The Dove 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

The practice had effective systems to assess, monitor and continue to improve the quality and safety of service. There were processes for monitoring patients’ health in relation to the use of medicines including medicines that require regular monitoring. There were processes in place to monitor staff training.

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.

Patient feedback regarding learning culture indicated this needed further development. However, patients stated they felt listened to when they raised concerns and changes were made when appropriate.

Staff told us of an open and honest working environment, where they felt supported and able to raise concerns. This aided the development of staff and services.

Information on how to make a complaint was displayed in the patient waiting area and on the practice website. The practice had received 50 complaints between January 2024 and September 2024. We reviewed the management of complaints and saw evidence that effective systems were in place. Significant event reporting forms were available to all staff to access from the practice computer system. Staff were provided with access to a Freedom to Speak Up Guardian. Staff and leaders understood their responsibilities and knew how to identify and report concerns and safety incidents. Significant events and complaints were appropriately managed and staff were involved in identifying any learning. Feedback and learning from significant events and complaints was shared with staff via their managers and at staff meetings.

We could not collect evidence from patient feedback to score this evidence category. However, the practice shared with us examples of how care and support was planned and organised with people, partners and communities in ways that ensured continuity and included patient’s feedback. The views of people who used the service, partners and staff were listened to and considered. Our observations raised no concerns.

Staff told us about signposting and workflow systems regarding external services and the use of referrals. There was a system for processing information relating to new patients including the summarising of new patient notes. We found staff were knowledgeable in their role and were aware of support networks in the local area.

Practice partners were positive about their interactions with the practice staff and other organisations,. They told us how care was coordinated when different teams, services or organisations were involved.

There were systems and processes to share information with staff and other agencies to enable them to deliver safe care and treatment. This included regular multidisciplinary meetings between the practice staff and other health and social care professionals such as health visitors, community midwives and social workers. Referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals.

We could not collect evidence from patient feedback to support scoring this evidence category. Our observations raised no concerns. The evidence we reviewed did not identify any concerns about people’s experience regarding safeguarding at this practice.

Staff we spoke with had a clear understanding of their safeguarding responsibilities and the processes in place for reporting concerns. Staff were aware of the safeguarding lead and could access additional information within the practice to support them in taking action as required.

There were regular discussions between the practice and other health and social care professionals such as health visitors, school nurses, community midwives and social workers to support and protect adults and children at risk of significant harm. Partners told us about regular meetings that were held within the practice where safeguarding was discussed. They spoke positively of practice systems to ensure people were protected from abuse and neglect and told us that prompt action was taken when required.

The provider had systems and processes to ensure patients were safeguarded from harm. These processes were communicated to staff. We reviewed staff training records and found not all staff were trained to the appropriate level for safeguarding children. The practice took immediate action and provided evidence during our assessment to demonstrate that all staff had completed appropriate training. There were systems to identify vulnerable patients on records. Disclosure and Barring Service (DBS) checks were undertaken when required. We gained remote access to patient records and found no risk associated with patients on the safeguarding register.

We could not collect evidence from patient feedback to score this evidence category. Our observations raised no concerns. The evidence we reviewed did not show any concerns about people’s experience of how risks are assessed and managed and the information they receive on keeping themselves safe.

Staff told us that people were informed about any risks and given appropriate safety netting advice. Leaders told us about systems to regularly review consultations to ensure risks were managed whilst respecting patient choice.

The practice had multiple systems to support effective risk management. Routine clinical meetings shared identified risks and lessons learned. Formal risk assessments were routinely maintained and required actions were undertaken in a timely manner. Patients identified as at risk were involved in discussions and informed of options available to them to minimise risks. Non-medical prescribers who prescribed medicines following obtaining advanced clinical prescribing qualifications had regular audits of their clinical practice and received daily supervision and support. (A non-medical prescriber is a registered healthcare professional who has completed training to be able to prescribe certain medicines without needing to ask a doctor).

Staff told us they felt safe to work at the practice. The facilities, equipment and technology were well-maintained so they could work safely and deliver a good standard of care to their patients. Staff were aware of how to raise concerns around safety of equipment or premises to ensure identified risks were reduced.

We found no concerns regarding the location of the practice or the equipment held, which was maintained according to requirements. Patients appeared to face no difficulties physically accessing the service.

Risk assessments were undertaken as required to maintain a safe environment for patients and staff. Assessed risks were managed appropriately and in a timely manner. The provider engaged with the premises landlords to ensure effective oversight of risk assessments undertaken by the landlords. We found there were some gaps in staff knowledge relating the management and storage of clinical waste. We saw that not all clinical waste bags awaiting collection had been labelled correctly. This was shared with staff during the assessment who advised action would be taken to remind staff of appropriate protocols.

Although some patients stated interactions with staff on occasions were not always positive , the majority of feedback we reviewed indicated patients had good experiences and we did not identify any concerns with staffing levels. Patients were complimentary about staff and the support they provided.

Leaders explained their recruitment processes to ensure appropriate numbers of suitably trained staff were employed to support the delivery of consistently safe, good quality care that met the needs of the patient population. They discussed recruitment efforts in the preceding 2 years to stabilise the practice team and ensure there were enough staff available in all functions. Staff told us they received the support they needed to deliver safe care and that they could request additional training or support if needed.

There were various policies related to the management of the practice to help maintain a safe and effective workforce. This included recruitment, appraisal, supervision, incident reporting, performance management and training. There were systems to ensure staff with specific protected characteristics were not disadvantaged. There were enough staff to provide appointments and prevent staff from working excessive hours. There was an effective approach to managing staff absences and busy periods. We reviewed staff training records and found not all staff had completed training to the appropriate level for safeguarding children or in learning disability and autism awareness. The practice took immediate action and provided evidence during our assessment to demonstrate that all staff had completed appropriate safeguarding training The practice advised they had identified this gap in learning disability and autism training prior to our assessment. Staff undertaking lead roles had completed appropriate training. During our assessment the practice assigned appropriate training to all staff and submitted evidence to demonstrate that all staff had completed part 1 of the training. They advised part 2 would be completed in October 2024.

Feedback we received from patients was limited regarding infection prevention and control (IPC). However, patients told us the surgery was always clean and well maintained.

Whilst the majority of staff were able to discuss their responsibilities in relation to IPC, we spoke to the recently appointed lead for IPC who advised they needed further training to ensure they could confidently carry out the role. They told us they were in discussions with management for support. We saw the IPC policy needed further review to ensure it was personalised to the service.

The practice was visibly clean and suitable personal protective equipment (PPE) was available throughout the practice. Information posters were displayed including those related to sharps injury management, effective handwashing and clinical waste management to support good practice.

IPC policies were followed and audits ensured infection control was reviewed regularly. Actions from audits were completed in a timely way or the risk was mitigated when delays occurred. The practice had clear roles and responsibilities, including a lead for IPC. Staff received role appropriate training.

We could not collect specific evidence from patient feedback to score this evidence category. Our observations raised no concerns. Feedback we received from care home representatives was positive about their experience on behalf of their residents in respect of managing medicines. They told us the practice was proactive in regular reviews of patients’ medicines.

Staff told us that they involved patients in decisions about their medicines during reviews and assessments. We found that staff had good knowledge of current and relevant best practice and professional guidance.

Medicines were stored safely and securely with access restricted to authorised staff. Blank prescriptions were kept securely, and their use monitored in line with national guidance. Staff had the appropriate authorisations to administer medicines including Patient Group Directions (PGDs) or Patient Specific Directions (PSDs). The practice held appropriate emergency medicines and systems ensured stock levels and expiry dates were monitored. A risk assessment had been undertaken for the decision not to hold specific emergency medicines. There was medical oxygen and a defibrillator on site and systems to ensure these were regularly checked and fit for use. Vaccines were appropriately stored, monitored and transported in line with The UK Health Security Agency (UKHSA) guidance to ensure they remained safe and effective. The practice could demonstrate the prescribing competence of non-medical prescribers, and there was a regular review of their prescribing practice supported by annual appraisals, clinical supervision and training.

There was a process for monitoring patients’ health in relation to the use of medicines including medicines that required monitoring (for example, warfarin, methotrexate and lithium). There was appropriate monitoring and clinical review prior to prescribing. The practice had a system for recording and acting on safety alerts. We carried out a remote review of the clinical record system and found appropriate actions had been taken in response to safety alerts received.

People’s medicines were appropriately prescribed and administered in line with the relevant legislation and current national guidance. Accurate, up-to-date information about people’s medicines was available, including when they moved between health and care settings. The remote review of patients who were prescribed medicines that required monitoring demonstrated that the majority of patients had received appropriate blood monitoring prior to medicines being prescribed. Our searches did identify 11 patients with heart failure who were prescribed medicines to support reduction of blood pressure who were overdue monitoring. We looked at 5 of these patients records and shared our findings with the practice. The practice undertook further investigations and found that for 6 of the 11 patients appropriate monitoring had been done in the hospital. For the remaining 5 patients the practice had contacted them and arranged an appointment for a review. Our searches also found that for 172 out of 247 patients who were prescribed blood thinning medicines did not have their creatinine clearance levels recorded in their notes. Creatine clearance is used to measure how well the kidneys are working. The provided evidence to demonstrate that they had recognised this as an area for urgent action in the months preceding our assessment. They advised they were in the process of recalling all of these patients to undertake the appropriate tests to ensure that up to date creatinine clearance scores could be recorded, rather than using historical data. In addition, following our feedback the practice reviewed all of the records for these patients and found they were able to calculate creatinine clearance scores for 66 patients, leaving 106 still to action. They assured us that work to review these patients was being prioritised for completion. Systems had already been developed and implemented to reduce the risk of recurrence.