The Osmaston Surgery Also known as Dr I R Shand & Partners

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

There had been some improvements in the delivery of safe care and treatment since our previous inspection. Systems now supported learning from significant events, patients’ complaints and national safety alerts. The practice worked as part of a multi-disciplinary team to support vulnerable adults and children and processes for the management of safeguarding concerns were now in place. There had been a significant improvement in the management of emergency medicines and equipment. Health and safety risk assessments had been completed to mitigate potential risks within the practice. Referrals to specialist services were appropriate and there was a documented approach to the management of test results. An infection prevention and control (IPC) lead was now in place and IPC audits had been completed. Improvements had been made to the monitoring and prescribing of medicines that require monitoring. We found ongoing concerns in the quality statements for learning culture, safeguarding, safe and effective staffing, infection prevention and control and medicines optimisation. This resulted in a breach of regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We reviewed 2 complaints received by the practice and found that the practice's complaints policy had not always been adhered to. One complaint had not been responded to or investigated. The other had been investigated and responded to however, the patient had not been informed of their right to go to the Parliamentary and Health Service Ombudsman (PSHO) if they were not satisfied with the outcome of the practice's investigation. However, we found that patients were aware of the complaints process. The practice had received 15 complaints within the last 12 months. We reviewed the trends and found that 8 of the complaints related to poor telephone access to appointments. The practice was aware of this and were reviewing their telephone system.

Leaders told us they used incidents and complaints to improve systems and processes. Most staff were aware of the processes for raising and reporting a complaint or significant event. If they were not, they knew how to find the appropriate policies for support. Staff told us that learning from significant events was shared with staff through monthly team meetings and email notifications. If staff were unable to attend the meetings then minutes were available for them to refer to. Staff were encouraged to report issues of concern so they could be discussed and investigated.

Systems were in place to act on national alerts for example, patients prescribed medicines which may cause birth defects during pregnancy. A tracking log was maintained to record and monitor concerns and trends identified within the practice. There was a complaints policy and a significant events policy available within the practice and staff were aware of how to access these policies. The 2 significant events we reviewed had been fully investigated and learning from them was shared with staff. However, of the 2 complaints we reviewed, the complaints policy had not been adhered to.

The practice worked in partnership with the multidisciplinary community team. Minutes from these meetings showed that patients were involved in making decisions about their care and treatment. Where patients, did not wish to engage with these services for additional support, patients’ decisions were respected. Appropriate referrals were made to health and social care services as required. Patient comments received from Healthwatch were mixed. One patient had a good experience and outcome, and a referral to appropriate services had been made promptly. The other 3 patients felt their concerns had not been listened to or taken seriously.

Leaders told us they worked collaboratively with community staff to share information and provide additional support and access to services for patients when needed. Staff told us that there was a documented approach to the management of test results and this was managed in a timely manner.

Minutes from the multidisciplinary community support team meetings showed that the practice worked with external health and social care providers. The provider worked with the health visiting service to ensure children and their families received appropriate support. A representative of a care home, where the practice provided care and treatment, told us there had been improvements in the systems and care pathways between the home and the practice. They told us that a GP was in close contact with the home to discuss any issues as they arose. This ensured patients were seen in a timely manner following admission and their medicines were reviewed as required.

Systems had been put in place to enable the practice to attend monthly multidisciplinary community support team meetings to support adults and children who required additional support. We found that the provider had appropriate processes in place for the referral of patients to secondary care and specialist services.

We did not receive any feedback from patients regarding safeguarding concerns during this assessment.

Staff were aware of the processes to follow if they identified a potential safeguarding concern and how to access appropriate safeguarding policies for support. They told us they had completed safeguarding training for children and vulnerable adults and were aware of who the safeguarding leads were within the practice. Staff attended monthly safeguarding meetings within the practice and they knew how to locate minutes from these meetings. Leaders told us the children’s safeguarding register was discussed internally and externally as part of a wider multidisciplinary meeting. Leaders had set up a safeguarding task group to manage information relating to safeguarding.

The Integrated Care Board (ICB) shared their safeguarding assessment of the processes in place at the practice to safeguard children and vulnerable adults with the CQC. The assessment identified areas of good practice for example, clear lines of accountability for safeguarding. However, it identified areas for improvement for example, the need to embed processes for the induction and training of staff in safeguarding, improve policies to support safeguarding. The practice had an action plan in place to address these issues.

Policies to support staff in the safeguarding of children and vulnerable adults were in place and there was a system of review. There were named safeguarding leads within the practice and a system of identifying those patients with a safeguarding concern. Safeguarding meetings were held on a 3-monthly basis with the health visitor. Discussions took place around children with emerging health care needs, changes to the health visiting service, immunisation update, care navigation and future plans. Monthly community support team meetings were also held, to discuss the needs and support available to vulnerable adults. However, not all staff had completed safeguarding training at a level appropriate to their role.

Data from the national GP patient survey showed that the percentage of respondents who stated that the last time they had a general practice appointment, the healthcare professional was good or very good at listening to them was 74%. This was below the local average of 86% and the national average of 85%. Our remote clinical searches of patients’ records demonstrated that patients were given information about risks relating to their medicines to support them to make an informed choice of any additional action or precautions they needed to take. We received mixed comments from Healthwatch regarding patients trying to communicate their needs to health care professionals working at the practice. One patient had a good experience and outcome, as their needs were recognised and acted upon promptly. Other patients felt their needs had not been listened to or taken seriously and the attitude of the health care professional was dismissive.

Leaders told us that patients were discussed at monthly multidisciplinary team (MDT) meetings to provide an holistic approach to delivering care. The practice worked closely with the dementia specialist nurses to involve patients and families living with memory impairment. Leaders had reviewed the most frequent attendees to the practice over the previous 12 months and identified them as having multiple complex needs. Where required, referrals were made and patients’ needs were discussed at MDT meetings. Leaders shared examples of collaborative working and information sharing with community staff to provide additional support and access to services for patients when needed. Emergency department letters received by the practice were reviewed to identify patients who had been admitted to hospital with suicidal concerns. This group of patients were contacted by the practice, offered a GP appointment and a referral to the social prescriber for support. Staff shared with us examples of when they had acted on potential risks to patients. Staff were aware of where emergency medicines and equipment were kept in the case of a medical emergency.

The practice was equipped to respond to medical emergencies. Risk assessments had been completed to determine the range of emergency medicines held within the practice and a system to monitor medicine stock levels and expiry dates was in place. There was medical oxygen and a defibrillator on site and systems were in place to ensure these were regularly checked and fit for use.

Staff we spoke with told us they were trained in emergency procedures such as fire safety. They told us their induction process had included details of actions to take to promote fire safety and fire checks were carried out within the practice. A member of staff had attended additional training for their role as a fire marshal.

The facilities and premises were appropriate for the services being delivered. We found that the practice was clean, tidy and well maintained. The practice had made reasonable adjustments when patients found it hard to access services. There was ramped access for patients with mobility difficulties, dexterity or musculoskeletal conditions and patients with pushchairs. Consulting rooms on the first floor were accessible via the stairs, and reception staff asked patients if they needed to be accommodated on the ground floor when booking appointments.

Staff had completed fire training to support their own safety, and the safety of patients, in the event of a fire. A fire safety drill had not been undertaken since July 2023 but was planned for May 2024. The provider forwarded their fire safety log to the CQC following the assessment. There was confusion between what was recorded in the log and what leaders told us regarding the date of the last fire safety drill. We reviewed the fire safety log and found that the practice had identified concerns in response to the last fire safety drill and a significant event had been raised. The fire safety log identified a repeat drill was planned for 6 months time. There was no clear rationale for why there was a 6 month delay in repeating the drill in light of the identified potential risks to patients. We found the majority of environmental risk assessments had been completed in 2021. These had been reviewed and found to be satisfactory. There were also plans in place to review and amend the risk assessments in the near future. Control of Substances Hazardous to Health Regulations (COSHH) risks assessments and risk assessments for the storage of medical oxygen were in place.

Healthwatch shared 2 patient comments with the CQC where patients had commented negatively on the availability of staff. They commented that more GPs were required and there was a period of time when the practice was without a practice nurse.

Some staff stated that staffing levels remained insufficient especially within the reception and nursing teams and this had a negative impact on the needs of patients, in particular patients with long-term conditions. However, some staff told us that staffing levels had increased and staff rotas had been revised to ensure adequate staffing. Following our assessment, the provider sent us details of recruitment adverts that had been put in place to recruit more staff. Leaders and staff told us that staff completed a structured induction programme. We received mixed feedback from staff regarding training. A clinical member of staff told us they did not always feel supported to complete their essential training or professional development and had sometimes completed this in their own time. Leaders told us there was no expectation for staff to complete training in their own time. A skills analysis had been completed, which identified gaps within training. Most members of staff we spoke with told us they had protected time for learning and development. All of the staff we spoke with told us that they had received an annual appraisal. Staff told us that systems were in place to supervise and support staff working in advanced roles, for example non-medical prescribers.

There were policies in place to support the safe recruitment of staff and staff immunisation against potential health care acquired infections. We reviewed the records of 2 recently recruited members of staff and found appropriate recruitment checks had been carried out, including Disclosure and Barring Service checks and immunisation status. Confirmation of required recruitment checks for clinical staff provided through an employment agency had been provided for locum staff. Staff completed the majority of their training through an e-learning platform. Leaders had recently identified that the training system had been incorrectly set up so staff had not completed all the required training, in particular safeguarding at the appropriate level for thier role. Following our assessment the provider sent us a list of staff training requirements and told us this would be shared wilth all the necessary staff.

On the day of our on site assessment, we spoke with a patient registered with the practice. They told us that the practice was always very clean and tidy.

Staff told us they had completed infection prevention control (IPC) training and that an IPC lead within the practice had been identified since our previous assessment. Staff were aware of where to locate policies regarding IPC for support. We spoke with the new IPC lead within the practice. They told us they had met with the local Derby IPC team and could contact them for advice and support. The provider showed us evidence that the IPC lead had completed training to carry out this role. However, the IPC lead told us they felt they needed additional training to be able to fulfil this role effectively. They were not aware of any IPC audits completed in the practice and had not completed any themselves. They had however completed a handwashing audit. Reception staff told us they had access to spillage kits to deal with any bodily fluid spillages.

Infection prevention and control audits had been carried out within the practice. We found that actions had been taken to address the issues identified. We observed that the arrangements for managing waste kept patients safe. The Control of Substances Hazardous to Health Regulations (COSHH) risk assessments were in place for staff to refer to.

Following our inspection the provider sent us a record of the immunisation status for the 2 GP partners. However, the required blood checks to monitor that immunity to Hepatitis B had been acquired following a course of Hepatitis B immunisations, was not available. A risk assessment to mitigate potential risks had not been completed. There was a policy in place to support infection prevention and control and a named infection prevention and control lead had been identified within the practice to provide oversight in this area. The majority of staff were up to date with their immunisations or had appointments for vaccinations. There was also evidence of review of the policy over time.

The CQC received 22 complaints from patients prior to our assessment of which 2 related to challenges of obtaining prescriptions. During this assessment, we received feedback from 3 patients regarding medicines management which related to problems with the online repeat prescription ordering system which led to delays in obtaining prescriptions.

Leaders told us there was a system for recording and acting on safety alerts. Clinical staff we spoke with understood how to deal with these. Leaders told us alerts on the electronic patient records were used to inform staff when patients were prescribed high risk medicines. Leaders were aware that many medicine reviews were not up to date. When patients did not engage with medicine reviews, leaders told us there were systems in place to address this. A non-medical prescriber told us there were regular reviews of their prescribing practice supported by clinical supervision and auditing of the effectiveness of their consultations and prescribing.

Medicine reviews were carried out by both GPs and pharmacists. We found that repeat prescriptions were signed by an appropriate clinician before they were issued to patients. Staff now had the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions). Vaccines were appropriately stored and monitored in line with UKHSA guidance to ensure they remained safe and effective. When vaccines had been affected by a recent break in the cold chain, appropriate action had been taken by the practice. Blank prescriptions used in clinical rooms were kept securely, and their use was monitored in line with national guidance. However, systems to record and track other prescription stationery held within the practice were not in place. Following our assessment the provider sent us evidence of new systems they were putting in place. Our remote clinical searches showed that medicine reviews had not always been completed as part of a review of patients with long-term conditions.

There were policies in place to support medicines, management. For example, the monitoring of patients prescribed medicines that required monitoring and the management of Medicines and Healthcare products Regulatory Agency (MHRA) alerts. Our remote clinical searches showed that there was an effective process in place for monitoring patients’ health in relation to the use of medicines. Patients were given specific advice and guidance when prescribed medicines that could cause potential harm.

National prescribing data showed that the practice was effective in ensuring that antimicrobial prescribing optimised patient outcomes and reduced the risk of adverse events and antimicrobial resistance. The data showed that the practice positively managed the prescribing of medicines used to improve the quality of sleep. Data showed there had been a slight improvement in the practice’s overall prescribing of medicines since our previous assessment. Medicine optimisation information provided by the Integrated Care Board (ICB) supported the information held by the CQC. The ICB report stated that the GP partners were helpful and responsive to queries and that they were responsive to suggestions made by the ICB’s medicine optimisation team.