Wordsworth Health 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 practice was rated inadequate in the safe key question in the previous inspection in December 2022 to January 2023. We found the practice had made improvements. Leaders had implemented new systems and processes to keep people safe. Improved systems were in place, for example, for the safe management of high-risk medicine, drug safety alerts, recruitment procedures, significant events and safeguarding protocols.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke to two patients who told us they had enough time during their consultation and felt involved in decisions about their care and treatment. This was reflected in the GP patient survey, with 83% of patients saying they were involved as much as they wanted to be in decisions about their care and treatment. The practice received 24 complaints in the last 12 months. we reviewed a sample of complaints and found they had been investigated appropriately with patients informed of outcomes.

Leaders and staff were able to explain how to identify and report concerns, safety incidents and near misses in line with practice policy. Leaders and staff were able to discuss evidence of learning from complaints and significant events. We reviewed minutes from team meetings, which evidenced safety incidents being regularly discussed. Staff told us there was an open culture and they felt able to and encouraged to raise concerns.

In our previous inspection, we found the practice could not demonstrate they had complete oversight regarding the management of patient safety alerts. At that time, the practice policy contained little information as to the process of managing safety alerts. In this assessment, we found the practice demonstrated improved oversight in managing patient safety alerts. We reviewed patient records who may have been affected by a Medicines and Healthcare products Regulatory Agency alert, and we found all patients were informed of the side effects of the medicines. The practice revised its safety alert management policy, detailing the responsibilities for reviewing and distributing alerts, providing guidance on historical patient safety alerts, and specifying the frequency and timing of searches for both current and past alerts. In the last inspection, we could not be assured the practice had a safe and consistent approach to managing significant events and complaints; in this assessment, we reviewed a sample of significant events and complaints which demonstrated the practices’ end-to-end process of managing significant events and complaints were effective. In the last inspection, the practices’ significant event policy did not reference the National Reporting and Learning System (NRLS) or advocate good practice to share any relevant learning within their primary care network (PCN); in this assessment, the policy was updated to include details of current patient safety systems and how information was shared with other practices in the PCN.

Patients we spoke to told us healthcare professionals were good at treating them with care and concern, with the GP Patient Survey showing that 70% of patients saying healthcare professionals they saw or spoke to was good at treating them with care and concern during their last general practice appointment. As a response to this, the practice increased the length of appointments times from 10 minutes to 12 minutes. Subsequently, results from an in-house unverified patient survey showed 79% of patients stated the last healthcare professional they saw or spoke to treated them with care and concern. Eighty percent of patients from the National GP Patient Survey felt their needs were met during their last general practice appointment.

Leaders and staff told us there was a system to ensure referrals to specialist services were documented and contained the required information. GP partners were responsible to monitor urgent referrals and any delays. On the day of the assessment, we saw urgent referrals were managed in time. Staff told us there was a documented approach to the management of test results and these were reviewed in a timely manner. There was appropriate clinical oversight of the results, including when reviewed by non-clinical staff. Leaders explained they had dedicated members of staff to process information relating to new patients including the summarising of patient notes.

Leaders explained they held regular multidisciplinary team meetings to discuss complex patient needs and safeguarding concerns. The local integrated care board told us they did not have any concerns about the practice.

There was a system to ensure referrals to specialist services were documented, contained the required information and to monitor urgent referrals and delays. The practice had a system to monitor the uptake of referrals. As part of the assessment, we reviewed clinical records on the practices’ database and found no issues relating to referral timeliness and a review of the pathology results and workflow tasks demonstrated they were dealt with promptly.

Patients we spoke to had no concerns regarding safeguarding.

During the last inspection, we found some systems were not in place to safeguard patients from harm. We found the provider could not demonstrate evidence safeguarding registers were regularly reviewed, safeguarding training was not complete for all staff members and the safeguarding policies did contain relevant appropriate detail. Leaders informed us that improvements were made since the last inspection. The practice’s safeguarding GP Lead and deputy lead conducted weekly safeguarding sessions where they discussed patients on the safeguarding register.

Safeguarding leads met monthly with the health visiting team and reviewed children at risk. The safeguarding GP lead spoke in detail of 2 incidents that occurred within the last 12 months that required escalation. In one example, the GP lead was required to communicate with the health visiting team and a local primary school.

The practice updated their systems and processes to keep patients safe and safeguarding from abuse. A review of the safeguarding policy showed the practice added mandatory information for handling Female Genital Mutilation (FGM) cases. A review of patient records found the practice had a system to highlight vulnerable adults and children to staff. A review of the practices’ safeguarding register showed the practice were conducting regular reviews of children and adults on their registers. The practice conducted a safeguarding audit between July 2023 and March 2024 to support compliance with their safeguarding arrangements. The audit ensured there were clear lines of accountability and governance arrangements in place. The audit also ensured systems and policies were updated and that there were arrangements for information sharing with external stakeholders. We examined staff training records for safeguarding and found staff members were up to date with their mandatory safeguarding training.

We spoke to two patients from the Patient Participation Group who spoke positively about getting through to someone at the practice on the phone and in their experience of speaking to someone at the practice.

Leaders told us there was an effective approach to managing staff absences and busy periods. The practice utilised GP locums and were able to arrange cover for reception/administrative staff absences. Reception and administrative staff told us they felt there was enough staff to meet patient demands. Reception and administrative staff were able to explain the actions they would take if they encountered a deteriorating or acutely unwell patient and were able to explain how patients were triaged.

In our last inspection, we found sepsis training was not complete for one member of staff. During this assessment, we reviewed a sample of ten staff training records and found sepsis training was completed for each staff member. Administrative staff we spoke to were able to explain the signs of suspected sepsis and we found the practice was equipped to respond to medical emergencies. Staff had completed the appropriate training for anaphylaxis basic life support training. The practice had a locum induction pack for agency staff to follow.

The practice told us facilities and equipment were safe, and that equipment was maintained according to manufacturers’ instructions. There were systems for safely managing healthcare waste. Staff explained any maintenance concerns were promptly responded to by the leaders.

We conducted a site visit of the practice on 24 July 2024 and found the practice was well maintained.

In our previous inspection, the practice could not provide a safety risk assessment regarding the control of substances hazardous to health (COSHH). For this assessment, the practice submitted evidence of a safety risk assessment carried out in April 2023. The practice completed a fire risk assessment and a health a safety risk assessment in March 2024. The practice provided evidence of annual portable appliance testing and calibration of equipment. All staff members completed their fire safety training and health and safety training.

The national GP patient survey carried out from January to March 2024 had 118 responses. This found 88% of respondents had confidence and trust in the healthcare professional they saw or spoke to during their last general practice appointment. Seventy percent of patients stated the healthcare professional was good at treating the patient with care and concern with 80% saying their needs were met. However, 59% of patients found the reception and administrative team helpful which was significantly below the 83% of the national average. The practice conducted an in-house survey and results showed that 81% of respondents found receptionists helpful or fairly helpful. We spoke to two patients from the Patient Participation Group who spoke positively about their experience at the practice and told us they found both clinical and non-clinical staff helpful.

In the last inspection, we found the practice could not demonstrate clinical staff had been appropriately trained and competency checked. For example, the provider could not demonstrate evidence that healthcare assistants received Care Certificate standards training and completed appropriate training regarding the management of long-term conditions associated with health checks. We were also not assured appropriate formal supervision for clinical staff was completed nor did we find evidence of a completed induction for 8 out 10 staff members. The practice told us they introduced a quality improvement action plan and monitoring systems to review training and competency of clinical staff on a regular basis. Leaders at the practice told us all clinical staff were sufficiently trained and provided evidence of clinical supervision by the GP partners. The practice conducted an in-house survey in 2024 and found 86.36% of staff felt they had the necessary resources and told to perform their job effectively and 77% of staff were either satisfied or very satisfied with the upskilling and training opportunities provided by the practice.

The practice conducted a two-cycle audit to review their compliance with HR checks. The second cycle, run on July 2024, showed the practice was 100% compliant with HR check requirements. We reviewed ten staff files of both clinical and non-clinical staff and found all the necessary checks had been completed, including DBS checks, the Care Certificate standards training for healthcare assistants and appropriate training for core-specific roles. We found all staff had completed the mandatory training for their role with regular appraisals being carried out. In the last inspection, we found the practice did not submit a complete record of immunisations for all members of staff. In this assessment, we found the practice demonstrated a safe system was in place to effectively manage infectious diseases and staff immunisations through our review of staff records. A clinical supervision policy was revised in July 2023 and outlined the role of the supervisor and which healthcare profession would be supervised by whom. The practice submitted evidence of a clinical supervision audit and clinical supervision for a range of clinical staff.

During the assessment we spoke to 2 patients from the Patient Participation Group. Both patients had no concerns regarding the infection control of the practice, and fed back that the practice maintained a clean and safe environment.

Leaders at the practice informed us one of the GP partners was the lead for infection control and along with one of the practice nurses, conducted regular infection prevention audits and checks of the premises.

We visited the practice site and found appropriate standards of cleanliness and hygiene were being met.

An external infection control audit conducted by NHS England was completed in July 2023, with an action plan created for the practice to work through. Staff completed an internal infection prevention control audit in February 2024 as part of their annual risk assessment. The practice completed a legionella risk assessment in March 2024.

We did not speak to patients regarding medicines optimisation.

We spoke to a range of clinical staff, and they were able to tell us how they monitored patients’ health in relation to the use of medicines including high risk medicines such as warfarin and lithium. Staff were able to explain the protocols in place and who was responsible for the monitoring of vaccines, emergency equipment and emergency medicines.

During our site visit, we observed the practice held appropriate emergency medicines with a system in place to monitor stock levels and expiry dates. Medical oxygen and a defibrillator were available and easily accessible. The vaccine fridge was maintained at the appropriate temperature. Staff had the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions).

The practices’ prescribing policy included details of repeat prescribing, medication reviews and reviewing patients who are discharged from secondary care organisations. The practice revised their medical emergency policy, which included the practices’ systems in place to monitor the fridge and clinical room temperatures for the storage of medicine. The practice reviewed their emergency drug cupboard and emergency trolley monthly. Emergency equipment such as the defibrillator were checked monthly. The practice did not stock controlled drugs.

As part of our assessment, clinical record searches were undertaken by a CQC GP specialist advisor. These searches were visible to the practice. We examined 4 patients prescribed methotrexate; an immunosuppressant used to treat inflammation. We found all 4 patients were being monitored appropriately, with the prescription quantity dosage reduced whilst the practice had contacted the patients to perform a blood test before issuing a new prescription. We also examined patients who were prescribed azathioprine; a medicine used to treat inflammatory conditions. We examined 2 patient records and found both patients were being monitored appropriately. We examined 5 patients prescribed lithium: a mood stabiliser. We found all five patients were being monitored appropriately. The practice prescribed Angiotensin Converting Enzyme inhibitors or Angiotensin Receptor Blockers to 1,077 patients. We examined five patient records and found patients were being monitored appropriately with blood tests arranged to conduct further monitoring for two out of the five patients. In our last inspection, we were not assured the provider had complete oversight regarding the management of patient safety alerts; in this assessment, we reviewed 2 patients who prescribed citalopram and identified no issue with the monitoring of both patients.