Naseby 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

The Safe key question has been rated Requires Improvement. All quality statements for this key question were included in this assessment: Learning culture, Safe systems, pathways and transitions, Safeguarding, Involving people to manage risks, Safe environment, Safe and effective staffing, Infection and prevention control, and Medicines optimisation.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

As part of this assessment, we reviewed patient feedback from the National GP Patient Survey and asked the practice to share details of our Give Feedback on Care process with patients. We received no specific patient feedback relating to learning culture from these sources however prior to our assessment CQC received four complaints from patients about the practice. Feedback from one patient stated they had experienced a lack of engagement from the practice management when they had raised concerns.

Feedback from staff showed that they were able to explain the process of how they would report an incident or who they would seek guidance from to do so. Staff told us they were encouraged to report incidents and felt confident to do this. They felt they were able to raise and discuss concerns in an open environment and that the practice’s clinical and management team were approachable. Staff told us they participated in quality improvement, including clinical audits, and attended practice meetings where learning was shared from incidents and complaints. Prior to our assessment, the clinical system operated at the practice had changed and leaders told us they had experienced problems with patient information being transferred across to the new system. However, GPs confirmed they had not reported a significant event in relation to the migration of the clinical systems.

The practice had policies in place to manage incidents and complaints. The practice provided us with evidence of incidents and complaints and as a result of one incident, the practice had applied the duty of candour. The practice had a process in place to receive, disseminate and act upon alerts received through the Medicines and Healthcare products Regulatory Agency (MHRA) and the Central Alerting System (CAS). We reviewed patient clinical records to check patient safety alerts were actioned in line with guidance, for example patients prescribed Sodium Valproate medicine. This medicine is associated with a significant risk of birth defects and developmental disorders in children born to women who take valproate during pregnancy. Since 2018 any use of valproate in patients of childbearing potential has to be within the terms of the Pregnancy Prevention Programme. We reviewed the patient records of four patients prescribed this medicine and found gaps in the care processes for three patients.

The National GP Patient survey found 75%of patients knew what the next step would be after contacting their GP practice and 94% knew what the next step would be within two days of contacting their GP practice. These results were in line with national averages.

Leaders told us there were systems in place for the management of referrals, clinical correspondence, pathology results and summarising to ensure safety and continuity of care for patients. They told us that clinicians made appropriate and timely referrals in line with protocols and up-to-date evidence-based guidance. Staff we spoke with understood the referrals processes and how to manage correspondence. As part of our assessment however, we reviewed the clinical records of patients with diabetes. We noted that many patients had been referred to a diabetes clinic but there was a lack of clinical oversight of these patients by the practice following this referral.

As part of our assessment, we contacted the NHS Birmingham and Solihull Integrated Care Board and asked for their feedback about the practice. From the feedback we received from them there was no specific information related to this area.

The practice had a referral policy and procedure in place. We observed that urgent 2-week wait cancer referrals were dealt with appropriately and we were provided with audits undertaken for 2-week wait and urgent referrals. There were systems in place for safety-netting cervical screening to ensure that a result was received for each cervical screening sample undertaken.

Staff were aware of the processes to follow if they identified a potential safeguarding concern and how to access appropriate safeguarding policies for support. They had completed safeguarding training for children and vulnerable adults and were aware of who the safeguarding lead was within the practice.

Leaders told us the safeguarding register was discussed internally but planned to have monthly safeguarding meetings in the future and they understood the need to have meetings with external bodies. Whilst staff feedback showed awareness of safeguarding processes, our review of clinical records found these processes were not always followed.

The Integrated Care Board (ICB) shared with us that prior to our assessment the practice had contacted the ICB and sought advice about safeguarding registers including what they need to do, who to include, how to colour code and how often to review.

Policies to support staff in the safeguarding of children and vulnerable adults were available however, we were not assured there was an effective and embedded safeguarding system in place to safeguard patients from abuse. As part of our assessment, we reviewed the safeguarding registers for adults and children and found these were not up to date. For example, our review of patient records identified children which should have been on the practice’s safeguarding register and found there was a lack of coding and alerts applied to family members to highlight children with safeguarding needs within the household.

The National GP Patient survey results found 86% of patients were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment; and 85% of patients felt the healthcare professional they saw or spoke to was good at listening to them during their last general practice appointment.

Staff feedback demonstrated that all staff were aware of the location of the emergency medicines and medical equipment. Receptionists knew how to prioritise patients who reported symptoms that may be clinical emergencies including symptoms of sepsis. Staff we spoke with were aware of how to raise the alarm in the event of an emergency and the use of the panic alarm system integrated into their clinical system.

The practice had a resuscitation and medical emergency policy in place. The practice was equipped to respond to medical emergencies including a range of emergency medicines and medical oxygen and a defibrillator. There was a system to monitor emergency medicine stock levels and expiry dates; and emergency equipment was regularly checked to ensure they were fit for use. Sepsis was covered within staff induction and staff received annual sepsis training updates. Pulse oximeters, blood pressure machines and thermometers were available to enable the assessment of patients with presumed sepsis. In addition to sepsis training, first aid and anaphylaxis training was provided as part of staff induction and staff received annual training updates in these areas.

Staff told us they had undertaken required mandatory training in respect of health and safety, such as fire safety training and were aware of fire alarm testing procedures and the designated fire assembly point. Leaders showed us architect plans for the practice for a building extension and internal refurbishment. Leaders told us the complete refurbishment internally and externally would satisfy current infection control and health and safety requirements; and NHS standards of newly built health centres.

There was appropriate signage in place within the practice, such as for fire escape routes and fire assembly points. However, we found the practice premises required improvement. There was a ramp at the practice entrance but there was no automatic door to assist patients using wheelchairs to access the building entrance and no doorbell facilities to alert staff if a patient needed assistance to gain access to the practice building. A new doorbell was fitted shortly after the assessment visit. Although the corridors met the minimum requirements for wheelchair accessibility, the upcoming building work plans included widening the downstairs corridors to improve wheelchair accessibility.

Parking onsite at the practice was severely limited and there was no marked designated disabled parking space at the practice. However, the practice is a corner house building which has off-site parking on two adjacent roads. Leaders told us the practice refurbishment would address all of these areas and improve accessibility for patients.

The practice had a variety of risk assessments in place to monitor safety such as fire and Control of Substances Hazardous to Health (COSHH). The practice ensured equipment was maintained with regular portable appliance testing (PAT Testing) and re-calibration.

The National GP Patient survey found 73% of patients felt the reception and administrative team at the practice were helpful. The national average was 83%. The National GP Patient survey also found 79% of patients felt the healthcare professional they saw or spoke to was good at treating them with care and concern during their last general practice appointment. The national average was 85%. During our onsite assessment we spoke with patients who provided positive feedback about staff. We also observed staff interactions with patients in the waiting area and found the reception team were polite and caring with patients. Prior to our assessment however, we received 4 complaints from patients about the practice. Within these complaints patients raised concerns about staff attitude.

Leaders told us that staffing levels were actively monitored on a weekly basis, and that rotas were in place which ensured that there was the right mix of staff numbers and skill mix in place to deliver safe and effective care. Staff told us the administrative team all worked part time and could provide cross-cover of shifts if required. Leaders told us that GP locums were used when necessary to provide clinical care for patients and a GP locum pack was provided for GP locums with necessary information about the practice to carry out their role. With the planned building extension and the two additional clinical rooms being built, leaders explained this would increase the capacity to retain the current PCN pharmacist and physiotherapist for more regular and longer hours at the practice.

As part our assessment, we spoke with staff and reviewed the systems and processes for clinical supervision within the practice. We found there were no formal arrangements in place for the clinical supervision of the practice nurses or the health care assistant. GPs told us there was a clinical supervision template in place which was used on a monthly basis, but we saw no evidence of this, and staff told us they had not received any formal clinical supervision from the GPs. GPs told us that a PCN pharmacist undertook medication reviews however as part of our review of patient records, we observed multiple examples of a medication review code being applied to patients’ records without any evidence of an effective medication review by the pharmacist. We were therefore not assured there was an effective and embedded system for clinical supervision.

The practice had Recruitment, Disclosure Barring Service (DBS), and Raising Concerns, Freedom to Speak and Whistleblowing policies in place. All staff were appropriately qualified. The practice had an induction programme for all newly appointed staff. Relevant professionals (medical) were registered with the General Medical Council (GMC) and were up to date with revalidation. Revalidation is the process by which doctors demonstrate they are up-to-date and fit to practise. The practice understood the learning needs of staff and provided protected time and training to meet them. There was a mandatory training schedule in place and there was a staff training matrix to monitor when updates were due. Staff received annual appraisals however we found there was limited information documented as part of the appraisal process for individual staff members.

As part of our onsite assessment, we spoke with patients registered at the practice and no concerns were raised regarding the cleanliness of the practice.

Staff told us they had completed infection prevention and control (IPC) training. One of the GPs was the nominated infection control lead for the practice to provide oversight in this area and undertake audits. Staff were aware of where to locate policies regarding IPC for support. Reception staff showed us they had access to spillage kits to deal with any bodily fluid spillages.

We observed the practice facilities were clean. Appropriate arrangements were in place for managing waste and clinical specimens to keep patients and staff safe. We saw cleaning staff completing cleaning schedules and a designated area was used to store cleaning equipment. Handwashing facilities, liquid soap, paper towels and antimicrobial handrub were available within clinical rooms. However, we observed elbow taps were not available within one of the consulting rooms we inspected, and this had not been identified as part of an infection control audit the practice had undertaken. We raised this with leaders who told us taps would be addressed as part of the planned internal refurbishment of the premises and the service had completed a building health and safety risk assessment which highlighted a new compliant sink was required.

The practice had an infection control policy and a blood and body fluid spillage procedure to support staff with infection control. Infection prevention and control was covered within staff induction and staff received training updates every three years. The practice provided us with evidence of a hand hygiene audit which had been carried out with staff. Appropriate personal protective equipment was available for clinical staff and clinical equipment was cleaned on a regular basis. Leaders ensured appropriate environmental risk assessments were carried out such as periodic water sample checks for a bacterium called Legionella which can proliferate in building water systems.

Prior to our assessment CQC received four complaints from patients about the practice. Two of these complaints related to a lack of medication reviews being provided for patients prescribed medicines.

Staff described the systems in place for the safe ordering, storage, and administration of medicines, including vaccinations. Clinical staff and leaders explained the systems they had in place to ensure medicines were prescribed safely and in line national guidelines.

As part of our assessment, a CQC GP Specialist Advisor (SpA) conducted a series of clinical searches of patient records to assess the practice’s procedures around prescribing and medicines management. This included clinical searches of medicines prescribed for patients which require monitoring. From our review of clinical records, we were not assured the practice was operating an effective, embedded system to ensure patients received necessary and timely monitoring, blood tests and medication reviews across a range of medical conditions. In addition, we reviewed a sample of medication reviews which had been undertaken for patients in the last 3 months and identified concerns with the quality of the review. For example, we found examples of a clinical code being applied to patients records of a medication review, however there was no further detail about this review.

Vaccines were ordered and transported in line with Public Health England guidelines, and we observed they were stored appropriately within clinical fridges. We saw daily records of the maximum, minimum and current temperatures of the vaccine fridge were maintained. The practice held appropriate emergency medicines and had a system in place to monitor stock levels and expiry dates.

Staff had the appropriate authorisations to administer medicines (including Patient Group Directions). We reviewed a sample of PGDs and found these had been appropriately signed by staff and authorised by a General Practitioner. There was a prescription security policy in place and blank prescriptions were kept securely, and their use was monitored in line with national guidance. The practice had policies in place for medicines management however our review of clinical records found these were not being operated effectively.

Data showed that the practice had systems in place to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Outcomes from our review of prescribing data confirmed this. For example, the percentage of broad-spectrum antibiotic items prescribed that are co-amoxiclav, cephalosporins or quinolones was lower than national averages. Broad-spectrum antibiotics are a type of antibiotic that are effective against a wide range of bacteria. Our clinical searches however identified issues with the systems in place to ensure patients received necessary and timely monitoring, blood tests and medication reviews and therefore we were not assured some patients, such as patients with diabetes, had the best outcomes.