Medlock Vale Medical Practice

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• 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 saw that there was enough staff in place and the provider had recently recruited new staff into the practice. Staff training was appropriate and up to date and staff had received induction, annual appraisal and clinical supervision. Experienced staff who had been with the practice for many yeawere being utilised to train and support new staff across the organisation and to ensure consistency over their four sites. They were able to demonstrate safe systems, pathways and transitions were in place. Referrals to specialist services were appropriate and monitored and there was a documented approach to the management of test results. We also saw that appropriate systems were in place to manage prescribing for patients and medicines optimisation. The clinical searches revealed that recording and coding in the clinical system was appropriate and advice was given to patients on how to manage their conditions. Although we did not identify specific areas of clinical risk in any of the clinical records reviewed, the clinical searches did identify records where improvements could be made. The practice was responsive to feedback given as a direct result from our reviews. We found a positive learning culture. Staff knew how to identify and report concerns, safety incidents and near misses. The practice learned and made improvements when things went wrong with a system in place to manage and act on significant events. However, in some cases, we saw the process was inconsistent and this could be improved further to prevent any near misses.

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 had opportunities to provide feedback and they knew how to make a complaint. We received more than 200 responses from people via Give feedback on care (GFOC) with mixed views about the service. The negative concerns alluded that there were insufficient numbers of staff, and the staff were sometimes rude and unhelpful. Positive feedback was also received about clinical staff and overall improvements that had been seen over recent months. We reviewed the areas of concern that had been highlighted to us and found that these were already known to the practice and improvements were already underway. However, these had only recently been implemented and it was not possible to establish whether a positive impact had yet been achieved.

Leaders told us they used incidents and complaints to improve systems and processes and we saw evidence of this. Staff understood their duty to raise concerns and report incidents and told us these were discussed in team meetings to identify learning which we saw. Staff and leaders were able to share examples of incidents and complaints, learning and improvement. Staff told us they felt able to raise concerns when things went wrong. There was evidence of learning and dissemination of information. The practice demonstrated that when concerns were raised, action was taken and improvements were implemented.

The practice had a significant event policy and complaints policy which was accessible to all staff members. The practice discussed events and incidents during team meetings and learning was shared with staff. The practice had a duty of candour policy and involved people when managing significant events and errors. The practice had a clear system in place to record and investigate complaints. From the sample of significant incidents we reviewed, we found the practice responded to concerns and complaints in a timely manner. The practice offered apologies to people when appropriate. We saw from evidence provided that lessons were learnt from individual concerns and complaints and that action was taken to improve the quality of care. However, we were not satisfied that all significant incidents were reported and documented with a full review and learning at all times. The provider held a log of significant incidents and a log of complaints which they used to identify themes and trends. On review we did find some inconsistencies and improvements could be made to both these processes to ensure nothing is missed.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

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

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.

People told us they were concerned there was not enough suitably qualified, skilled and experienced staff to meet their needs. They also said that generally over the last year the surgery had improved in many areas. Appointments were more readily available and communication had improved. According to feedback there were other things that could still improve such as being able to book appointments more flexibly and choose a preferred GP and the provider had recently increased the number of clinical staff to help with that. However people felt the practice did not have enough staff to meet their needs.

We discussed the feedback highlighted about staffing during the GP interview and had no concerns from the responses given by the leaders. There were no concerns from the results of the clinical searches. Leaders told us they had listened to staff and patients and made improvements. We discussed how staffing levels were agreed and the provider demonstrated enough clinical and non-clinical staff to meet patient demand. There was also a bank of administration staff that could be used to cover planned and unplanned leave. Staff we spoke with told us they received training and supervision. Managers showed us a quality improvement programme underway to utilise the knowledge and skills of experienced staff to support and mentor newer staff over all sites.

We saw processes in place such as rotas and audits around staffing levels and appointment times. The rotas were reviewed daily to ensure there was enough clinical and non-clinical staff to meet the needs of patients. Appointment systems were set up and reviewed regularly to ensure that staffing levels were appropriate. Quality improvement projects were in place such as utilising the knowledge and skills of experienced staff to support those newer and less experienced. A training matrix showed that staff received regular training and supervision and there were protocols in place to support staff when dealing with specific areas of concern such as patients presenting with medical emergencies.

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’s feedback was mixed. Patients highlighted some serious concerns about the management of medicines such as changes to medicines without any discussions, staff unable to find medication changes on the clinical system, difficulty obtaining repeat prescriptions and delays for new patient access to repeat prescriptions. However, we also received positive feedback from patients about good service received following a diagnosis of diabetes and helpful GPs who were kind and considerate when dealing with medication worries.

During our assessment we spoke with the provider and clinical leads. Leaders were all aware of their roles and responsibilities surrounding medicines management. There was a specific GP lead with oversight of medicines management at the practice. We discussed the concerns that had been raised by patients around medicines and were satisfied from those discussions that there had been no risk of harm to anyone. Leaders demonstrated through discussion that patients’ concerns had been listened to and improvements were being made. For example, clinical meetings attended by clinical staff from all four sites were used to discuss complaints, significant incidents, medical alerts and patient concerns. Actions were then taken from those meetings and relayed back to patients and staff. We saw that the existing home visit policy was recirculated to all staff following an incident that resulted in a wrong person being visited in a nursing home.

The scope of our focussed assessment did not identify areas of concern requiring detailed observations of care. The score applied reflects the findings of previous assessments.

There was no statistical or negative variation in data available to CQC around prescribing safety. There were regular clinical meetings with clinical staff across all four sites discussing medicines management. The practice had registers for people with learning disabilities, mental health conditions, long term conditions, palliative care, and carers and safeguarding. We were shown how those patients’ medicines were assessed and monitored and had no concerns. There was a process for medicines reconciliation undertaken by GPs when changes were highlighted in letters of discharge, or changes were made after consultant outpatient appointments. There were policies and procedures in place for the general management of medicines and these were managed and available to staff on a shared area within their computers.

Patients needs were assessed appropriately as seen from the review of clinical records by the GP specialist adviser (SpA). The SpA also reviewed 5 particular cases that had been raised to us by patients who were unhappy about their care and treatment, specifically with regards to medicines management. During review of those cases, no specific areas of concern were identified that would have negatively impacted on the care and treatment provided to the patients concerned. The GP SpA reviewed patients’ records who had been prescribed DMARDs (a disease modifying antirheumatic drug used to treat pain) and a medicine called Amiodarone that prevents and treats arrhythmia and also requires monitoring. On review of patients receiving these medicines, no concerns were found. They also reviewed Drug Safety and MHRA (The Medicines and Healthcare products Regulatory Agency) Alerts. No concerns were identified.