Birchwood 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

We assessed a total of 2 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 good. Our rating for this key question remains good. We found safety was a high priority. There was a culture of learning from incidents and complaints and staff took concerns seriously. Reported events, incidents and complaints were investigated and changes implemented to reduce the likelihood of them happening again. There were safe and secure systems in place to manage medicines.

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.

People’s feedback supported that there was a positive culture surrounding safety and learning. People felt their views mattered to the provider and people felt they were responsive to concerns and feedback they gave. The Patient Participation Group felt valued by the provider and that the provider was open and honest with them regarding their service.

Reporting of significant events was encouraged amongst staff and learning was shared with all staff to aid improvement through various staff meetings. Staff felt well supported and cared for. They felt that providing a safe environment both for staff and patients was a priority for leaders. We saw evidence of appropriate staff supervision and the provider implemented daily sessions for case discussion, allowing staff opportunities to seek support and learn from others.

The provider had robust systems in place for reporting significant events and managing complaints. Significant events were well documented and followed a clear process. Complaints were sensitively managed. There was effective oversight of the complaints process and they were responded to in a timely and comprehensive manner. Learning was shared with trainees within the practice and there was regular opportunity to learn from others and seek support. Medicines and Healthcare products Regulatory Agency (MHRA) alerts were appropriately managed. The practice had clear systems in place to manage both current and historical alerts. Detailed policies and procedures were in place to support a safe learning culture.

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.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.  On the whole, 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. However, we received mixed feedback from care home representatives, relating to the repeat ordering process, with some telling us it worked well while others told us they experienced delays.

Staff received regular training on medicines management, and 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.  Staff found colleagues supportive and approachable, and they told us communication across the practice was excellent and they were kept informed. Clinical pharmacy staff were involved in clinical meetings where prescribing and medicines management were discussed regularly. Regular searches and audits were in place to ensure the practice delivered timely reviews. Leaders and staff told us that regular reviews and feedback to staff with a prescribing qualification was given to ensure medicines were prescribed in line with current guidance. Staff explained how they monitored the fridges and room temperatures where medicines were held within the practice on a daily basis. Staff and leaders told us they had systems and processes in place to support the safe prescribing of medicines.

We saw that staff managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.  We observed via the practice 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.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. Prescription stationery was managed appropriately. 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. There was a process for the safe handling of requests for repeat medicines and evidence of effective structured medicine 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 informal and formal clinical supervision, 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. Cold chain and medicines storage policies were in place with medicines and vaccines being stored within the recommended temperature range. The practice had procedures in place to ensure appropriate emergency equipment and emergency medicines were available and were checked regularly.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment showed that the number of antimicrobials issued by the provider was higher than local and national averages. The practice were aware of this and had identified this was due to the number of GP registrars at the practice. They had taken action to address this through education and audits which had resulted in a reduction of antibiotic prescribing over the last 12 months. There was an ongoing programme of regular clinical auditing of prescribing that focused on improving care and treatment. 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. High quality structured medicines reviews using templates were being carried out with all medicines being discussed and documented discussions around compliance and any side effects. We saw evidence of monitoring requirements being checked when doing medicines reviews and tests being arranged where needed as well as medicines being adjusted or changed as necessary, for example to address side effects.