The Andover Health Centre 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 and inspected against four quality statements, Learning culture; safeguarding; safe and effective staffing and medicines optimisation. During our assessment of this key question, we found people did not always receive safe care and treatment. People with long-term health conditions and those prescribed high-risk medicines were not always monitored to ensure their health did not deteriorate. When medicine reviews did take place, records were not always sufficiently comprehensive to demonstrate it was safe to continue prescribing. The practice was not aware that all test results had not been actioned and there was a risk that people might not receive timely treatment. There was a lack of appropriate actions in relation to safety alerts which meant people were at risk of harm. This resulted in a breach of regulation 12 Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found staff did not have time to update their training or keep summaries of people’s records up to date to inform future care and treatment decisions. Due to the practice not having a lead nurse for the previous 12 months, mentoring and monitoring of staff had not taken place. Staff were also not available to review people with long-term conditions such as asthma and diabetes to ensure people received safe care and treatment in line with national guidelines. This resulted in a breach of regulation 18 Staffing of the Health and Social Care Act 2008 (RA) Regulations 2014. Records relating to persons employed did not always include information relevant to their role. The provider could therefore not assure themselves that the recruitment policy had been followed. This resulted in a breach of regulation 17 Good governance of the Health and Social Care Act 2008 (RA) Regulations 2014. Although the practice investigated and responded to complaints appropriately, they did not demonstrate that learning was derived and shared with staff.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We could not collect sufficient evidence to score this evidence category. Information we did collect showed that people had opportunities to provide feedback and they knew how to make a complaint. People told us they had enough time during their consultation and they felt involved in decisions about their care and treatment.

Leaders told us that safety incidents were investigated and recorded on a significant events log. Staff and leaders understood their duty to raise concerns and report safety incidents and near misses. GP partners told us they were responsible for investigating incidents which required clinical review. Staff were not always aware what learning had taken place following the review of safety incidents to know what changes were needed to improve care for people.

Meeting minutes from senior partner and practice management weekly meetings showed significant events were discussed. We saw an example of actions taken as a result of a significant event where the practice implemented procedures for escalating acute and urgent issues at the two local care homes to ensure safe care and treatment could be provided in a timely manner. Records of complaints and significant events did not always show what lessons had been learned from all safety incidents or complaints and what changes had been made to improve care for other people. For example, we found the practice had recorded 12 significant events in the last 12 months with 6 in the process of or awaiting to be investigated. There were descriptions of the incidents with root causes identified, however, actions were not always recorded to show how learning had been shared with staff and what service improvements had been made. We identified that the practice had recorded 26 complaints and 6 concerns in the last 12 months. We found 14 complaints and all 6 concerns had no learning outcomes noted. The practice had a complaints policy in place which included a complaints response timeframe of 10 working days for investigation. Further acknowledgement communication was sent to people that exceeded this timeframe. From the sample of complaint records we reviewed; we found the practice responded to people’s complaints in a timely manner. This incident reporting system complied with the requirements of the duty of candour.

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.

Staff were able to identify local arrangements for raising safeguarding concerns. However, they told us they were not aware of how to identify or flag vulnerable people through their clinical records. This meant people’s risks and vulnerability to abuse and discrimination might not be readily available to ensure this was taken into account when planning people’s care and treatment. Leaders told us senior managers discussed concerns about vulnerable people at weekly partners’ meetings. Meetings with Health Visitors in relation to children of concern were discussed quarterly. There was a weekly online frailty team multi-disciplinary team (MDT) meeting attended by the adult safeguarding lead GP. Staff told us they reported and discussed concerns with the local authority where required. Leaders were able to describe how the practice would investigate and provide an appropriate ongoing package of care for people in vulnerable circumstances and gave examples of how this care was planned during clinical meetings.

Not all staff had completed the appropriate level safeguarding training in line with national guidance. There was a lack of oversight to ensure staff complied with training and that staff had the knowledge and skills to protect people from potential harm. For example, we found clinical staff, 2 GPs had not completed safeguarding vulnerable adults level 3 training and 2 GPs had not completed both safeguarding children and vulnerable adults training. In addition, 2 nurses and 2 health care assistants (HCA’s) had not completed safeguarding children and vulnerable adults level 3 training. There was a safeguarding system and policy in place for vulnerable adults and children reviewed in April 2023 to ensure information was correct and kept up to date. There were designated safeguarding leads who held oversight of new and existing safeguarding concerns. Local arrangements and key contacts for making a safeguarding referral were available to staff. The practice held a register of vulnerable patients. Clinical staff meetings were held to discuss vulnerable patients as a standing agenda item to agree appropriate actions. A mixture of clinical and non-clinical staff members had chaperone responsibilities as part of their role. Those staff members had completed the relevant training and risk assessments had been completed for non-clinical staff.

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.

The practice’s national GP patients survey results from 2023 showed that people were treated with care, were listened to and had confidence with staff in line with local and national averages, including meeting mental health needs. The practice had received 3591 feedback forms via the Friends and Family Test (FFT) in the last 12 months of which 339 referenced comments about staffing. People received caring and an attentive service with the majority of people satisfied with the overall experience received by staff at the practice.

Administrative staff told us that they had no protected time to complete mandatory training due to workload pressures. Clinical staff told us there were booked time slots to complete mandatory training. Staff told us that administrative cover work was not sufficient and they were therefore not able to keep up to date with regular tasks such as summarisation of people’s notes. We identified a backlog of summarisation dating back to July 2023. Staff responsible for this task told us they did not have capacity to carry out this work to ensure people’s records contained up to date information to inform treatment decisions. In response, leaders told us that although systems and processes were in place to summarise new patient paper notes, a backlog of notes had accumulated due to administrative staffing pressures. Staff told us that they had not always received regular appraisals and supervision in line with the practice’s policy.

There was a recruitment policy in place which included how the practice processed personal data in accordance with the General Data Protection Regulations (GDPR). The policy did not outline the requirements to obtaining a full employment history for prospective staff prior to employment. We carried out a review of the provider’s recruitment checks in relation to three members of staff and found systems and processes were ineffective to ensure that information was available and up to date for persons employed in line with practice policy. For example, we identified unexplained gaps in employment history records. Interview records on file had not been sufficiently completed to reflect an audit trail of decision making such as employer comments or scoring. We identified a staff member had commenced employment without references provided to assure the individual was of good character and confirmed previous employment responsibilities. Risk assessments were required to be completed for administrative staff in place of Disclosure and Barring Service (DBS) information as per practice policy. However, we found risk assessments had not been completed for all admin staff. There was a lack of oversight in maintaining records relating to people employed. The practice was able to demonstrate clinical staff registration documentation to professional bodies, where such registration is required by the work the person performs and title the persons uses. The practice had been operating without a nurse lead for the past 12 months who held responsibility for Chronic Obstructive Pulmonary Disorder (COPD) management in addition to being involved with acute same day care. Records showed that mandatory training modules had not always been completed by all staff in line with practice policy. The practice supported 2 GP Registrars and we found dedicated time was allocated to review care planning and records with the duty GP. Weekly tutorials were also provided by the duty GP.

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.

Following our review of clinical searches, the registered manager took immediate action in relation to one high-risk person and outstanding workflow, which included blood monitoring and invites for medicines reviews which they had not identified prior to our visit. Staff we spoke to were unaware of the unactioned workflow we identified during our clinical searches. As a result of our feedback, leaders told us that GP’s were given access to all incoming workflow mailboxes to prevent future delays in reviewing incoming results for people. Leaders told us that emergency medicines were checked regularly and that records to demonstrate an audit trail of medicine stock checks would be implemented to improve practice processes following our feedback.

During our on-site visit, we observed that the practice had medicines stored for emergencies. We saw that the practice did not store a particular emergency medicine and stocked an off-label alternative. The practice had not risk assessed whether they had stored a specific emergency medicine or had a protocol in place to stock an off-label alternative. We saw there were some medicines that required refrigeration such as vaccines that were not always stored appropriately within temperature range. We saw that records had not been documented to demonstrate the actions taken in response to medicines stored out of safe temperature ranges. The fridge data loggers were not set to the recommended time intervals. After the assessment, leaders told us that the data loggers had been reset to recommended time intervals and processes to record fridge temperatures including any actions required in the event of fridges recording temperatures outside of safe ranges had been updated. We observed that not all fridges at the practice had been appropriately locked to ensure access from members of the public were restricted. Therefore, there was a risk of unauthorised people accessing medicines.

There was a lack of embedded process for monitoring peoples’ health in relation to the prescribing of high-risk medicines, in particular with blood monitoring requirements in accordance with national guidelines and effective medication reviews. There was evidence that the process for managing safety alerts was not being followed appropriately to ensure people were protected from harm. We found records which showed emergency equipment was stored and monitored appropriately for the previous month. However, there was a lack of audit trail to demonstrate consistent medicine checks over longer periods of time.

During our remote clinical searches, we found that people who were prescribed high-risk medicines were not always monitored appropriately to ensure safe care and treatment was provided. We found four people identified who were not prescribed the correct dose of an anti-depressant medicine. This placed people at risk of arrythmia of the heart. We identified 400 people prescribed a Direct-Acting Oral Anticoagulants (DOAC). We found 46 of these people did not receive appropriate monitoring. This placed people at risk of harm if prescribed an incorrect dosage or are not monitored at the correct intervals. People who received medicine reviews did not always have records to ensure it was safe to continue prescribing. We identified 2621 medicine reviews completed in January 2024. We reviewed peoples’ records throughout the clinical searches and found medicine reviews were not recorded appropriately and did not contain a review of recent prescriptions, medicine dosages and blood monitoring requirements in line with national guidelines. This placed people at risk of ineffective care and treatment.