Ling House Medical Centre

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• 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 all quality statements from this key question and our rating is Good. Overall, we found the practice provided safe care and treatment for patients. The practice promoted a culture of openness and collaboration. Staff were encouraged and supported to raise concerns. There were systems in place to ensure people were safe and safeguarded from abuse. The practice operated from modern premises with good systems and processes in place for the management of facilities, equipment and infection prevention and control. There were safe recruitment processes in place and staff had received inductions, appraisals and had undertaken mandatory training. There were systems and processes in place to support medicines management. Prescribing outcomes were in line with local and national averages. A review of patient clinical records found that patients’ medicines management and treatment were safely managed by the practice.

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.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no specific views or concerns about the learning culture at the practice. We noted that the provider would contact patients who were affected by an incident to offer a verbal or written apology and an explanation.

Leaders told us that they promoted a culture of learning and encouraged staff to report incidents openly. Feedback from staff showed that all staff were able to explain the process of how they would report an incident or who they would seek guidance from to do so. Staff told us they were encouraged to report incidents and felt confident to do this. They felt they were able to raise and discuss concerns in an open environment and that the practice’s clinical and management team were open and transparent. Staff told us they participated in quality improvement, including clinical audits, and attended meetings where learning was shared from incident and complaints.

The practice had systems and processes in place, underpinned by policies, to manage incidents and complaints. At this assessment we reviewed a selection of incidents and complaints and saw appropriate action had been taken and learning shared through meetings. We saw evidence in the investigation of an incident that the practice had applied the duty of candour. The practice had systems and processes in place to receive, disseminate and act upon alerts received through the Medicines and Healthcare products Regulatory Agency (MHRA) and the Central Alerting System (CAS). We saw that a log was maintained of all safety alerts received and action taken. A review of clinical records indicated that patient safety alerts were actioned in line with guidance. The practice had a schedule of quality improvement activity, including clinical audits, to drive patient care and outcomes. The practice provided a selection of meeting minutes and we saw evidence that incidents and complaints had been discussed. We saw that staff had access to minutes of meetings.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no specific views or concerns in this area.

Leaders told us there were systems in place for the management of referrals, clinical correspondence, pathology results and summarising to ensure safety and continuity of care for patients. They told us that clinicians made appropriate and timely referrals in line with protocols and up-to-date evidence-based guidance. Staff we spoke with understood the referrals processes and how to manage correspondence.

We spoke with the NHS West Yorkshire Integrated Care Board ahead of this assessment. From the feedback we received from them there was no indication of concern in this area.

The practice had formal policies in place to manage referrals, clinical correspondence, pathology results and medical record summarising. We observed that urgent 2-week wait cancer referrals were dealt with appropriately and a system was in place to ensure they were sent in a timely manner and that patients had attended for their appointment. There were systems in place for safety-netting cervical screening undertaken at the service, to ensure that a result was received for each cervical screening sample undertaken by their sample takers. Test results and patient correspondence were managed in a timely manner, including when staff were absent. Clinical records of new patients were mostly received by electronic transfer. Those that were received in paper form were summarised in the practice clinical record system. From a selection of patient records reviewed, we saw that patient consultations contained appropriate information and demonstrated that care and treatment was being delivered in a safe way.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no specific views or concerns with safeguarding.

Leaders told us safeguarding systems and processes were in place which included leads, policies, training, risk registers, meetings and coding and flagging of vulnerable patients on their clinical system. They told us there were processes in place to follow-up on children with frequent attendance at accident and emergency, and when children had not been taken to secondary care appointments or for childhood immunisations. Staff feedback indicated that all staff knew who the safeguarding children and adult leads were and how to access safeguarding policies and procedures. Staff confirmed they had undertaken safeguarding children and adult training. Staff who acted as a chaperone were able to describe their role and responsibility.

We spoke with the NHS West Yorkshire Integrated Care Board ahead of this assessment. From the feedback we received from them there was no indication of concern in relation to safeguarding.

The practice had established processes in place to identify, record and action safeguarding concerns. This included the development of safeguarding policies and a safeguarding handbook. There was a safeguarding children and adult clinical lead supported by a safeguarding administrator who was responsible for safeguarding-related recalls and workflow. Training records showed that staff had undertaken safeguarding children and adult training, preventing radicalisation, Mental Capacity Act (MCA), Deprivation of Liberty Standards (DoLS), learning disability and autism awareness training. At the time of our assessment, some non-clinical staff were working towards level 2 safeguarding children training which the practice had prioritised and would be completed at their September protected learning time (PLT) session. There were systems to identify vulnerable patients on their clinical records. The practice held regular safeguarding meetings. As part of this assessment, we reviewed some safeguarding records and found evidence of safeguarding alerts and appropriate codes on the records of children, their siblings and vulnerable adults. We saw staff who acted as a chaperone were trained for the role and had received a Disclosure and Barring Service (DBS) check. At our on-site inspection we observed notices displayed in the practice to advise patients that a chaperone service was available, if required.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no specific views or concerns in this area.

Staff feedback demonstrated that all staff were aware of the location of the emergency medicines and medical equipment, for example oxygen and the automated external defibrillator (AED). Staff told us they had completed basic life support and sepsis training relevant to their role. Non-clinical staff were aware of ‘red flag’ presenting complaints, for example patients with shortness of breath, and what action to take if they encountered a deteriorating or acutely unwell patient. Staff we spoke with were aware of how to raise the alarm in the event of an emergency and told us they used the panic alarm system integrated into their clinical system.

The practice had resuscitation and emergency medicines policies in place. At our on-site inspection we observed that the practice was equipped to respond to medical emergencies, including suspected sepsis. We reviewed processes around the management of emergency equipment and medicines and saw there were regular checks in place which were recorded. Records confirmed that staff had completed basic life support and sepsis training. The practice used a patient navigation tool integrated within their clinical system which included question prompts for reception staff to follow to ensure patients were appropriately managed.

Leaders told us there were systems and processes in place to ensure premises and equipment maintenance were undertaken to required timescales. Staff told us they had undertaken required mandatory training in respect of health and safety, such as fire safety training, and that they had no concerns related to health and safety in the practice.

The service operated from purpose-built premises which had recently been refurbished and had created more clinical space. The facilities and premises were appropriate for the services being delivered. At our on-site visit we observed the premises to be clean, modern and accessible. Lifts were available for staff and patients. There was appropriate signage in place, such as for fire escape routes and fire assembly points.

We reviewed premises and facilities documentation and found maintenance records for the fire alarm system and fire extinguishers, portable appliance testing (PAT) and calibration of medical equipment. In addition, we saw evidence of a valid gas safety certificate, Electrical Fixed Installation Condition Report (EICR) and Lift Operating and Lifting Equipment Regulations (LOLER) certificate. We saw risk assessments had been undertaken for fire, health and safety, Control of Substances Hazardous to Health (COSHH) and Legionella and that remedial actions had be completed. There was a record of regular fire alarm testing, fire evacuation drills and trained fire marshals.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no concerns in this area. They told us staff were caring, professional, friendly and helpful.

Leaders told us that staffing levels were actively monitored, and that rotas were in place which ensured that there was the right mix of staff numbers and skill mix in place to deliver safe and effective care. Managers demonstrated systems and processes in place for recruitment, induction, appraisals and training, which were supported by policies and procedures accessible to staff. Managers told us that mandatory training had been identified for clinical and non-clinical staff and there were systems in place to monitor when updates were due. Staff told us they had access to an employment handbook which provided key information such as absence and grievance processes.

As part of our on-site inspection, we assessed recruitment procedures and reviewed 3 clinical and 2 non-clinical staff recruitment files. We found all relevant employment documentation in accordance with regulations were in place. For example, photographic identification, references, Disclosure and Barring Service (DBS) and professional registration checks. We saw the practice had a system in place to capture the immunisation status of staff at the point of recruitment. From the selection of employment records reviewed we found that staff vaccination was maintained in line with current guidance, relevant to their role. There were gaps in vaccination records for some existing staff and the practice had been working with those staff and occupational health services towards compliance. There was a mandatory training schedule in place. We noted some mandatory training had not been scheduled at the frequency in line with guidance or to a level in line with a job role. The practice had rectified this when raised during the assessment processes and had prioritised training in these areas. We saw that all staff who had been at the practice for over a year had received an annual appraisal. The practice could demonstrate how they assured the competence of staff employed in advanced clinical practice, for example, prescribing nurses. Trainees and non-medical prescribers received appropriate support and supervision. A folder was available to locums to provide them with the necessary information to carry out their role safely.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no specific views or concerns regarding infection prevention and control (IPC).

Feedback from staff informed us that they had a good understanding of IPC. They knew who the nominated lead was and how to access relevant polices. They told us they had received IPC training relevant to their role. We spoke with the nominated lead at our on-site visit who told us they had dedicated time to undertake this role. However, they had not undertaken any additional training to support the lead role. Immediately after the inspection the practice told us they would source appropriate IPC training.

There was an effective approach to assessing and managing the risk of infection. On the day of the on-site inspection, we observed the premises to be clean, tidy and clutter-free. We found posters around the practice including sharps injury, handwashing and clinical waste to support good practice. The cleaner’s cupboard was tidy and contained appropriate colour-coded equipment and cleaning materials. Appropriate personal protective equipment and bodily fluid spillage kits were available to staff. Clinical equipment was cleaned on a regular basis and records were maintained.

There were comprehensive IPC policies in place, which were accessible to staff. IPC audits were undertaken monthly. We reviewed 2 recent audits and found the practice had acted upon issues identified in the audits. The arrangements for managing waste and clinical specimens kept people safe.

As part of the assessment process, we reviewed patient feedback from the National GP Patient Survey, the NHS Friends and Family Test (FFT) and an internal survey. In addition, we asked the provider to share details of our Give Feedback on Care process with patients. Patients providing feedback for this assessment had no specific views or concerns in this area.

Clinical staff and leaders explained the systems they had in place to ensure medicines were prescribed safely and in line with practice policy and national guidelines. There was a nominated medicines lead. Performance in relation to medicines outcomes were closely monitored through clinical audits and discussed in clinical meetings. Staff described established systems in place for the safe ordering, storage, and administration of medicines, including vaccinations.

As part of our assessment, a CQC GP specialist advisor (SpA) conducted a series of remote clinical searches of patient records to assess the practice’s procedures around prescribing and medicines management. This included the management of patients prescribed disease-modifying antirheumatic drugs (DMARDs) and some medicines requiring monitoring, as well as the management of patient safety alerts, medicines usage, medication reviews and potential missed diagnoses. The results showed the practice had appropriate systems in place to ensure patients were appropriately monitored and safety alerts about medicines were implemented. There was a process for the safe handling of requests for repeat medicines and evidence of effective medicines reviews for patients on repeat medicines. The practice had a process and clear audit trail for the management of information about changes to a patient’s medicines, including changes made by other services. At our on-site inspection, we found the practice held appropriate emergency medicines safely and monitored stock levels and expiry dates. Vaccines were appropriately stored, monitored and transported in line with guidance to ensure they remained safe and effective. Medical gases, such as oxygen, were stored safely with appropriate warning signage.

There were medicines policies in place covering repeat prescribing, controlled drugs and vaccine management. The practice held appropriate emergency medicines and had a system in place to monitor stock levels and expiry dates. Staff had the appropriate authorisations to administer medicines, including Patient Group Directions or Patient Specific Directions. The practice could demonstrate the prescribing competence of non-medical prescribers, and there was regular review of their prescribing practice supported by clinical supervision and peer review. Blank prescription stationery was securely stored, and its use was monitored in line with national guidance.

Data showed that the practice had systems in place to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Outcomes from our clinical notes review and prescribing data reviewed confirmed this. For example, the percentage of antibiotic items prescribed that are co-amoxiclav, cephalosporins or quinolones was lower than local and national averages. The practice engaged in the Lowering Anti-Microbial Prescribing (LAMP) project which enabled them to monitor their prescribing. There was a programme of regular clinical auditing of prescribing that focused on improving care and treatment.