The Molebridge 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. We assessed 3 quality statements for this key question and found the service was not always safe. We were not assured leaders always responded to concerns raised by staff, patients and concerns raising from workforce issues proactively. Staff told us they did not feel listened to, and monthly meetings did not give adequate time to discuss all that was required to ensure shared and continual learning. At times there was an inadequate number of staff working at the practice. Staff did not always have effective supervision to provide safe care, and we found some staff working outside of their scope of practice. Clinical searches of patient records were carried out as part of our inspection. We found that not all medicine alerts had been acted on and some medication reviews was overdue for patients.

This service scored 16 (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 did not always demonstrate a proactive and positive culture of safety based on openness and honesty. Representatives from the Patient Participation Group (PPG) told us they had raised patient concerns with the provider and there was a public meeting where concerns raised by patients were forwarded to CQC. Staff told us they did not always feel listened to in regard to concerns they were raising. For example, concerns about staffing levels were raised but no effective action had been taken by the provider.

Staff told us they attended a monthly clinical meeting. However, the data discussed included information from the provider’s 3 other practices (not within the same geographical area and with different health economies). The meetings lasted 1 hour, and staff told us this was not enough time to discuss all that was required. For example, Medicines and Healthcare products Regulatory Agency (MHRA) alerts, significant events, complaints, and to discuss challenging clinical scenarios. Meeting days and times remained static, and some staff told us these meeting were held on days they were not working. We reviewed the minutes taken for these meetings and found there was not enough information for any staff member who had been unable to attend to understand what was disseminated and discussed.

We did not look at Safe systems, pathways and transitions during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

We did not look at Safeguarding during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

We did not look at Involving people to manage risks during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

We did not look at Safe environments during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

Patients contacted us via our Give Feedback on Care forms. The Patient Participation Group (PPG) also contacted us about concerns raised from patients. They told us that patients were unable to book appointments in a timely manner. They also told us the branch surgery was unexpectedly closed on some days and that appointments with GPs and nurses were cancelled at the last minute.

We did not gain assurances that the provider had clear processes in place to manage safe and effective staffing. For example, staff told us there were shortfalls to cover clinical and non-clinical activities due to absences. There was a lack of oversight to manage staff rotas to ensure there was adequate cover in place to meet the needs of patients. For example, we were told the branch surgery had closed at short notice on occasion due to being understaffed. We found that staffing rotas were not managed effectively or in a timely manner. Meaning that patients were sometimes unable to book appointments in advance due to not knowing which staff would be available. We noted that lone working arrangements had not been risk assessed adequately.

We reviewed 27 patient records that indicted non-GP staff (for example Healthcare Assistants, Physician Associates and Primary Care Doctors) had been at times working outside their scope of practice, or evidence of poor practice. The provider could not demonstrate how they assured the competence of staff employed in non-GP patient facing roles, as there was a lack of oversight and clinical supervision arrangements in place. Some of the patient notes we reviewed showed clinical supervision for these roles had failed to adequately assess the risks to the health and safety of patients. Where a supervisor had signed off tests requested there was no indication, they had reviewed the clinical reason for them and so agreed with the requests. However, we found no evidence of actual patient harm.

We did not look at Infection prevention and control during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

During our review of patient records we found that on 2 occasions medicines required through a Patient Specific Direction (PSD) were given without the required authorisation from a prescriber. A PSD is an instruction to administer a medicine, by a prescriber, to individually named patients Where the prescriber has individually assessed the patient and has adequate knowledge of the patient's health.

We found that quality assurance systems required strengthening to ensure processes such as patient monitoring and reviews were actioned in a timely manner. We noted that clinicians did not always have the most up to date information about a patient’s medical condition due to monitoring being overdue. We found there was no collective approach to manage this effectively or consistently. For example, we noted that a health check was recorded as complete on a patient record before the results of the blood tests were received.

We noted repeat prescriptions were being signed without prompting a recall for a medicines review where monitoring was overdue. We reviewed medical reviews completed for 5 patients and found 2 were not completed in accordance with National Institute for Health and Care Excellence (NICE) guidelines. Our patient searches indicated 58 patients as having polypharmacy requirements (being prescribed multiple medicines at the same time) and having no medication review in the last 18 months. We reviewed 5 of those patient records and found 2 showed a medicines review was overdue.

Our review of patient records identified that care was not always managed in line with guidance and legislation. We reviewed male patients prescribed a medicine that can be used to treat epilepsy and bipolar disorder and found no written record informing them of potential side effects.

We reviewed 5 patients prescribed a medicine to treat the symptoms of an overactive bladder and found that blood pressure readings were not in place for all 5 records reviewed.

We reviewed a patient prescribed 13 salbutamol inhalers in a year. We found no evidence of discussions with the patient to help manage their asthma and review the effectiveness of the medicine.