The Humbleyard 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 assessed a total of 8 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was Requires Improvement. Our rating for this key question has improved from Requires Improvement to Good. Action had been taken since our last inspection such that when things went wrong, staff acted to ensure people remained safe. Managers investigated all reported incidents and shared learning to reduce the likelihood of them happening again. Action had also been taken such that the practice now had systems in place to ensure the safe management of Controlled Drugs. Systems for sharing learning from safety alerts had also improved although we noted that some relevant staff were not included in alert communications. The practice had systems, practices and processes to keep people safe and safeguarded from abuse (although we identified some training gaps). Appropriate standards of cleanliness and hygiene were being met (although auditing arrangements were not always working effectively).

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 told us that if they felt the need to raise concerns, they had confidence that staff would treat them with compassion and understanding.

Managers encouraged staff to raise concerns when things went wrong. We saw evidence that during staff meetings, the whole team discussed and learnt from clinical issues. Most staff felt there was an open culture and that safety was a top priority. They gave examples of where learning from incidents had led to safety improvements.

Action had been taken since our last inspection such that the provider had processes for staff to report incidents, near misses, safety events and to support learning. There was a system to record and investigate complaints. We saw evidence of how learning from incidents resulted in changes that improved patient safety.

People told us that their views were routinely listened to and taken into account (for example regarding referral and treatment options). They spoke positively about how the practice expedited and monitored referrals.

Staff across clinical and non-clinical teams were aware of the practice’s process for making referrals and we were told of a collaborative, joined-up approach towards referral tracking.

The local Primary Care Network Pharmacy Lead told us the practice worked with partners to establish and maintain safe systems. They highlighted that communications were good and that GPs were routinely available to discuss any patient concerns.

Systems were in place to ensure safety and continuity of care was a priority throughout people’s care journeys. We saw evidence that the effectiveness of these systems was monitored and managed to keep people safe. For example, the practice routinely monitored workflow to ensure that incoming correspondence was appropriately acted upon in a timely manner. The practice also operated an urgent cancer referral protocol which detected if a referral was requested although we noted that this process was not routinely being audited.

Although people did not highlight any safeguarding concerns and had not accessed practice protocols in the past, they felt assured that if needed, the provider would take immediate action to keep people safe from abuse and neglect.

Staff confirmed the name of the practice’s safeguarding lead and there was a strong understanding of safeguarding at all levels and of how to take appropriate action. There were effective systems, processes and practices to make sure people were protected from abuse and neglect.

Joint safeguarding discussions were frequent and GPs were routinely available to discuss any safeguarding concerns. The local Integrated Care Board (an NHS organisation responsible for planning health services for their local population) told us there were effective systems, processes and practices in place to make sure people were protected from abuse and neglect.

The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse. Meeting minutes confirmed routine discussion of safeguarding matters with other health care professionals such as health visitors and district nurses. We also noted however, that some nursing staff had not received training to the appropriate level. Shortly after our inspection the provider forwarded an action plan outlining how this would be addressed.

People told us how clinicians routinely worked with them to manage risks (for example highlighting the potential risks of a particular medication or benefits of a particular treatment). People were informed about any risks and how to keep themselves safe.

Protocols were in place for dealing with various types of clinical risk. For example, patients whose condition deteriorated whilst at the practice, presented with immediate clinical risk or those who had missed an annual medications review or health checks.

We saw evidence of processes for managing risks (including those relating to safeguarding, missed medications reviews and health checks). Protocols were also in place to ensure that patients were to be able to access care or treatment by a GP or appropriate member of the practice team in line with their clinical needs. Risks associated with emergency situations were fully recognised, assessed and managed.

Leaders told us they planned to schedule biannual fire marshal meetings to discuss risk management and review evacuation drills. Staff told us they were satisfied with the health and safety arrangements within the practice.

People were cared for in a safe environment that was purpose built and designed to meet their needs. Facilities, equipment and technology were well-maintained and consistently supported staff to deliver safe and effective care.

The provider had systems in place to ensure that equipment, facilities and technology supported the delivery of safe care. For example, arrangements were in place to ensure that medical equipment was periodically calibrated. There were also effective arrangements in place to monitor the safety and upkeep of the premises (for example health and safety risk assessments; and routine servicing of firefighting equipment and fire alarm system). However, we also noted that at one practice location, a fire risk relating to the CCTV system being in close proximity to patient notes had yet to be actioned and emergency lighting checks were not being logged. When these matters were highlighted, the provider took action to address fire risks.

The national GP Patient Survey and CQC patient interviews highlighted that people were satisfied with staffing levels. People also told us that staff were qualified and had the skills needed to carry out their roles effectively.

Leaders told us noted how challenges regarding recruitment and staff retention continued to impact on the practice’s ability to deliver patient centred care. For example, we were told that the practice’s coding team would shortly be reduced due to staff leaving the practice. Leaders told us the practice had invested in new technology to manage this staffing reduction. Staff told us the practice ensured they continued to remain competent to undertake their roles. For example, through competency checks and by monitoring training needs. They felt supported and spoke positively about how training opportunities were available to further develop competency in their roles. We did note however some gaps in safeguarding training.

Records confirmed that staff had received up-to-date training in systems, processes and practices. Recruitment checks were carried out in accordance with regulations. Staff received the support they needed to deliver safe care (for example, through structured supervision and training).

People told us they did not have any concerns about the practice environment and that standards of cleanliness and hygiene were always met.

Staff had received infection prevention and control (IPC) training and were able to identify the practice’s IPC lead. Reception staff were able to explain the process for receiving and storing clinical specimens.

We observed that the practice environment was clean and that appropriate standards of cleanliness and hygiene were met.

We looked at infection prevention and control governance arrangements. Systems were in place to monitor staff IPC training. The practice also undertook regular IPC audits (for example covering the overall environment and consultation rooms). At one location however, although the IPC audit confirmed that infrequently used water outlets were flushed weekly to control a bacterium called Legionella which can proliferate in water systems, confirming documentation could not be located. IPC risk assessments had been completed but we noted that these had been designed for care home environments. Also, although a checklist of weekly cleaning responsibilities had been created, there was no record of cleaning schedules logs.

People who used the dispensary at the Hethersett and Mulbarton sites were able to get their medicines from 8:30pm – 1:00pm and 2:30pm - 5:45pm. Feedback from people was positive and we saw that they appreciated the dispensary staff. People told us that staff routinely involved them in reviews of their medicines and helped them understand how to manage their medicines safely. People knew who to contact if their condition did not improve or they experienced any unexpected symptoms.

Staff found colleagues supportive and approachable, they told us communication across the practice had improved since our last inspection but could be better to ensure they were kept informed. Dispensary staff held regular meetings with a GP and the practice’s Business Manager. All dispensing staff had received appropriate training and annual appraisals (although one had been delayed). Staff received regular training on medicines management. They felt confident managing the storage, administration and recording of medicines. Staff managed medicines-related stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

The dispensary was clean, tidy and well organised with only authorised people having access. Medicines stocks within the dispensary were secure, managed well, and expiry dates regularly checked, including vaccines, and controlled drugs. Medicines that required cold storage within the practice were being appropriately kept within temperature monitored fridges.

Standard Operating procedures were in place for dispensary activities and had been updated appropriately since our last inspection. The dispensary team processed information about people’s medicines in a timely manner and ensured it was updated. There were clear processes to deal with the supply of repeat medicines. The dispensary team worked closely with the pharmacist to ensure all medicine tasks were completed and any problems with medicines supply were dealt with appropriately. Dispensary staff recorded incidents and near misses and these were reviewed regularly. For example, we saw an example of learning following incidents where the medicines had been handed to the incorrect patient because of similar names, procedures had been put in place to minimise any reoccurrence. There were appropriate systems and controls in place for the management of Controlled Drugs. All emergency medicines were available, although a refrigerated medication used to treat low blood glucose had not been included in periodic expiry date checks. Action had been taken since our last inspection such that the provider had improved systems to manage and respond to safety alerts and medicine recalls..

The practice completed annual audits as part of the Dispensary Services Quality Scheme (DSQS). Current audits either finished or in the process of being completed ensured that people had received the correct information about their medicines such as steroids or anticoagulants. 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 consistent with local and national averages.