Watling Medical 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

The service had a good learning culture and people could raise concerns. Staff knew how to identify and raise concerns and managers investigated incidents when they occurred. People were protected, involved in decisions about their care and kept safe, and staff managed medicines appropriately. The process to manage safety alerts was not failsafe which we highlighted to the provider. This was updated and improved during the assessment process. Although staff received training and regular appraisals to maintain high-quality care, we found that not all staff had undertaken training at the right level such as safeguarding. This was addressed during the assessment. Not all recruitment files contained the relevant required information. Whilst return to work interviews were held, there was no formal feedback for staff returning to work after a long period of absence, to ensure they were competent and aware of any changes in working practice. The facilities and equipment met the needs of people, were clean and well-maintained but not all risks were identified and mitigated.

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.

Although the provider had processes for staff to report incidents, near misses and safety events these were discussed between the individuals involved on a need to know basis. There was no regular formal meeting with formal agenda discussing all things relevant to the practice such as incidents, safeguarding, practice risks, safety alerts, complaints, learning and feedback from patients and staff. There was no such meeting that included all staff, with minutes sent out and stored in a place that all staff could view at a later date if they were unable to attend. The process to manage safety alerts was not effective because there was no system for regular audit and review. The practice did not follow their own policy with regard to the management of safety alerts. They did not ensure all safety alerts were logged, reviewed, and actioned. They did not maintain records of actions taken in response to alerts and did not include safety alert management in staff training and induction as per their own policy.

However, there was a positive culture of safety based on openness and honesty and managers listened to concerns about safety and investigated any events. Lessons were learnt to identify and embed good practice and staff told us they felt that safety was a top priority. Managers encouraged staff to raise concerns when things went wrong.

The service collaborated 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 collaborated with other providers to deliver shared care when patients moved between services . Referrals and test results were managed in a timely way.

The service collaborated 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 the practice maintained a list of vulnerable people, working with other organisations to keep them safe and well cared for. However, not all staff were trained to appropriate levels. This was addressed during the assessment process and all safeguarding training was undertaken to appropriate levels for each member of staff.

The service collaborated 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. Staff could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

Contracts were in place to ensure the premises were maintained and there was a business continuity plan in place which was monitored and reviewed. However, the service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. For example, health and safety risk assessments and audits were undertaken but potential risks were not always identified and addressed. We found sharps bins that were not wall mounted and not risk assessed, oxygen kept inappropriately, wet floors in the waiting room and a dangerously slippery car park due to the weather conditions.

The service made sure they had the right amount of qualified 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. The learning needs and development of staff was managed appropriately through supervision and appraisal, and staff were working within their agreed areas of competence. However, not all recruitment practices were followed, and we found training of some staff was either not at the correct level or was not up to date. This included safeguarding training, mental capacity awareness for non-clinical staff, induction for staff returning to work and incomplete documentation for staff employed. We were told by managers that a supervision policy and programme was in place for physician associates. We spoke with the physician associates who confirmed they were supervised. The supervision policy stated that all supervision sessions should be documented and stored in personnel files but we did not see evidence of that. As part of the assessment process and prior to the site visit it was identified that physician associates were undertaking unaccompanied home visits which was against guidance. This was resolved and stopped before the site visit.

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 nurse was the designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, but risks relating to non-mounted sharps bins had not been identified. The practice took actions to mitigate any risks when we informed them of this during the inspection process.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened. Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff received supervision on medicines optimisation, and said they felt confident managing the storage, administration and recording of medicines. We saw that prescription stationery was managed appropriately and securely. The provider was proud of the way the practice managed and monitored the prescribing of antibiotic medicines. This was reflected in national reports which showed them to be lower than the local and national averages and evidenced good practice. There were protocols to ensure that medicines were prescribed safety and people received medicines reviews and monitoring. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment and we saw evidence of case studies that were discussed and learned from. However, some medicine reviews were simply coded and were not documented in detail which meant they could not demonstrate up to date required monitoring before issuing prescriptions.