Millrise 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

Safeguarding systems, processes and practices were in place. Staff had received safeguarding training relevant to their role and most were aware of the safeguarding leads. Staff were able to share examples on what would constitute a safeguarding concern although some staff told us they were not confident in responding to safeguarding concerns or how they accessed the policy. There was a system for recording and acting on significant event and analysis (SEA) but not all staff were aware of the outcomes. Recruitment checks were not carried out in accordance with regulations. Some staff felt there were not enough staff to provide safe, high-quality care with a lack of systems in place for sickness and busy periods. Some staff had left the practice and vacant posts had been advertised. Most staff were up to date with essential training although some considered they would benefit from more role specific training to better equip them in their work. Not all staff had received an induction to their work or an appraisal. Clinical staff received supervision but were not sure how their competencies were assessed. Systems for the safe management of medicines, including emergency medicines and equipment and medicines optimisation, were in place. However, some processes required review. Medicines alerts were actioned, but risks had not always been discussed with patients during their medication reviews. Our clinical searches identified some omissions in the oversight of the monitoring of patients with long term conditions and those prescribed high risk medicines. The practice took immediate action to mitigate risks to these patients. Measures had been taken by leaders to action and address the areas for improvement in infection prevention and control (IPC). For example, they had employed a new cleaning contractor and addressed areas such as cleaning schedules in clinical rooms.

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.

The patient participation group (PPG) told us they were aware of the complaints process and shared an example of a complaint raised on social media that was discussed during a meeting held. They told us they found the practice open and honest and that patients could access information on how to make a complaint on site and on the practice website.

Staff understood their duty to raise concerns and report incidents, and most were able to share an example of a significant event but not all staff were aware of the outcomes as these had not been shared practice wide. Staff told us changes made by leaders were not always effectively communicated to the wider team and some felt they were not always listened to.

Complaints, significant events as well as compliments were used as quality improvement learning events. The practice had a complaint and a significant event policy which was accessible to staff. However, complaints and incident outcomes had not been shared practice wide to ensure learning and verbal complaints were not regularly documented. The practice shared information about their duty of candour on their website. The practice had a system to record and investigate complaints. Some of the complaint records we reviewed did not have documented outcomes, however, these were actioned during our site visit. Complaints we sampled were responded in a timely manner.

We received no specific feedback from patients regarding their experiences for this quality statement. However, we received concerns regarding the backlog of workflow documents, which may have impacted on patient care.

Staff shared examples of how they worked with the wider multidisciplinary team and referred patients to other services and how delays were monitored. Staff told us regular meetings were held with external agencies where vulnerable patients or those receiving end of life care were discussed and actions recorded. The practice worked with a range of partner agencies.

The CQC had received information of concern about a processes backlog hospital discharge summaries, letters, or test results. Our clinical review of the various task lists on the practice electronic system showed action had been taken to address this clinical risk. The practice governance lead had ensured this was added to the practice risk register and highlighted the risk and any delays to activity to mitigate the risk at the clinical governance meetings. Regular multidisciplinary team meetings were held to discuss patients who may be vulnerable. We reviewed 5 patient records where a do not attempt cardio-pulmonary resuscitation decision (DNACPR) had been recorded. We found patients’ views had been sought and respected. These were documented on recommended summary plan for emergency care and treatment (ReSPECT) forms or within the consultation notes when forms were not present. (The ReSPECT process creates a summary of personalised recommendations for a person's clinical care in a future emergency in which they do not have capacity to make or express choices). We found there was a multi-disciplinary approach to the palliative care meetings and documented. The practice was a veteran's accredited service and listed as a ‘Safe surgery.’ The practice had introduced a system which reminded clinicians at the end of their consultations to send tasks to the medical secretaries/admin team when a referral was needed. The practice had recently implemented a system to remind clinicians to complete referral documentation The practice engaged with their local PCN. The practice patients benefited from the additional staff members employed by the PCN as a collective of GP practices. The practice hosted the PCN board meeting every other month and attended monthly Integrated Care Board (ICB) meetings.

Staff told us they had not all been informed of the practice safeguarding lead. Staff demonstrated an understanding of the reporting and recording processes and were able to share examples of what they considered constituted a safeguarding concern and the action they would take in response.

The CQC had received no information of concern in relation to safeguarding from stakeholders such as Healthwatch and Staffordshire and the Stoke on Trent local Integrated Care Board (ICB).

The practice maintained a safeguarding adults and child register which was regularly reviewed. The practice had reconciled its safeguarding registers to that of the local safeguarding team. The practice had nominated safeguarding leads and administration support. Records had specific read codes that were current with alerts, icons, information regarding parental responsibility and family contacts. Not all staff knew how to access the safeguarding policy. The practice safeguarding policy was updated during the site visit to include contact details of the Local Authority and change of practice manager. A review of staff training records showed staff were up to date with their training and had received the required level of training appropriate for their role. The practice had completed a safeguarding electronic coding audit to ensure the systems they employ were effective and robust. Meetings were held with staff from relevant health and social care agencies to discuss vulnerable, frail, palliative and end of life patients

We received no specific feedback from patients regarding their experiences for this quality statement.

Staff were trained in basic life support and receptionists were aware of actions to take if they encountered a deteriorating or acutely unwell patient and had been given guidance on identifying such patients. Staff we spoke with were aware of the location of the practice emergency medicines and equipment. Staff told us they had requested additional education, knowledge support for patients who contacted the practice with potential suicidal ideation.

The practice held suggested medicines in the event of a medical emergency. We saw these were generally checked weekly, however, there were no formal deputising arrangements in place when the designated staff member was on leave/sick. The provider agreed to action this. A designated staff member was unaware of how to check the practice defibrillator, and this was fed back as an education action point to the practice leaders. The practice maintained electronic registers to support those patients who were vulnerable or had mobility or communication needs. Staff completed on-line training and had awareness of the Mental Capacity Act. Staff had the appropriate authorisations to administer medicines (including Patient Group Directions-PGDs or Patient Specific Directions PSD). The current nursing staff team however, were registered non-medical prescribers and did not require the PGDs. Our clinical searches identified areas for improvement, for example, asthma reviews when a patient received a steroid medicine, the electronic patient record alerts were not consistently actioned or completed. Our clinical searches reviewed potential missed diagnoses of diabetes. The findings showed the practice did not robustly follow the guidance on interval testing following a blood test that is used to diagnose type 2 diabetes and repeat the blood test within 2 to 12 weeks to formalise the diagnosis. The practice demonstrated that despite downloading pathology results due to an unknown electronic issue, these were not being saved into the patient’s records. This was reported to their IT provider. Interim measures were put in place of documenting the results into the consultation records. We saw evidence on the actions taken following the CQC clinical searches. The CQC GP Specialist Advisor considered the actions taken by the practice leadership as mitigation of the risks.

Policies and procedures were in place for the management of health and safety and staff were aware of how to access these. Fire marshals had undertaken additional training for the role. Systems were in place for the regular checks of fire alarms, extinguishers and fire evacuation procedures. Evidence provided by the practice showed equipment was regularly calibrated and electrical items were PAT (portable appliance testing) tested. We found the premises were well maintained. There were a variety of processes in place to ensure the environment was safe.

The PPG representative told us they had no concerns regarding staffing and were always able to obtain an appointment when they required. They felt the practice had adapted well during and post Covid 19 and considered all health services had struggled with staff shortages, recruitment and retention.

Staff told us there had been instability in the management of the practice over the previous 2 years causing inconsistent leadership for the team. They also told us there had been high levels of staff sickness and turnover of staff resulting in periods when specific tasks and duties had not been completed potentially putting patients at risk and existing staff under pressure. Most staff considered there were not enough staff to provide high quality care, particularly reception staff and GPs. Leaders acknowledged the concerns shared and told us they had recently recruited 2 new salaried GPs, who were due to join the team shortly negating the need for locums and bringing the total to 6 doctors. They told us in the last 6 months, they had recruited 3 new receptionists and had acquired the services of 2 other staff from the training hub to help with the reception and admin tasks within the practice. An interim practice manager was currently in post until the recruitment of a new practice manager had taken place. Staff told us they had received essential training. Some staff considered they would benefit from more role specific training to better equip them in their work. Clinical staff told us they received supervision, however, not all staff were aware of how their competencies were assessed. Staff told us they had not always received regular appraisals to review their performance and discuss their training and development needs. Staff told us a range of meetings were held but they would welcome more whole team meetings.

The provider had recruitment processes in place however, they were not working in line with their recruitment or safeguarding policies. For example omissions in the staff recruitment records including delays in obtaining satisfactory evidence of conduct (references), disclosure and barring service (DBS) checks and staff immunisations. We reviewed training records and found most staff had received essential training. Clinical staff had access to supervision to support them in their roles. There were meetings held including clinical meetings and these were recorded. There was no evidence of completed staff induction documentation available on the staff records we sampled.

Leaders told us that they had taken action to address areas for improvement in infection prevention and control (IPC) following the last CQC inspection in 2023. For example, they had employed a new cleaning contractor and addressed areas such as cleaning schedules in clinical rooms. Cleaning schedules were in place in addition to a newly appointed IPC lead. The IPC lead together with the interim practice manager had an IPC audit in progress and had identified a number of previous concerns had not all been actioned. Staff completed infection prevention and control training and were aware of the systems and processes to follow to ensure clinical specimens were handled safely in their role.

Clinicians told us they worked to current NICE guidance and local clinical protocols. Staff provided examples such as hypertension, gout and antibiotic guidelines

Appropriate arrangements were in place for the management of vaccines and for maintaining the cold chain. The practice had taken steps to ensure the vaccine fridges could not be accidently switched off. Referrals were made in line with evidence-based guidance. There was a system in place for reviewing and actioning patient information. For example, documents, laboratory test results and cytology reports however, this was not always effective. We found the pharmacists had workloads that required review. For example, the medicines tasks that ebbed and flowed daily to ensure that this workload was appropriately prioritised and achievable. Our clinical searches identified the practice was not always discussing risks with patients prescribed medicines that could cause birth defects. The practice took action to address our findings to ensure people were protected from harm. There was a process for the safe handling of requests for repeat medicines. Bins for sharps, clinical waste, medicines including a purple topped bin used for cytotoxic medicines were available and appropriately labelled.