- GP practice
Rope Green Medical Centre Also known as Dr Hadrill and Partners
Report from 8 January 2025 assessment
Contents
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
Safe
The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and 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 managed medicines well and involved people in planning any changes. However, MHRA (Medicines and Healthcare products Regulatory Agency) historical alerts were not always reviewed.
This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.
Learning culture
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.
Managers encouraged staff to raise concerns when things went wrong. During staff meetings, clinical issues were discussed and cascaded appropriately to the whole team. 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.
Safe systems, pathways and transitions
The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.
There were systems in place for processing information relating to new patients. The service worked with other providers to deliver shared care and when patients moved between services. Referrals and test results were managed in a timely way.
Safeguarding
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. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. Not all staff were appropriately trained in safeguarding, the practice addressed this and organised training members of staff who needed more advanced training.
Involving people to manage risks
The service worked with people to understand and manage risks by thinking holistically.
Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.
Safe environments
The service detected and controlled potential risks in the environment. They made sure equipment, facilities and technology supported the delivery of safe care.
Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed.
Safe and effective staffing
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. 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. Safe recruitment practices were followed.
Infection prevention and control
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 lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.
Medicines optimisation
The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.
We found some issues in relation to a small number of patients being overdue required monitoring when on high risk medication. This was raised during the inspection and the practice booked all patients identified in for monitoring during the assessment period. The practice also set up new systems to reduce the risk of this happening again.
The provider had systems to manage and respond to safety alerts and medicine recalls. However, MHRA (Medicines and Healthcare products Regulatory Agency) historical alerts were not always reviewed, we raised this during the assessment and the practice put in a new system to identify any new patients which the legacy alerts may apply to.
People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely. Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was lower than local and national averages.