Wensum Valley Medical Practice West Earlham Health Centre

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 practice provided care in a way that kept patients safe and protected them from avoidable harm.

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.

Patients we spoke with told us that when they have complained or given feedback about their concerns the practice told them they had investigated the issue and where possible had made changes. 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.

The practice staff told us they learned and made improvements when things went wrong. Staff told us they knew how to identify and report concerns, safety incidents and near misses. They told us and we saw evidence of learning and dissemination of learning to staff. Staff confirmed they could attend regular meetings held face to face and via a video link. Minutes were available for those unable to attend. Feedback we received from staff was positive about the learning culture within the practice.

The practice had systems and processes in place to record and manage any safety events in a timely way. They had a significant events policy and a reporting process for staff to raise concerns. There was a culture of learning with staff encouraged to report concerns for the whole practice team to learn. The practice demonstrated how they investigated, identified learning, and made any improvements that were required. We reviewed some ways the practice shared learning with staff such as team meetings, where minutes of meetings were taken which demonstrated a formal approach to managing learning. The practice had a complaints policy in place and information accessible to patients. The complaints we reviewed showed they were recorded, investigated and patients received a final response which included contact details of the Parliamentary Health Service Ombudsman if they wanted to escalate their complaint. Learning from complaints was identified and monitored to completion in a timely manner. The practice team had effective systems and processes in place to manage and respond to national patient medicine and safety alerts. Leaders and members of the medicines team at the practice explained how this worked to assure patient care and treatment safety. The employed pharmacists managed the process to determine which alerts required urgent action, patient records were reviewed, and treatment or medicine changes were made where appropriate. During the searches undertaken as part of the remote assessment we reviewed 1 safety alert and found 8 out 52 patients that had not received information or change of medicine resulting from an alert. We reviewed 5 of those 8 records and found all were only overdue by no more than 1 month. All patients had been contacted by the practice.

Patients and patient representatives we spoke with gave positive feedback in relation to referrals being made appropriately and being supported during waiting times to be seen by other services. Care home representatives gave an example of where a referral had been made appropriately.

Staff told us they had the information they needed to deliver safe care and treatment. Individual care records, including clinical data, were written and managed securely and in line with current guidance and relevant legislation. Staff told us reviews were undertaken by the practice to ensure that systems and pathway guidelines were adhered to.

We received positive feedback from partners we spoke with in relation to ensuring safe systems of care, including when patients are receiving care and treatment from a range of services.

There were systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment. There was a documented approach to the management of test results, and this was managed in a timely manner. Referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals.

Staff feedback highlighted that the practice cared for many patients with complex needs. Registered patients included a variety of vulnerable patients, some of which did not speak English as a first language, as well as patients with complex care needs including homeless patients, asylum seekers and refugees. The practice was also situated in a deprived area; data published by Public Health England showed that the practice was in a deprived area (2 of 10) with 1 being most deprived and 10 being least deprived. Staff told us they had a high number of safeguarding cases for their practice population. Staff told us they were aware of the practice and local safeguarding policies; they knew who the practice safeguarding leads were and how to report any concerns. There was evidence of, and staff confirmed they attended regular meetings where safeguarding discussions took place.

We received positive feedback from partners on how the practice’s proactive approach to safeguarding kept vulnerable patients safe (for example regarding referrals, assistance with following up patients and effective information sharing).

The practice had clear systems, practices and processes in place to keep patients safe and safeguarded from abuse. These were clearly communicated to staff. Partners and staff were trained to appropriate levels for their role. There were system alerts to identify vulnerable patients on their medical records.

Patients spoke positively about how the practice ensured care met individuals’ needs and enabled them to do things that mattered to them. We spoke with a member of the patient participation group who told us the practice were open to discussing any concerns raised in respect of safety.

Staff told us there was an effective approach to managing staff absences and busy periods. This had been improved with the successful recruitment of clinical and non-clinical staff. They told us emergency equipment and medicines were easily available and they were routinely checked. They confirmed they had received additional training such as recognising patients whose may have symptoms of deteriorating health.

There were effective arrangements for supporting patients to identify manage and mitigate risks. The practice had guidance for staff to identify and escalate risk to an appropriate clinician and staff had also received appropriate training. The practice had a clinical triage and on the day appointment team, where patients with urgent needs were triaged, responded to, and supported as appropriate.

Staff told us there were systems, practices and processes to keep patients safe. Issues identified from risk assessments and safety checks were escalated to the management team, logged and monitored to completion.

During our visit we looked at the 3 sites used by the practice. We observed the practices to be clean and uncluttered. Fire exits were clear and fire safety equipment easily available.

The practice demonstrated a proactive approach to using risk assessments to identify and mitigate risks. For example, we reviewed a sample of risk assessments which included health and safety, fire risk and pregnancy risk. Risks had been identified and actions taken to mitigate the risk. Where necessary, the practice liaised with the owner of the premises. The practice had arrangements to ensure business continuity in a range of circumstances, which included extreme weather conditions. The practice used digital services securely and effectively and conformed to relevant digital and information security standards.

Most patients told us they received support from staff at the practice in a timely way. They told us they found staff knowledgeable and well trained. Representatives from the Patient Participation Group told us they had no concerns about staffing levels and spoke positively about the recent appointment of a new doctor. Some patient feedback we received (3 out of 17 respondents) was negative regarding staffing levels and staff skills and or training.

Staff told us there was an effective induction system for temporary staff tailored to their role. There were enough staff to provide appointments and prevent staff from working excessive hours. This had been achieved by the recent recruitment of both clinical and non-clinical staff. There were on going plans to further recruit another GP to meet the demands of the growing practice population list. We received feedback from staff, either those we spoke with or via the staff questionnaire we sent. Staff who were responsible for specific clinical interventions, for example reviews of patients with long-term conditions, cervical screening, and childhood immunisation, told us they had received specific training.

The practice had clear processes and demonstrated that recruitment checks were carried out in accordance with regulations including for locum staff. All new staff received an induction programme which included role specific areas of work. An induction programme was also available for temporary staff and Primary Care Network employed staff who worked at the practice. The practice was able to demonstrate that staff had the skills, knowledge, and experience to carry out their roles. Staff who were responsible for reviews of patients with long-term conditions had received specific training. Staff had completed training deemed mandatory by the practice, which included for example, infection prevention and control, equality and diversity and safeguarding training, appropriate to their role. The majority of staff had undertaken learning disability and autism awareness e-learning and were in the process of arranging the face-to-face element of this training. The practice demonstrated they had clinical oversight of the prescribing competence of all clinicians. There was a regular review of their practice supported by clinical supervision or peer review, audits, and protected time for case review. Staff had access to regular appraisals.

Feedback we received from patients was positive in respect of the cleanliness of the environment.

We received feedback from staff, either those we spoke with or via the staff questionnaire we sent. The staff told us they were aware of who the leads were and had no concerns about the infection prevention and control (IPC) processes. There was a clinical lead for IPC who had protected time to ensure checks and improvements were made. Staff told us there were systems in place for dealing with specimens and bodily fluid spills. A full IPC audit was undertaken at each site and a combined action plan was in place. Where improvements were required, these had been actioned, or there was a plan in place. Discussion of IPC had been held in various meetings such as the regular nurse meeting.

During our on-site visit to each site, we observed the practices to be clean and tidy. We found systems in place for cleaning of equipment within the clinical rooms. The storage of medicines was managed appropriately. We did not identify any concerns relating to infection prevention and control.

The processes in place had ensured appropriate standards of cleanliness and hygiene were met. Staff had received training and had carried out a detailed infection prevention, and control (IPC) audit. They had systems to monitor actions identified had been completed. For example, the replacement of damaged chairs. The practice had a process of ensuring they had recorded the vaccination status of staff in line with current UK Health and Security Agency (UKHSA) guidance if relevant to their role.

Feedback we received from care home representatives was positive about their experience in respect of managing medicines. Records confirmed the practice was proactive in regular reviews of patients’ medicines. When acute medicines such as antibiotics were required, the practice organised these in a timely way. Patients we spoke with told us they were involved in regular reviews of their medicines.

Leaders and staff told us that new procedures had been implemented over the past months to ensure medicines were managed safely. Additional staff including a pharmacist with a prescribing qualification had been employed. Staff told us they had improved the recall system for patients and had worked cohesively to ensure every contact counted. Regular searches and audits were in place to ensure the practice delivered timely reviews. Clinical staff had received additional training and advice on completing templates and reviews documentation to evidence that all medicines had been reviewed. Leaders and staff told us that regular reviews and feedback to staff with a prescribing qualification was given to ensure medicines such as antibiotics were prescribed in line with current guidance. An area the practice had identified, and our searches confirmed needed further monitoring was to ensure patients who had been prescribed 2 or more doses of steroids were followed up in line with evidence-based guidance. The practice told us and showed evidence that their policy and learning to staff had been updated. Staff explained how they monitored the fridges and room temperatures where medicines were held within the practice on a daily basis.

The practice staff showed us via their clinical system and recall templates that they had systems and processes in place to effectively monitor and manage patients’ medicines, including medicines which required additional monitoring. Across the 3 sites the practice held appropriate emergency medicines, and risk assessments were in place to determine the range of medicines required. There was a system in place to monitor stock levels and expiry dates. Vaccines were appropriately stored, monitored, and transported in line with the United Kingdom Health Security Agency (UKHSA) guidance to ensure they remained safe and effective.

The practice had systems for the appropriate and safe use of medicines, including medicines optimisation. There was a process for reviewing patients’ health in relation to the use of medicines including medicines that require monitoring and systems were in place to ensure appropriate monitoring and clinical review prior to prescribing. The practice provided evidence prior to this assessment of their detailed approach to encourage patients to attend for their reviews. This included the various communication methods they used such as SMS messaging and telephone calls for those patients who failed to comply with the practice requests. There was a process for the safe handling of requests for repeat medicines and evidence of effective medicines reviews for patients on repeat medicines. Clinical staff approved all medicines added to the prescribing page before any were issued. Medicines prescribed in hospital were added to the clinical records. The practice demonstrated the process in place to ensure the prescribing competence of non-medical prescribers, there was regular review of their prescribing practice supported by clinical supervision or peer review, audits, and protected time for case review. The systems ensured that 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. Prescription forms were stored securely Cold chain and medicines storage policies were in place with medicines and vaccines being stored within the recommended temperature range. The practice held appropriate procedures to ensure 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.

As part of the assessment, we conducted searches on the practice clinical system and reviewed a selection of patients’ records. There was a process for monitoring patients’ health in relation to the use of medicines including medicines that require monitoring for example, warfarin, methotrexate and lithium. We reviewed some patient records and found there was appropriate monitoring and clinical review prior to prescribing the medicines for all patients taking these medicines. The practice had taken steps to ensure appropriate antimicrobial use to optimise patient outcomes and reduce the risk of adverse events and antimicrobial resistance. Regular reviews and feedback to staff was given to ensure medicines such as antibiotics were prescribed in line with current guidance. An area the practice had identified, and our searches confirmed needed further monitoring was to ensure patients who had been prescribed 2 or more doses of steroids within 12 months were followed up within an appropriate time frame. The practice told us and showed evidence that their policy and learning to staff had been updated. A regular monitoring search had been implemented to ensure the improvement was sustained. From our review of patient records we saw clinicians used their clinical decision making to reduce the quantities of medicines prescribed to further encourage patients to attend their reviews.