Dr Michael Coggan

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

We reviewed 2 quality statements in the Safe key question – Learning Culture and Medicines optimisation. The scores for the other quality statements are based on the previous rating for this key question. There was a culture of safety and learning. Staff we spoke with told us they were encouraged to raise concerns and felt supported in doing so. Incidents and complaints were appropriately investigated. There was an effective system for reporting, recording, and learning from significant events, however learning from complaints were not always routinely shared with all staff. 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. The practice provides a dispensing service to their patients living in a rural location. We found this was appropriately delivered and well managed.

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.

The practice policies and processes were accessible to all staff to support their work. Staff and leaders had systems and processes in place to report incidents, near misses, patient safety and staff concerns. These demonstrated a commitment to the safety of the patient population. The practice had a significant events policy and a reporting process for staff to raise concerns. Risk management processes at the practice enabled the identification, recording, monitoring and review to prevent, mitigate and manage risks/incidents. There had been 7 significant events in the last 12 months, and we saw incidents were fully investigated. There was evidence that changes had been made as a result of identified learning. There was a learning culture at the practice, where staff were encouraged to report concerns to learn and prevent a recurrence of incidents in the future. The practice investigated the cause of incidents to identify areas for improvement and to prevent reoccurrences. There was a system to record and investigate complaints. The complaints we reviewed showed they were recorded, investigated and undertaken in a timely manner. People received an apology, and actions were taken. Lessons learnt were discussed with staff directly involved with complaints and with clinical members of the team however, complaints were not always shared with all staff to be used as a learning opportunity. When things went wrong, staff apologised and gave patients honest information and support. The practice had a complaints policy in place which outlined the complaints process. This was accessible to patients on the practice website. The provider encouraged audit as an outcome of learning from an event for example, a two-cycle audit to ensure patients over 65 years of age taking a non-steroidal anti-inflammatory medicine were taking a gastro-protective medicine.

Staff we spoke with told us they were able to raise concerns and, report when things went wrong. We reviewed minutes from meetings, which evidenced that clinical issues were regularly discussed between members of the team at the practice, and within the wider Primary Care Network, where applicable. Staff we spoke with told us incidents were discussed in team meetings to understand the actions and the learning. However, staff told us learning from complaints was not always discussed in these meetings. Staff we spoke with told us there was an open culture and they felt able and encouraged to raise concerns.

People told us they had enough time during their consultation to ask questions and feel involved in decisions about their care. They told us they felt safe receiving their care at the practice and that it was always clean and tidy. There was access for patients to a friends and family form in the practice and on the practice website to understand patient experiences. We noted the practice had received 9 complaints in the last year. We saw evidence they had all been investigated and patients were informed of outcomes. In the reception area we saw information for patients about the complaint's procedure was visible.

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.

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

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.

The practice completed annual health reviews for patients with long-term health conditions and those on registers such as learning disability, palliative care and safeguarding. These registers were reviewed regularly, and reports run to identify any on-going monitoring needs for patients. During the searches undertaken as part of the remote assessment we found effective structured medicine reviews were carried out. There was minimal evidence of any missed monitoring or reviews. The practice provided us with evidence that any missed monitoring found during the remote searches had been undertaken and added to their monitoring system. During the remote interview with the GP, they explained the regular reporting undertaken monthly to monitor the treatment and medicine reviews of patients. The practice has systems and oversight in place to monitor the appropriateness of non-medical prescribers and clinical supervision was documented. The practice had effective systems in place for the safe management of their clinical correspondence workflow. Accurate and up-to-date information about people’s medicines was available, when they moved between health and care settings. The practice had systems and processes in place to effectively monitor and manage patients’ high-risk medicines. Antibacterial prescribing was higher than expected, leaders were aware of this and had a plan in place to reduce prescribing when appropriate. Antibiotic/antibacterial resistance is driven by overuse of antibiotics/antibacterials and prescribing them inappropriately. Appropriate prescribing of helps to reduce the spread of antibiotic/antibacterial resistance. The practice had exceeded the 95% World Health Organisation (WHO) immunisation rates for all 5 required indicators. We saw 100% compliance in all indicators.

Patients we spoke with told us they were involved in regular reviews of their medicines. People spoke positively about the dispensing service provided by the practice, which supported patients living in a rural location.

The provider had effective systems and processes in place to manage and respond to national patient medicine and safety alerts. Leaders at the practice explained how this worked to assure patient care and treatment safety. Nominated staff members managed the process to determine which alerts required urgent action, patient records were reviewed, and treatment or medicine changes were made when applicable. During the searches undertaken as part of the remote assessment we reviewed two safety alert and found only 2 patients that had not received information or change of medicine resulting from an alert. The practice provided evidence of the work they had undertaken during the assessment, and the changes made to their own reporting system to ensure all patients were safe. The practice confirmed no harm had been identified for these 2 patients. Patient group directives (written instructions to help with the supply or administration of medicines) were in place and had been signed by staff and the authorising lead in line with national guidance. Prescriptions were stored securely, and a record of serial numbers was maintained. Cold chain and medicines storage policies were in place to manage potential risks for example, medicines and vaccines being stored within the recommended temperature range. Vaccines were ordered and stored in accordance with national guidelines and the practice had a process to monitor the temperature of medicine fridges. The practice held appropriate emergency equipment and emergency medicines which were checked regularly. There were appropriate arrangements in place for the safe management, use and oversight of controlled drugs.

Medicines were seen to be managed and stored safely and appropriately during our onsite assessment. The practice had systems and processes in place to effectively monitor and manage patients’ medicines which required monitoring including high-risk medicines. Staff showed us that emergency medicines held at the practice and the system to monitor stock levels and expiry dates. We were shown the medical oxygen and a defibrillator on site and systems the system to monitor and regularly check they were fit for use. Medicines were stored safely and securely with access to the areas where medicines are stored restricted to authorised staff. Medicine stocks were managed and disposed of appropriately. Records showed the processes were effective.

The staff told us there were appropriate systems for controlled drugs that were kept on the premises. We were shown written procedures for the safe ordering, receipt, storage, administration, and balance checks which were in line with national guidance. Staff explained how they monitored the fridges and room temperatures where medicines were held within the practice on a daily basis. Staff told us the procedure they followed if temperatures fluctuated outside the guideline for safe medicine storage. This involved contacting medicine manufactures to understand the medicine temperature tolerances. Staff showed that vaccines were appropriately stored, monitored and transported in line with UKHSA guidance to ensure they remained safe and effective.