Wadebridge and Camel Estuary 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 have rated the practice as good for providing safe services because: The practice had a culture of reporting and investigating incidents and significant events. Learning from the investigations was shared with staff and systems and processes reviewed and developed to improve services. There were systems and processes to monitor patients prescribed medicines which required additional monitoring. Whilst our clinical searches found gaps in monitoring the practice had addressed these and took immediate action to develop systems to prevent these risks reoccurring. A pharmacist had been recently appointed to support the practice with undertaking medicine reviews and managing medicine procedures within the practice. Patients prescribed medicines which required additional monitoring had not always been followed up in line National recommendations. The practice took immediate action to address this to ensure patient safety.

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.

Staff said they were able to speak to managers about concerns and felt supported and listened to. They confirmed that action was taken to address issues raised.

The practice had a system in place to monitor significant events. Meetings were held monthly with the wider staff teams to discuss significant events, review learning and discuss improvements. In addition to this process, we saw they used a process to monitor incidents. This included undertaking an investigation into the cause and actions taken to address concerns. The practice had a system to manage medicines safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) which included a policy, a log of actions completed by the dispensary manager and lead which were recorded within an electronic system for all staff to access. In addition to this the practice had a carried-out audits following safety alerts received from the Medicines and Healthcare products Regulatory Agency (MHRA) and taken appropriate actions to safeguard patients. The practice had systems and processes for using learning from complaints to drive improvements. Complaints were discussed regularly at meetings and lessons learnt to improve practices shared with the wider staff teams. The practice had a system in place for the auditing of systems and processes. Audits conducted identified areas of concern, actions taken and provided a clear audit trail to demonstrate continuous improvement. However, the practice did not have a risk assessment in place to address the risk of staff accessing the dispensary and accessing patient medication history. Following our onsite assessment the practice addressed this immediately and implemented a risk assessment, which identified all staff who had access to the dispensary including external cleaning staff were DBS checked and had signed a confidentiality agreement.

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.

Staff were able to describe the system to identify patients who required monitoring based on the medicines they were prescribed. However, our remote searches of clinical records identified a number of patients who had not received appropriate monitoring within recommended timescales. The practice took immediate action and made arrangements for these patients to be reviewed and also carried out searches of all patients to ensure there were no patients at risk. We spoke with non-medical prescribers (clinicians who are not GPs) who told us they were able to discuss their prescribing each day with a duty GP.

Systems and processes were followed to ensure the cold chain process was safe. The recording of temperatures were documented via an electronic system. Staff were knowledgeable regarding action to take should the cold chain be compromised. The vaccine fridges were clean and not overfull. The vaccine fridge was not locked and was stored in an unlocked room. This did not ensure the security of medicines. The practice advised this would be addressed following our onsite visit. We looked at the emergency medicines and equipment held by the practice and found the emergency medicines were stored securely in the lead nurses’ room and emergency medical equipment was stored elsewhere in the practice. We found equipment and medicines were monitored to ensure medicines were not used past their expiration dates. A defibrillator was kept on site, which contained the pads suitable for adults and children under the age of 8 years old. The practice carried out routine checks of the defibrillator to ensure it remained fully operational. Dispensary staff had allocated roles within the dispensary on a day to day basis. We saw staff processing prescriptions, checking and filling prescriptions and providing the medicines to patients. The dispensary appeared calm and efficiently run. Medicines awaiting collection were stored in a collection area, within the dispensary, with the patient label with appropriate information attached. This meant confidentiality of the patient medicines was promoted. The dispensary staff ensured controlled drugs were ordered, stored, and recorded in line with the requirements of the Medicines Act. We observed the stock of controlled drugs held by the practice matched the balance in the controlled drugs register.

Following our remote clinical searches of patient records the practice reviewed and strengthened their systems to ensure patients who required monitoring were followed up in a timely way. The electronic patient record system provided an alert to all staff regarding patients prescribed certain medicines to ensure monitoring was carried out in line with national guidelines. The practice had allocated staff to carry out searches of the electronic systems to identify patients and arrange appointments. The practice had identified medicine reviews had not been carried out consistently and in sufficient detail to identify any risks or issues. Action had been taken to address this and a pharmacist had been recruited by the practice. Their job role would include carrying out medicine reviews using a standardised template. The practice had a system to secure blank prescriptions. However, this did not consistently identify the traceability of prescription stationary. Following our onsite assessment, the practice had taken action to rectify this which provided us with assurances regarding the ongoing security of prescription stationary. Medicines within the practice were generally manged in a safe way. However, vaccines were stored in an unlocked fridge in an unlocked room. The practice provided assurances this would be addressed immediately. There was no formal audit carried out of the practice of non-medical prescribers with regards to prescribing. However, a nominated GP provided support each day to the non- medical prescribers and discussed complex or challenging cases with them at the end of or during each clinic.

Our remote clinical searches identified shortfalls in patient monitoring on certain medications. Patient records for 2 out of 5 patients prescribed medicine for inflammatory conditions showed a cause for concern. Shared care protocols were not consistently recorded in patient records. (Shared care is a formal local agreement that enables GP’s to agree and accept responsibility for the safe prescribing and monitoring of specialist medicines). One patient had a medication review which was only coded and did not show any detail. Medication had been issued without the required blood tests being completed for 3 patients prescribed medication to treat heart failure. Alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) were received by the practice and circulated to appropriate clinicians for action to be taken when necessary. However, prescribing of a medicine used to lower blood sugar for 2 patients did not demonstrate information had been provided regarding the risks of these medicines. This had been identified in a previous MHRA alert. Patient records did not demonstrate that the practice had discussed the risks of taking certain medicines when pregnant. The practice proactively reviewed all patients at potential risk and we saw evidence during the on-site visit which demonstrated the risks had been discussed with women of child bearing age. We reviewed the clinical records for 5 patients with the long term condition hypothyroidism (under active thyroid condition) who had not received a blood test for 18 months. The records for 2 patients showed they were overdue for monitoring and this had not been identified by practice. The practice took immediate action to ensure all patients registered with the practice prescribed this medicine were contacted if their review was overdue. At the time of the site visit evidence was provided to demonstrate patients had been to the practice or were booked in for monitoring.