My Specialist GP

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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

There had been improvements in the provision of safe systems since the previous inspection. We found the service was clean and well maintained. The GP's at the service assessed risks to patients, acted on them and kept good care records. The staff had the skills and received relevant training to protect patients from abuse and harm. Staff supported patients to make choices that balanced risks of harm with positive choices about their lives. We assessed that the provider made necessary improvements and requirements relating to the regulation surrounding safe care and treatment were now being met.

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.

Patient feedback indicated people had positive experiences of using this service. They said the clinicians were knowledgeable in all aspects of the treatment, were caring and provided clear information about the treatment offered.

The feedback received demonstrated the provider had reflected on the last inspection and made the required improvements to delivery of safe care. Significant events were reviewed and discussed at the clinical meetings to share learnings and to improve processes. Staff worked within a no blame culture that promoted learning. Staff reported incidents or errors and understood the duty of candour policy.

The practice had a system to act on central alerting system (CAS) information and alerts issued by the Medicines and Healthcare products Regulatory Agency (MHRA). There were processes in place to enable learning to be shared with relevant staff to reduce the risk of repeat issues.

Patients were referred to appropriate services as required. The potential for onward referrals was discussed as part of the consultation. We noted the service was now able to directly make cancer referrals to secondary care onto the NHS cancer pathway and did not have to go through the NHS GPs. The improved process enabled faster access and improved continuity care for people.

Feedback from staff demonstrated there were systems in place which ensured safety and continuity of care for patients. Patients were signposted to alternative services on presentation of clinical symptoms in line in line with protocols and up to date evidence-based guidance. Patients could be referred to appropriate private specialists or their own GPs.

We did not receive any feedback from partners as part of this assessment.

The service had a process where all cancer referrals and diagnosis were recorded as significant incidents on to the log, to ensure proper follow up by the administration team at the service. Staff demonstrated a clear understanding of the process for handling urgent referrals and were able to explain their responsibilities in following up to ensure that patients had received and attended their appointments. The service had a system in place to retain medical records in line with Department of Health and Social Care (DHSC) guidance in the event they ceased trading.

All staff received training for safeguarding adults and children that was relevant to their roles. They were aware of who the safeguarding lead was and understood who to contact if they needed further guidance or to make a referral.

The service had systems to safeguard children and vulnerable adults from abuse, this included safeguarding policies and procedures that guided staff on how to raise safeguarding concerns to the relevant authority.

People were involved in decisions about their treatment and the records indicated any procedure was fully explained to patients before it went ahead. The clinician discussed all possible risks and recorded this in each patient’s notes. People were given time to consider if they wanted the treatment to go ahead. People were given aftercare information, and the staff made a follow up appointed for anyone who had a minor surgery at the service.

The clinicians prescribed, administered or supplied medicines to patients and gave advice in line with legal requirements and current national guidance. Where there was a different approach taken from national guidance there was a clear rationale recorded in patient notes for this which protected patient safety.

The service carried out audits to ensure prescribing was in line with best practice guidelines. For example, the antibiotic prescribing audit reflected on the local guidelines and NICE treatment protocols. We noted that patient records included clear reasons for providing the treatment and when this would be refused. All relevant staff were trained in basic life support and the service was equipped to manage medical emergencies. We found that there was a process in place for checking emergency equipment, and the checks of the expiry dates of medicines were effective.

Staff told us they had the equipment required to perform their roles and the information they needed to deliver safe care and treatment. The clinicians had adequate knowledge of the patient's health, including any relevant test results, and their medical history.

We saw that patients were cared for in a safe environment that was designed to meet their needs. Health and safety, and fire risk assessments were carried out by the practice and remedial actions were being monitored and completed. Facilities, equipment and technology were well-maintained and consistently supported staff to deliver safe and effective care.

Systems were in place to detect and control potential risks in the care environment and there was oversight relating to health and safety. We noted equipment was tested and maintained regularly, and risk assessments were carried out with identified actions and recommendations followed up or monitored. For example, there was routine checking of emergency safety equipment. The service conducted safety risk assessments such as fire and legionella (a term for a particular bacterium which can contaminate water systems in buildings). The practice’s health and safety policy ensured risk assessments were completed, and any actions are implemented.

Feedback collected by the service showed that patients valued the advice, guidance and treatment they received from the consultants at the service.

Staff told us the practice ensured they continued to remain competent to undertake their roles. They felt supported and spoke positively about how training opportunities were become competency in their roles.

Training records confirmed that staff’s mandatory and required training was up to date. We reviewed recruitment records for 2 new staff who had joined the service since the last inspection. We found recruitment checks were carried out in accordance with regulations. This included Disclosure and Barring Service (DBS) checks, immunisation records and appraisal records. There was evidence of supervision and appraisal for staff such as to show they received the support they needed to deliver safe care.

Patient feedback raised no concerns about infection prevention control.

Training in infection prevention and control (IPC) was provided. The training matrix showed most staff had IPC training.

We observed the premises to be visibly clean and tidy and the clinician was following IPC guidance. We found systems in place for cleaning of the clinical room and management of clinical waste.

We noted that practice had policies in place for infection, prevention and control which was accessible to staff and staff are aware of the action to take. For example, in the event of a sharp injury. All staff had completed infection prevention and control training and were aware of processes to follow to ensure clinical specimens were handled safely.

Patient feedback collated by the provider indicated no indication of concern in this area.

We found that since the last inspection the prescribing practices were monitored, overseen and audited. We saw evidence that best practice was shared during clinical meetings to provide consistent standards of care. However, we noted that some of the clinical audits did not indicate the aims and the impacts the audit had on the quality of care and outcomes for patients.

During our site visit, we found certain areas for improvement. The nurse used patient group directions (PGDs) to administer medicines. (PGDs provide a legal framework that allows some registered health professionals to supply and/or administer a specified medicine(s) to a pre-defined group of patients, without them having to see a prescriber.) We found the PGDs were not completed appropriately and there were gaps in signatures, auditing, and compliance with national standards. After our site visit the provider sent us evidence of immediate improvements made, and a completed review of all PGD authorisations.

We saw that the controlled drug prescription stationary was stored securely in a locker with only few clinicians having access to it. However, the prescription stationary storage process needed some improvements, i.e. blank prescription forms needed review to ensure a clearer audit trail. After our visit, the provider sent us evidence of immediate changes and improvement, including process and leadership oversight. We noted clinicians supported appropriate antimicrobial use to optimise patient outcomes and reduce the risk of adverse events and antimicrobial resistance. Prescribing data reviewed as part of our assessment confirmed this. We reviewed a sample of patient prescribing records to check for safe practices. We noted that the reviewed records included advice on medicines in line with legal requirements and current national guidance. Where there was a different approach taken from national guidance there was a clear rationale recorded in patient notes for this that protected patient safety. Since the last inspection, staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes. However, a few patients were who were being treated for MCAS (Mast cell activation syndrome) were prescribed Benzodiazepines and Z drugs (sedative-hypnotic medications) and it was not always clear whether patients had been informed of the risks of addiction or that there had been an attempt to wean these patients off the drug. This was immediately actioned by the practice after the assessment and provider had made a decision to discontinue repeat prescriptions for patients with Mast cell activation syndrome with a focus on safety and compliance with clinical standards.