Goodcare 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

This service maximises the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them. We reviewed all 8 quality statements in the Safe key question There was a culture of safety and learning. Staff told us they were encouraged to raise concerns and felt supported in doing so. Incidents and complaints were appropriately investigated and reported. There was an effective system for reporting, recording, and learning from significant events and complaints. Risks were actively managed and viewed as an opportunity to learn and improve. Our review of the remote searches of patient records showed that patients were being effectively and safely managed. There was a process for the management of medicines, including high risk medicines, with appropriate monitoring and clinical review prior to prescribing. Patients were involved in regular reviews of their medicines. Medicine management was effective. Expiry dates of medicines were monitored, recorded and all in date, however we did identify that the practice did not stock one emergency medicine and had not undertaken a risk assessment. The practice was also doing monthly checks for reviewing emergency medicines and equipment (however, the Resuscitation Council recommends a minimum of weekly checks). Fridge temperatures were recorded daily and no temperatures had gone out of range.

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.

People using the service did not raise any concerns about the practice’s learning culture.

Leaders informed us they had systems in place to report, investigate and learn from significant events, complaints or incidents that occurred. Staff told us they had regular meetings where they discussed incidents and learning from them.

The practice had a significant event/critical event toolkit policy which had been reviewed in September 2024. We saw evidence that incidents were discussed at clinical and practice meetings. The practice had a system to manage medicines safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) which included a policy reviewed November 2024, and a log to record alerts. Alerts were disseminated to the required members of the team and where action was required, searches were conducted of clinical records to identify patients who may be affected. Alerts and any action taken was stored centrally so that all staff could access. From a sample of patients’ records we reviewed, we found action had been taken on alerts received, for example: Our remote GP Specialist Advisor (SpA) completed remote searches of the practice’s clinical system which included reviewing the management of an alert related to medicines which may cause a risks of non-melanoma skin cancer. The search identified 5 patients taking this medicine and we reviewed all 5 patients’ records. We found all patients had been informed of the risk before our assessment. When things went wrong, staff apologised and gave patients honest information and suitable support. We noted an open culture in which all complaints were highly valued as being integral to learning and improvement. The practice had a complaints policy in place which clearly outlined the complaints process, we also saw a and a duty of candour policy. We noticed that although the complaints policy detailed who patients could contact if they were dissatisfied with the outcome of their complaint, in all 3 complaints we reviewed this information was not provided. When we raised this with the practice, they informed us all future responses would include this information. The practice kept a record of all complaints received and reviewed this for any themes/trends and action taken as a result of complaints.

Patients did not raise any concerns regarding safe systems of care operated by the practice.

The staff we spoke to were all aware of care pathways, including referrals and taking on care of those patients who had been discharged from other services. Leaders at the service shared relevant information with staff in team meetings.

The service had processes in place to ensure that referrals and discharges were managed quickly. There were also systems in place to ensure that where care was shared, information was shared between organisations, for example where blood tests and monitoring were undertaken by another organisation.

We saw systems and pathways were effective. We saw a referral policy, and pathology policy reviewed October 2024. All blood results were processed on the same day.

Evidence reviewed showed that care and support was planned and organised with people, together with partners and communities in ways that ensured continuity. The views of people who used the service, partners and staff were listened to and taken into account.

We didn’t receive any concerns about safeguarding from people using the service.

All staff knew who the safeguarding lead was. Clinical staff had regular had discussions during clinical meetings. We saw the practice had safeguarding registers for both adult and children. We saw safeguarding polices had been reviewed in October 2024. The practice often used searches to follow up patients who did not attend appointments.

The service worked with other agencies to support patients and protect them from neglect and abuse. Staff took steps to protect patients from abuse, neglect, harassment, discrimination and breaches of their dignity and respect.

We saw records that most staff had completed safeguard training to appropriate levels for their role. Before we started the assessment the practice informed of us that they were aware of issues with staff files/documentation. They explained there had been a significant event and knew that all staff files did not have the necessary documentation, but had an action plan and was working at making sure all files were updated.

The service had systems, services, and processes to keep, people safe and safeguarded from abuse. A review of patient records found the practice had a system to highlight vulnerable adults and children to staff. The leaders submitted safeguarding children and vulnerable adults’ policies. Both polices were last reviewed in October 2024, which provided information for staff to follow to enable the safe response to a safeguarding concern.

We didn’t receive any concerns about involving people to manage risk.

Leaders told us that staff were informed in managing risk, and that standing items such as safeguarding and incidents were discussed at all meetings. Staff reported that they were included in risk management, and that they were happy to report when things went wrong

There were systems and process in place for risks to be identified, reviewed, and managed. We saw risk assessments, certificates, for example for portable appliance testing, calibration of equipment, Legionella, the lead GP explained he had regular communication with the building manager due to the ongoing refurbishment which was happening at the time of the assessment.

Leaders told us that there had been steady growth of the service list size over the last few years, and they were working with the landlords/building management, to review the current premises and look at ways to improve and expand facilities. During the assessment the building was undergoing refurbishment work to increase clinical space to meet the needs of the growing population.

Staff at the service were aware of where all emergency equipment was stored. They also knew how to manage spillages if these occurred. Leaders at the service were able to detail the policies and procedures that were in place to ensure that the environment was safe.

The practice was situated in a purpose-built building shared with two other GP practices and other health services. We observed that the clinical rooms, and offices used by the GP practice were fit for use. At the time of the assessment the practice was undergoing a refurbishment. All equipment had been checked and calibrated as required. The GP practice had a range of emergency medicines and equipment (such as a defibrillator and oxygen) in place to ensure that emergencies could be safely managed.

During the assessment, we reviewed the provider’s premises safety processes. The service had undertaken a full range of risk assessments to ensure that the environment was safe, including premises, and health and safety. Where there was learning from these risk assessments, we saw that the service acted quickly to address any specific issues raised.

We didn’t receive any concerns about safe and effective staffing.

Staff reported that there was a shortage of staffing at the service. Leaders were aware. They told us over the last 12 months they had issues with the recruitment and retaining managers. They explained they had started recruiting staff with a view for new staff to join in January once the refurbishment works had finished and there was more space for staff.

The service had a recruitment policy, last reviewed in September 2024. During the assessment we reviewed 6 staff files and found that there were gaps in some staff files; for example 3 files did not have signed contracts, 1 file did not have a CV, 3 files did not have induction check list, 2 files did not have appraisals. Before we started the assessment the practice informed of us that they were aware of issues with staff files/documentation. They explained there had been a significant event and knew that all staff files did not have the necessary documentation, but had an action plan and was working at making sure all files were updated. All staff whose files we checked had Disclosure and Barring Service (DBS) checks done.

We received no specific feedback in this area.

All staff knew who the lead for infection prevention and control was, the service carried out regular infection prevention and controls checks of the premises. In addition, staff carried out daily checks of the clinical rooms they worked in.

Clinical rooms were clean and well equipped. Leaders told us that they had implemented cleaning schedules at the service, and regular monitoring of cleanliness was in place.

Staff had completed an infection prevention and control audit in September 2024. The service had acted on any issues identified in the infection prevention and control audit. The provider ensured that facilities and equipment were safe and that equipment was maintained according to manufacturers’ instructions. There were systems for safely managing healthcare waste. The building manager completed a legionella risk assessment of the service February 2024.

We didn’t receive any concerns about medicines optimisation.

The leaders explained there was a process for monitoring patients’ health in relation to the use of medicines including high-risk medicines (for example, warfarin, methotrexate and lithium) with appropriate monitoring and clinical review prior to prescribing. Staff told us they had a system in place to ensure the safe prescribing of patient’s repeat medicines. Staff explained the systems they used to monitor vaccines, emergency equipment and medicines.

Staff received regular training on medicines management, and felt confident managing the storage, administration and recording of medicines. Staff had the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions). Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

Medicine management was effective. Expiry dates of medicines were monitored, recorded and all in date, however we did identify that the practice did not stock one emergency medicine and had not undertaken a risk assessment. The practice was also doing monthly checks for reviewing emergency medicines and equipment; however, the Resuscitation council recommends a minimum of weekly checks. Fridge temperatures were recorded daily, and no temperatures had gone out of range.

We reviewed the cold chain processes and found the recording of temperatures were well documented they were being monitored and recorded daily. We also found the vaccine fridge was clean, however the practice was using the bottom of the fridge to store stock which meant air was not able to circulate.

Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments

The service had a system in place to monitor the storage of medicine. The service had put systems in place to monitor the safe administration of patients’ medicines, the prescribing of repeat medicines and the monitoring of emergency medicines. The service has systems in place to monitor the temperature of vaccine fridges. The provider did not stock any controlled drugs.

As part of our assessment a number of set clinical record searches were undertaken by a CQC GP specialist advisor. These searches were completed with the consent of the provider, and to review if the service was assessing and delivering care and treatment in line with current legislation, standards and evidence-based guidance. We found that medicines were being prescribed safely and monitoring was appropriate overall. Our clinical record searches found safe management and monitoring of high-risk medicines and people with long-term conditions. We found the service had completed 485 annual medicine reviews in the last three months. There was a programme of regular clinical auditing of prescribing that focused on improving care and treatment.