Great Barr 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

At the last inspection, we found that the practice safeguarding processes were not embedded, no risk assessments had been completed to identify potential risks to patients or staff and the practice could not demonstrate that individual care records were managed appropriately and safe management of medicines needed strengthening. At this inspection we found some improvements had been made, however there were still a number of areas that needed reviewing and strengthening to ensure risks were mitigated. The practice had taken some action to improve processes for safeguarding registers and infection control. However, we found medicines optimisation, the actioning of safety alerts, safe and effective staffing, fire safety risk assessments, health and safety risk assessments, monitoring of clinical tasks and referrals and learning from incidents and significant events had not been embedded to ensure people’s safety was integral to the care and treatment they received.

This service scored 41 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Information reviewed demonstrated that people had opportunities to provide feedback. Feedback and information was available on their website. People had fed back through the GP National Patient survey which showed lower than local and national averages that there was enough time during their consultation, they felt involved in decisions about their care and treatment and had confidence and trust in the healthcare professional they saw or spoke to.

Staff understood their duty to raise concerns and report incidents and near misses, however we found limited evidence to demonstrate that staff were involved in investigating significant events and complaints and learning was shared to mitigate risks. We saw no evidence that any actions or lessons learned was discussed in practice meetings. We saw examples of incidents and complaints that had been reported, but on speaking with staff they were unaware of what incidents had occurred. Staff told us they felt they were unable to raise concerns and report when things went wrong. Feedback from staff demonstrated that the practice's culture for identifying incidents and complaints, learning and improvement to continually identify and embed good practices needed strengthening.

The practice had a significant events policy which was accessible to all staff members, however due to the lack of communication that staff shared with us, we were unable to gain assurances that staff were supported in identifying and reporting significant events. We found no evidence to demonstrate that learning was shared with staff through practice meetings. The practice had a system in place to record and investigate complaints and we reviewed a random sample of complaints and found they had been responded to in a timely manner. The practice offered apologies to people, however we found no evidence to demonstrate that people's feedback was used to improve quality.

Information we reviewed during our inspection demonstrated that there was a backlog in referrals being actioned in a timely way. We saw evidence of feedback from patients during our inspection which showed a lower than average result compared to local and national averages. For example, 70% of patients stated that the last time they had a general practice appointment, the healthcare professional was good or very good at listening to them. The local average was 79% and the national average was 85%.

Leaders told us that clinicians made appropriate and timely referrals in line with protocols and up to date evidence-based guidance, however during the remote clinical review we found numerous outstanding tasks and referrals that had not been actioned, some dating back to March 2024. We were unable to gain assurances that there was an effective system in place to ensure all patient information which included documents, laboratory test results and referrals were reviewed and actioned in a timely manner. We received conflicting information from leaders on who had the responsibility for overseeing the process of tasks and referrals being actioned, with no clear pathway in place to ensure there were effective systems in place to monitor workflow and ensure all actions were followed up and acted on appropriately.

The provider told us that there were processes in place that was monitored and managed to keep people safe. However, we found limited evidence to demonstrate that regular meetings were held with community teams to ensure that people was managed safely and appropriately to maximise high quality care.

We found systems for ensuring the safety of care provided to people required strengthening. For example: We found outstanding referrals, tasks that had not been acted on, no clear oversight of who had responsibility for managing tasks and referrals. There was a lack of communication between leaders and staff to ensure roles were clearly defined and actions were taken in a timely manner to reduce the delays in people receiving the appropriate care and treatment.

The practice had a safeguarding lead for adults and children and policies in place to support staff in the event of a safeguarding concern. Staff we spoke knew of the policies and procedures available to support them and what to do if they had any concerns about a patient. We were unable to gain assurances that safeguarding concerns were discussed in practice meetings and that children and young people who were not brought to their appointments were followed up. Staff who had been given the responsibility for overseeing safeguarding processes told us that due to the limited time they were provided with, they were struggling to maintain clear oversight of the safeguarding systems at the practice. The practice held a safeguarding register, and clinical system alerts were used to identify patients who were at risk of harm or abuse. Staff were aware that these flags could indicate a potential risk.

We were provided with minutes of safeguarding meetings that had been held, however there was no evidence to demonstrate that safeguarding concerns were discussed as part of a multi-disciplinary meeting with community teams involved, two of the set of minutes that we reviewed had no information of who had attended the meetings. We were unable to confirm that the practice engaged with other agencies such as the health visitor and school nurse to support and protect adults and children at risk of significant harm.

There were policies and processes in place to keep people safe and safeguarded from abuse. We found training had not been updated for the safeguarding lead and for clinical staff that were newly recruited we found no evidence that their training had been reviewed. Following the inspection we received evidence to demonstrate that the safeguarding lead had completed training relevant to their role. The practice held a safeguarding register, and patient records we reviewed showed that they had been appropriately coded where safeguarding concerns had been identified. Clinical system alerts were used to identify patients who were at risk of harm or abuse. Records we examined showed that all staff had a DBS check in place. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.

We were unable to gain assurances that leaders worked with services locally to understand and manage risks. No evidence was provided that there were regular interaction with the primary care network and other agencies to work holistically so that care met patients' needs. The practice had registers in place to support those patients who were vulnerable or who had mobility or communication needs. We found gaps in staff training with basic life support not having been updated by both clinical and non clinical staff. Some administration staff had not completed sepsis awareness training, however staff were aware of actions to take if they encountered a deteriorating or acutely unwell patients.

We found that processes required strengthening to ensure risks were managed appropriately. For example: patients prescribed high risk medicines and those that had long term conditions. We found that some patients had not been monitored or followed up to ensure they were receiving the appropriate care and treatment. There were some processes in place to ensure the practice prioritised care for their most clinically vulnerable patients and patients were told when they needed to seek further help and what to do if their condition deteriorated. There were systems in place to support patients who face communication barriers to access treatment (including those who might be digitally excluded).

Leaders told us that that health and safety, security and maintenance of the building was regularly reviewed to ensure this was to a safe standard. A fire drill had been carried out in August 2023. However, we found the fire risk assessment was out of date and following the inspection we received evidence to confirm that a fire risk assessment had been booked for June 2024. Fire alarms were tested on a weekly basis. A legionella risk assessment was carried out in September 2023, which identified areas of high risk. At the time of the inspection, we found there were still outstanding actions to complete. A health and safety risk assessment was not available on the day of inspection and the leadership team were unable to locate it. Some staff were out of date with training updates, which included fire safety training. Staff who had responsibilities for monitoring infection control told us that due to the restrictions on their administration time, they were finding it difficult to ensure they monitored the environment adequately.

During our site visit we found the premises were maintained with some processes in place to show the environment was safe. An infection control audit had been completed and actions identified and were in the process of being completed. Fridge temperatures were recorded daily, and a data logger was in place which was reviewed regularly to ensure the fridge temperatures were within a safety range. Some risk assessments had been completed and staff were aware of processes if issues arose of how to act and the reporting processes.

There were policies and procedures in place for the management of health and safety. Fire safety policies were in place and staff were aware of how to access these. Systems were in place for the regular checks of fire alarms, extinguishers and fire evacuation procedures. We found risk assessments were not available for health and safety and the fire risk assessment had expired. There were outstanding actions from the legionella risk assessment. The practice had completed assessments in place for the control of hazardous substances. Evidence provided by the practice showed equipment was regularly calibrated and electrical items were PAT (portable appliance testing) tested.

We found the process for the safe recruitment of staff was inadequate. The leadership team were unable to provide evidence that the appropriate checks had been carried out for newly recruited staff. We were told that disclosure and barring checks for all staff working in the practice and that all newly employed staff had completed an induction to ensure they were competent in carrying out their role, however no evidence was provided to confirm this on the day of inspection. There were clearly defined lead roles, but staff reported there was no support available to ensure they were able to do their roles effectively. We identified numerous gaps in staff training and we were unable to gain assurances that there was a process in place to monitor training updates. We requested evidence to support that newly appointed staff in advanced clinical practice had completed training deemed mandatory by the practice, however this was not provided. There were staffing rotas, but since the partners had returned to practice, changes had been made to the rotas which had impacted on staff being able to complete extra roles and responsibilities they had been given due to administrative time restrictions. We spoke with a range of staff during the inspection, who told us of the difficulties they faced in working together with the leaders of the practice and how this had impacted on their health and wellbeing. We found nursing staff were working excessive hours without due consideration by the leadership team to ensure they were being adequately supported. We were told by the leaders of the practice, that supervision of staff was in place, however we found no evidence to demonstrate this. Reception and administration staff who handled calls to the practice and arranged appointments with the clinical team were aware of potential red flag symptoms. Staff knew when to notify a GP or other clinicians with concerns about a patient who may be acutely unwell and/or deteriorating.

We found processes for safe and effective staffing were not effective. We requested 4 personnel files for both clinical and non-clinical staff, however these were not provided. We were unable to confirm that the appropriate checks had been completed prior to employment. We found on reviewing the training matrix, there was no evidence to support that newly appointed clinical staff had completed training deemed mandatory by the practice. On speaking with the leadership team we were told they had no evidence of what training the new staff had completed prior to joining the practice. We found that processes for supervision and oversight and staff was not in place. We identified numerous staff had not updated their training and staff reported they were provided with no time to do this. We found the practice was unable to demonstrate how they had assured the competence of staff employed in advanced clinical practice, for example, nurses, pharmacists and GPs.

The practice had an infection control lead, however we found that they had not been included in the set up of the minor surgery service and were unaware what infection control checks had taken place. The leaders told us that the appropriate checks had been completed and the infection control lead would be updated. We were provided with no evidence to confirm this had been actioned. All staff had completed infection prevention and control training and were aware of the systems and processes to follow to ensure clinical specimens were handled safely.

We observed the general environment to be clean and tidy and cleaning rotas were in place. Sharps bins were available in all clinical rooms which were signed, dated, safely sited and were not over-filled.

The practice had policies in place for infection, prevention and control which were accessible to staff and staff were aware of the action to take. For example, in the event of a sharps or contamination injury. There was an infection control lead in place, however we found that they were not included in all aspects of infection control to ensure the practice was following the appropriate guidelines. For example: the set up of the minor surgery service. There was an infection control lead in place and an infection control audit had been carried out in March 2024, the practice had achieved an overall score of 98%. On reviewing staff training we found all staff were up to date with infection control updates relevant to their role.

Staff and leaders told us they had reviewed their systems and processes and had discussed the changes that were implemented by the caretaking team following the inspection in April 2023. However, we found that the leaders had no clear oversight of prescribing and long term condition monitoring. During the remote clinical review we found some patients on high risk medicines had not been monitored appropriately and not all medicines were being reviewed during a medicine review with patients. The practice had recently employed 2 clinical pharmacists who we were told would have responsibility for actioning safety alerts and ensuring the appropriate action was taken. During the clinical review we found that not all medicine alerts had been acted on.

Emergency medicines, vaccines and medical equipment had been reviewed and were appropriately stored with clear monitoring processes in place. There were appropriate arrangements in place for the management of vaccines and for maintaining the cold chain. We saw fridge temperatures were routinely monitored and vaccines reviewed at random were in date and stored appropriately. The practice held appropriate emergency equipment and emergency medicines which were checked on a regular basis. Vaccines were ordered and stored in accordance with national guidelines and the practice had systems in place to monitor the temperature of vaccine fridges. Prescription paper was stored securely, and the practice maintained a record of prescription paper serial numbers. We looked at patient group directives (PGDs - a legal framework that allows some registered health professionals to supply and/or administer specified medicines to a pre-defined group of patients, without them having to see a prescriber (such as a doctor or nurse prescriber). We saw that they had been authorised appropriately.

We found some clinicians had not made appropriate and timely referrals in line with protocols and up to date evidence-based guidance. We were told there were systems in place to ensure all patient information including documents, laboratory test results and cytology reports were reviewed and actioned in a timely manner, however we found during the remote clinical review of patient records that there were 65 outstanding tasks for 2 GPs employed by the practice and a number of these tasks included referrals. We found there was a lack of systems in place to ensure all workflow was followed up and actioned appropriately. Our review of patient records in relation to the clinical searches identified that care records were not managed in line with guidance and legislation. The practice had systems for monitoring two week wait referrals to ensure patients were seen, however we were provided with no evidence to demonstrate that multidisciplinary meetings with other agencies were held to share and discuss information relating to patient care and treatment, for example, those on the practice palliative care register. We found outstanding actions for safety alerts and no effective systems in place to ensure all alerts were acted on appropriately to ensure people were protected from harm.

At the inspection in April 2023, we identified numerous concerns in the management of high risk medicines, safety alerts and medicine reviews. Following this inspection a caretaking team was implemented to oversee the practice who introduced a range of processes to address the concerns we found. At this inspection, since the partners have returned we found further improvements were required. During our remote clinical searches suggested a potential 40% of patients with heart failure who had been prescribed medicines to support the management of their condition had not received the appropriate monitoring. We reviewed a random sample of 5 clinical records and found all 5 clinical records had no evidence to demonstrate that the required monitoring had taken place before medicines had been prescribed. Clinical searches of patient records were carried out as part of our inspection. During the remote clinical searches in May 2024 evidence suggested that medicine reviews were not completely appropriately. We reviewed a random sample of patient records and found a patient who had not had all their medicines reviewed and another patient who had a clinical code on their record for medicine review, but we found no evidence a review had taken place. Further clinical searches suggested 102 patients over 65 years of age had been prescribed an oral nonsteroidal anti-inflammatory drugs (NSAIDs) or over 75 years of age on antiplatelets had not been prescribed the appropriate gastroprotection medicine as recommended in NICE guidelines. We reviewed a random sample of 5 patient records and found none of the patients we reviewed had been prescribed this medicine to reduce the risk of gastrointestinal bleeding.