Wood Lane Medical 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

- There was a system in place to learn and make improvements from significant events was effective. - The practice monitored and reviewed safety using information from a variety of sources. - The practice prescribing for antibiotic, hypnotic and anti-anxiety medicines was the same or slightly below the national average for prescribing of these types of medicines. - Clinical searches undertaken by the inspection team identified that the practice monitoring of patients (with known clinical conditions) did not always correspond with national guidelines.

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 national GP patient survey carried out from January to March 2023 had 120 responses. Although no specific questions were asked about learning culture, the survey found 81% of patients stated the healthcare professional was good at listening to them, and 91% of patients stated they were involved as much as they wanted to be in decisions about their care and treatment. In addition, 95% of patients had confidence and trust in the health care professional they saw or spoke to. This figure was comparable to scores obtained by other local GP practices whose patients were asked the same question regarding trust and confidence in care professionals. The practice had not carried out their own patient survey but reviewed their Friends and Family Test (FFT) results, which found between February 2023 and January 2024, that 33 out of 42 respondents said they were unlikely to recommend the practice. The (approximate) current number of patients listed as registered with the practice is 10,600.

We noted the provider kept a record of incidents and significant events. The provider was able to evidence to the inspection team a recent significant event, which showed that the provider had in place a system to deal with and act upon significant events. The assessment and inspection team were informed that incidents are discussed at next practice meeting following the incident/event. Meeting minutes are issued to ensure all staff were aware of incidents that had occurred and the steps the practice had put in place to mitigate any reoccurrence of the event/incident. The practice monitored, reviewed and responded to complaints. Leaders described a system for recording and acting on safety alerts.

We saw the record of recent recorded significant events which had occurred in the month prior to our assessment. We reviewed three sets of meeting minutes (October and November 2023 and January 2024) provided by the practice, however we could not see any minuted discussion relating to significant events. The inspection team therefore could not verify that learning from significant events/incidents were discussed at the monthly practice team meeting following the recorded event/incident, despite being told that this discussion occurred. As part of our inspection, clinical record searches were undertaken by a CQC GP specialist advisor. These searches were visible to the practice. We reviewed 5 patient records who may have been affected by a Medicines and Healthcare products Regulatory Agency (MHRA) alert. These alerts relate to recalls of medicines as well as new or revised prescribing information of medicines. Our CQC GP specialist advisor looked at a specific medication prescribed to manage conditions associated with the bladder. We conducted this search to ascertain if the practice was correctly monitoring patients on this medication, focusing on evidence that monitoring occurred to ensure that the patient’s blood pressure remained within an acceptable range to prevent uncontrolled hypertension. The five records we looked at, found that four records did not display that the required correct monitoring for patients on this medicine had taken place. We spoke with the lead GP at the practice regarding our findings relating to this clinical search on the day of the assessment. The following day, the practice provided the inspection team with an explanatory note of what actions they had taken in relation to all but one of the patients identified as part of the search.

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.

Leaders explained there were processes for monitoring patients’ health in relation to the use of medicines, with appropriate monitoring and clinical review prior to prescribing. This included high risk medicines (for example, warfarin, methotrexate and lithium). However, we found that some processes were not always effective, and this was identified during our remote clinical records searches. Staff told us that there was a system in place to ensure the safe prescribing of patients repeat medicines. Staff were able to explain the systems used to monitor vaccines, emergency equipment and medicines kept on site, so that they were fit for purpose. At the time of this assessment, in addition to GP’s, the practice had one independent nurse prescriber and three clinical pharmacists who were able to prescribe medication for patients (within their scope of knowledge).

The practice held on site a range of appropriate emergency medicines; however, these did not include a medicine for children who may experience croup. Medicines held on site were monitored regularly, and risk assessments had been undertaken to ensure that the medicines held were fit for purpose and in date. In addition to the emergency medicines, the practice also held oxygen and a defibrillator, which were also regularly checked. Blank prescriptions were kept securely, but additional activity would be required to ensure the practice monitoring was in line with national guidance. Appropriate authorisations were in place for non-clinical members of staff to administer medicines to patients when required.

In advance of our remote assessment and onsite inspection we asked the practice to submit policies and procedures for the inspection team to review. In relation to the management of medicines, we viewed practice policies and procedures for medicines reconciliation and repeat requests of medicines. Policies we viewed had either been created or reviewed in early February 2024. Although the GP partner told us the practice had completed medication audits, we did not receive evidence of recent audits of medicines for antibiotic or opioid prescribing. In addition, we did not see evidence of GP-led audits/checks conducted on the prescribing of medicine completed by the independent prescribers.

As part of our assessment/inspection, our CQC GP specialist advisor undertook clinical record searches. These searches were visible to the practice. We found that clinical monitoring at the practice was appropriate in all but a small number of areas on the day of our assessment. We undertook a search of patients taking a high-risk medicine, aldosterone. This medicine is known as a diuretic or a "water pill" and is used for the treatment of high blood pressure or heart failure. We sampled records for 5 of 15 patients and found two patients were overdue their monitoring. Another clinical search identified 108 patients taking pregabalin. This medicine is used to treat epilepsy, anxiety and nerve pain. We sampled 5 of 25 patients identified as possibly not having the correct monitoring and found three patients were overdue required monitoring. We found the practice had completed 832 annual medicine reviews in the last three months. We reviewed a sample of five records and found one did not have sufficient information regarding the review contained within the patients record. Similarly, prescribing of specific antibacterials (co-amoxiclav, cephalosporins and quinolones), was also in line with the national average for prescribing during the same period of October 2022 to September 2023. Between the 1st July to 31st December 2023, medicines data demonstrated that medicines prescribed at the practice for uncomplicated urinary tract infection and the total number of prescribed medicines to treat pain (per 1,000 patients), were in line with the national average for prescribing. We spoke with the lead GP at the practice regarding our findings relating to this c