Bridgemary 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 looked for evidence that people were protected from abuse and avoidable harm. At our last assessment, we rated this key question as Good. At this assessment, the rating has changed.

Safety was a top priority, and staff took all concerns seriously. When things went wrong, staff acted to ensure people remained safe. Managers investigated all reported incidents to reduce the likelihood of them happening again. Staff were able to share an example of a recent significant event, action taken and learning.

Staff were confident in responding to safeguarding concerns and had received the level of training relevant to their role. The service ensured workforce planning arrangements were in place to provide safe, high-quality care and staff had access to training and development opportunities to support them in their role.

Systems for the safe management of medicines, including emergency medicines and equipment and medicines optimisation, required improvement. For example, we found that not all recommended emergency medicines were held on site. Furthermore, our clinical searches identified some omissions in the oversight of the monitoring of patients with long-term conditions and the actioning of national safety alerts. The practice took immediate action to mitigate any potential risks to these patients.

The service was in breach of legal regulation in relation to safe care and treatment and good governance.

This service scored 62 (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 had a proactive and positive culture of safety, based on openness and honesty. Lessons were learnt to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Staff felt there was an open culture, and confirmed 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.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

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.

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, who were appropriately trained in safeguarding procedures. There was a designated safeguarding lead in place. The practice maintained a list of vulnerable people and acted on concerns, working in partnership with other organisations.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Emergency equipment was available and maintained. However, we noted that not all nationally recommended emergency medicines were present in the building. Furthermore, the practice did not have appropriate risk assessments in place to mitigate the risks of not having these medicines available. This was addressed immediately after the site visit. Staff could recognise a deteriorating patient and knew what action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The practice had implemented a risk-based patient coding system depending on people’s communication needs and co-morbidities. Higher risk patients had a named GP with dedicated clinics and reasonable adjustments for longer appointments. Audits had been carried out routinely to ensure patients were coded appropriately and kept up to date.

There were systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment. We identified processes to monitor delays in referrals and the practice carried out audits to ensure ‘two week wait’ (2WW) cancer referrals had been booked with secondary care providers as a safety netting mechanism (2WW cancer referrals are urgent referrals used to investigate symptoms to detect cancer).

The service detected and controlled potential risks in the care 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.

Staff felt 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.

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 received relevant training. Risk assessments and audits were completed, and actions taken to mitigate risks.

However, the practice held no record of cleaning schedules for the premises. There was no risk assessment in place to support the absence of a lock on the cupboard containing substances hazardous to health. This was not accessible to patients. Following our site visit, the practice ordered a lock to be installed.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely.

There was scope to improve protocols in place to ensure that medicines were prescribed safely, and ensured people received all recommended medicines reviews and monitoring. For example, we found that not all patients prescribed Benzodiazepines received basic medication reviews. The result of the findings was dealt with in a responsive manner by the practice.

Medicines, including controlled drugs, 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. Waste medicines were recorded and disposed of appropriately including medicines returned by patients.

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 in line with local and national averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

However, the provider did not have effective systems in place to manage and respond to safety alerts and medicine recalls. In addition, staff did not follow established processes to ensure people prescribed medicines with specific risks received recommended monitoring in line with national guidance. For example, we found that the monitoring process for patients prescribed Amiodarone required further detail. We discussed this with the practice who immediately developed an action plan to progress work on improving this.