Abbey Field 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 4 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good, however some improvements were needed in relation to medicines safety. At this assessment we found there was a culture of learning from safety events and when things went wrong, staff acted to ensure people remained safe. Safe systems and pathways were in place when people moved between different services. People were safeguarded from abuse. The dispensary at the provider provided a safe, effective and well-regarded service to supply people’s medicines. However, in other locations across the practice there were not always safe and secure systems to manage medicines. People did not always get appropriate advice about associated risks with their medicines.

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.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. A representative from the Patient Participation Group told us the provider took concerns seriously and worked together to made improvements to the service.

Leaders told us they used incidents and complaints to improve systems and processes. Staff understood their duty to raise concerns and report incidents. Most staff told us these were discussed in meetings to identify and share learning and minutes were available for those who attended and those unable to attend. Staff and leaders shared examples of incidents and complaints, learning and improvement. Most staff told us they felt able to raise concerns when things went wrong.

The practice had systems and processes in place to record and manage any safety events in a timely way. They had a significant events policy and a reporting process for staff to raise concerns. There was a culture of learning with staff encouraged to report concerns for the whole practice team to learn. The practice demonstrated how they investigated, identified learning, and made any improvements that were required. We reviewed some ways the practice shared learning with staff such as team meetings, where minutes of meetings were taken and shared with staff. The practice had a complaints policy in place and complaints information was easily available in the practice on the practice website. Learning from complaints was identified and monitored to completion in a timely manner.

People and their carers gave positive feedback in relation to referrals being made appropriately and in a timely way. People were supported during waiting times to be seen by other services. Practice staff liaised with other services to ensure care and treatment was provided in a coordinated way.

Staff told us they had the information they needed to deliver safe care and treatment. Staff had a good understanding of local referral processes and arrangements. Staff who undertook referrals to secondary care understood the e-referral system and there were appropriate systems in place to prevent delays. Staff told us audits were undertaken by the practice to ensure that systems and pathway guidelines were adhered to. Staff told us they attended regular multidisciplinary team meetings where people who may be vulnerable or those receiving end of life care were discussed, and any actions agreed were recorded in people’s records.

We received positive feedback from partners in relation to the practice having safe systems of care, including when people were receiving care and treatment from a range of services.

Staff had the information they needed to deliver safe care and treatment. Individual care records, including clinical data, were written and managed securely and in line with current guidance and relevant legislation. There were systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment. There were clear processes in place for acting when the practice received letters or discharge summaries from the hospital. Any actions required from these were forwarded to the appropriate staff team to action. We reviewed the task lists on the clinical system which showed these actions were managed in a timely manner. There was a documented approach to the management of test results which were also managed in a timely manner. Referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals. Policies were in place for non-clinical staff who processed correspondence and there were systems to review this work. The practice had a summarising protocol. Summarising is the process of extracting an accurate medical history from the medical notes of a new registered patient. We saw medical record summarising had a backlog, which had reduced since 2023. Notes for summarising were prioritised and capacity had been increased in the summarising team to continue to reduce the backlog.

Leaders and staff we spoke with and received feedback from, highlighted that the practice had many people registered who had complex needs. This included a variety of vulnerable people, some of whom did not speak English as a first language, as well as people with complex care needs including homeless people asylum seekers and refugees. The practice was also situated in a deprived area; data published by Public Health England showed that the practice deprivation score was 4 of 10, with 1 being most deprived and 10 being least deprived. Staff told us they were aware of the practice and local safeguarding policies; they knew who the practice safeguarding leads were and how to report any concerns. Staff told us they had received training in safeguarding children and adults, knew how to raise concerns and most staff knew who the safeguarding leads in the practice were.

We received positive feedback from partners on how the practice’s approach to supporting vulnerable people helped to keep them safe.

The practice had clear systems, practices and processes in place to keep people safe and safeguarded from abuse. These were clearly communicated to staff. There were system alerts to identify vulnerable people on their medical records and to keep safeguarding information up to date. The practice monitored children who had not attended the practice, reviewed their access with other services and escalated any concerns identified, as appropriate. There were systems for the oversight of Disclosure and Barring Service (DBS) checks. Most clinical and all non-clinical staff were up to date with safeguarding children and adults training to the appropriate level for their role. 3 of the 5 clinicians who were overdue training had training updates booked. We asked about the other 2 clinicians and were advised they would be booked onto an appropriate course.

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

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

People who used the dispensary at the Elmstead Market branch were able to get their medicines from 8am-3pm on Monday, Wednesday and Fridays and from 2pm-6.30pm on Tuesday and Thursdays. A survey of those people who were getting their medicines dispensed by the Elmstead Market dispensary were satisfied with the services provided by the pharmacy team with all people who completed the survey saying that staff were polite and took the time to listen. People told us their medicines were reviewed regularly and this was confirmed by the pharmacy team who undertook dispensing review of medication (DRUMs), which help identify any issues and whether any medicines were no longer required. We received feedback from care home staff who told us the repeat ordering process worked well and staff answered and dealt with any queries effectively. They told us people’s medicines were reviewed and there was appropriate liaison with other services, for example psychiatry.

Staff found colleagues supportive and approachable, and they told us communication across the practice was excellent and they were kept informed. Clinical pharmacy staff had regular meetings together with a GP to discuss issues and agree prescribing and current working responsibilities. All dispensing staff had annual appraisals and competency checks. The dispensary team shared issues and good practice across other dispensing doctor practices in the area.

The dispensary was clean, tidy and well organised with only authorised people having access. Medicines stocks within the dispensary were secure, managed well, and expiry dates regularly checked. Medicines that required cold storage within the practice were being appropriately kept within temperature monitored fridges, however we found out of date items including vaccines that had expired in May 2024 and August 2023 and an injection that was 2 years out of date. We informed practice leaders, and these items were removed immediately. Most emergency medicines were available, although there was no injection to treat low blood sugar should a person not be able to take a medicine orally. We informed practice leaders who told us they would take action to obtain the required medicine. Medicines at 1 location were not secure during working hours and could be accessed from a public corridor. We informed practice leaders who told us they would undertake a risk assessment for the secure storage of medicines.

Standard Operating procedures were in place for all the dispensary activities. The clinical pharmacy team supported the management of clinical information ensuring that clinical and discharge letters were actioned in a timely manner and medicines were updated appropriately. Patient Group Directions (PGDs) were in place to allow nurses to give vaccinations without a prescription and these had been appropriately authorised for use within the service. Dispensary staff recorded incidents and near misses and these were reviewed regularly to minimise any reoccurrence. Prescription stationary was managed appropriately. There were appropriate systems and controls in place for the management of Controlled Drugs. The provider did not have robust processes to inform people of the risks associated with certain medicines. Some safety alerts had not been actioned appropriately, such as informing people with certain diabetes medicines about important signs and symptoms of side effects and when it would be necessary to seek medical advice. Text messages had been sent to some people during our inspection to inform them of the risks. People taking medicines that could be harmful in pregnancy were not always advised appropriately and the required monitoring was not always in place. During our inspection text messages were sent to people to inform them of the risks and the practice was planning to review these people. It was not always clear that people had the required blood tests before starting some medicines, when we raised this for 1 person the practice logged this as a serious incident so it could be investigated and learning shared. The practice had also identified some people who were on 2 drugs that usually shouldn’t be given together, they put in place plans to review these people.

The practice belonged to the Dispensary Services Quality Scheme (DSQS) and completed annual audits as part of this, changes were made following 2 audits to ensure people received the correct monitoring. The practice was working with the Integrated Care Board (ICB) to ensure appropriate antimicrobial prescribing under the Rewarding Appropriate Prescribing scheme. People were not fully informed about the risks associated with certain prescribed medicines.