a review. Those people prescribed high risk medicines were reviewed by the pharmacists, with the GPs reviewing the remainder. The level of detail recorded in the electronic notes varied.

There was a system in place for tracking prescription stationery but it did not tally. Following our assessment the provider forwarded to us an updated process outlining the changes that had been introduced . Evidence that new tracking sheets which included the number of the first and last prescription had been introduced was provided following the assessment.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. The service had introduced short duration prescriptions for people who did not attend for routine monitoring. Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Staff stored medical gases, such as oxygen, safely. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes.