Askern 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

At our previous inspection in September 2021, the practice was rated Good at providing safe service. At this assessment we have rated the practice as good for providing a safe service. We found safeguarding systems, processes and practices were implemented and that staff had received safeguarding training that was relevant to their role. We undertook clinical searches on the practices clinical system, which were positive. Recruitment checks were carried out in accordance with regulations, although record keeping could be improved. The practice were able to provide health and safety and infection, prevention and control risk assessments. However we were concerned that there was no learning or improvements made from complaints. We did not feel they could demonstrate that there was a suitable system for the recording of significant events. We were concerned about the safe use of CCTV in the practice.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Prior to our assessment we received whistle blowing information from staff and complaints from patients both of which told us that complaints were not being dealt with and when patients asked the staff about how to complain they would not help them. Following our assessment, we were not assured that complaints had been dealt with effectively and lessons learned from them.

From the staff questionnaires there were no concerns raised regarding significant events. Staff said they raised them and attended meetings where they were discussed. Leaders told us significant events were discussed at their 3 weekly multi-disciplinary team (MDT) meetings.

We discussed the processes for significant events with staff and they showed us their policy and the minutes of their regular meetings where these were on the agenda and discussed. We asked for the number of significant events in the last 12 months. We were provided with 3, we did not feel that the documentation was in depth enough or that there was a log of these which was held centrally to be re-assured they were being picked up and managed fully. We saw there was a system for recording and acting on patient safety alerts. Our clinical searches of the practice system did not raise any concerns for this.

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.

The lead GP and one of the practice nurses were the leads for safeguarding, an example of a safeguarding issue which was raised was shared with us by the lead GP.

Our assessment raised no concerns regarding safeguarding at the service and partners had no specific feedback on this area.

Arrangements were in place to safeguard adults and children from abuse that reflected relevant legislation and local requirements and policies were accessible to all staff. The policies outlined who to contact for further guidance if staff had concerns about a patient’s welfare. Patient records were tagged with alerts for staff if there were any safeguarding issues they needed to be aware of.

We were concerned about the risks to patients from being unable to access appointments and treatment. We received feedback from staff, whistle-blowers, the patients (via complaints to CQC and GP National Survey), the patient participation group (PPG) and a care home where patients were resident that being able to get through on the telephone and that access was poor. However we did not identify any negative impact on patients in terms of their care.

The leaders at the practice provided us with feedback they had collected this showed 87% satisfaction from patients. They believed their patient satisfaction to be much higher than the national averages and that the GP National Survey had been poorly responded to and they believed they offered the highest numbers of appointments locally. The clinical lead explained to us the process for processing 2 week wait appointments for patients (this allows a patient with symptoms which may indicate underlying cancer to be seen as quickly as possible). Palliative patients were discussed at the practice multi-disciplinary team meetings (MDT).

We saw that the provider had a developed clinical audit programme. They had a system in place to manage safety incidents. Our clinical searches raised no concerns regarding the clinical records. We were concerned about the risks to patients from being unable to get through on the telephone to the practice and therefore being unable to receive treatment and care, although we found no examples where care had been delayed from our assessment.

Prior to our assessment we received information alleging that CCTV was being used by the provider against staff in a controlling and coercive manner. The provider told us that the CCTV in public areas was to protect staff, they denied that it was being used against staff. There had been previous incidents where staff had been abused verbally and physically. CCTV was in the staff reception area to monitor patients where it overlooked reception We asked the provider to share with us their registration certificate with the Information Commissioners Office (ICO), as they must be registered with them to use CCTV, we did not receive this. We received the practice data protection impact assessment (DPIA) with reasons for using CCTV which the ICO requires Following our assessment we received whistleblowing information and staff feedback from several members of staff stating that they were unhappy and uncomfortable with the use of CCTV in the staff reception area. They told us this was used to monitor what staff were doing, it had never been explained to them the reason it was there in the staff reception. Senior members of staff had an application on their mobile telephone so they could watch the CCTV and they monitored what staff were doing, remotely and often they received telephone calls from the senior staff querying their movements. They understood the need for it in public areas The reasons given on the DPIA for using CCTV did not include the monitoring of staff, it was said to be necessary and proportionate for the prevention and detection of crime and safeguarding of staff and visitors. The DPIA stated that staff had been consulted about the CCTV and that they welcomed it Following high level feedback regarding CCTV to leaders at the practice they told us that CCTV in public areas was used to safeguard staff. The CCTV in the Mexborough branch had been installed many years ago and staff were involved at that time with the choice of cameras & areas of installation

We carried out a walk around of the practice on our site visit and saw the environment was satisfactorily maintained, for example, the emergency equipment medication, appropriate calibration of equipment and portable appliance testing (PAT). The practice was clean, and we saw the cleaning staff’s cleaning schedules.

We saw that health and safety and fire risk assessments had been carried out. There was a fire procedure. The practice were not following the correct processes in relation to the safe and appropriate use of CCTV as recommended by the Information Commissioners office (ICO) and the Surveillance Camera Commissioner (SCC).

Patient feedback on staff was mixed, some people said staff were good and others told us that there were not enough staff at reception or manning phones due to waiting times to get through.

From feedback staff told us that there were not enough staff working at the practice, there was a high staff turnover and high levels of sickness, this was due to the practice culture. Leaders told us that they struggled to recruit staff and were currently advertising for staff. They agreed that the staff files needed a re-organisation. They had experienced staffing difficulties at management levels.

We saw the practice had a recruitment policy which was updated regularly. Recruitment checks were carried out. We sampled recruitment checks for both staff and GPs and saw that checks had been undertaken prior to employment. For example, proof of identification, references, qualifications, registration with the appropriate professional body, staff had a contract of employment. However, we were concerned there was no overall oversight of DBS checks or for the provider to tell if and when a new check was needed or oversight of staff vaccinations.

Our observations raised no concerns regarding infection control at the service and we received no specific feedback from patients on this area.

Staff showed us round the practice and explained to us the process for infection control and provided us with the information we needed. Most staff who completed our staff questionnaires were aware of who the infection control lead was for the practice.

We observed the premises to be clean and tidy. Equipment was managed appropriately, for example, sharps bins were available in all clinical rooms; signed, dated safely sited & not over-filled. The process for managing clinical waste was explained.

Appropriate standards of cleanliness and hygiene were followed. There were infection and prevention control policies and we saw the most recent infection control, minor surgery audit and cleaning schedules. Staff had received the appropriate infection control training.

In the previous six months prior to our assessment of the practice CQC received 4 complaints from patients stating that they were unable to obtain repeat prescriptions and several whistleblowing from staff stating the same information. When we carried out the assessment any outstanding repeat prescriptions were waiting to be authorised in the prescribed time limits of the practice policy.

As part of our assessment we interviewed the clinical lead GP and practice pharmacist. They were able to explain to us systems for the appropriate and safe use of medicines, including medicines optimisation the practice had.

We saw that the practice ensured medicines were stored safely and securely with access restricted to authorised staff. Staff had the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions). There were appropriate systems and written procedures for the safe ordering, receipt, storage, administration, balance checks and disposal of these medicines, which were in line with national guidance. The practice held appropriate emergency medicines, risk assessments were in place to determine the range of medicines held, and a system was in place to monitor stock levels and expiry dates. 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 UKHSA guidance to ensure they remained safe and effective.

We carried out remote searches of clinical records as part of our assessment to check how the practice monitored patients’ health in relation to the use of high-risk medicines. We found that patients mostly received appropriate monitoring at the required intervals. For example; Our clinical searches highlighted 29 patients prescribed methotrexate which is an immunosuppressant medication. A sample of five of those patients showed they had received the required monitoring. Clinical searches highlighted 29 patients prescribed a potassium sparing diuretic. A sample of five of those patients showed that one patient had overdue monitoring. There was a medicines alert where patients who are prescribed medication to lower blood glucose levels should be advised of the risk of certain side effects, we could not see that this had been evidenced in the patients’ clinical notes. We were advised that the practice would follow this up.

From the medicines optimisation (prescribing) data which is received by CQC from the NHS business services authority (NHSBSA) we saw that the practice data was either in line with national prescribing or for one outcome had lower prescribing, for example; Percentage of antibiotic items prescribed that are Co-amoxiclav, Cephalosporins or Quinolones from 1/10/2022 to 30/9/2023, expected average 7.8%, practice average 4.1% Number of antibacterial prescription items prescribed per Specific Therapeutic group Agesex Related Prescribing Unit (STAR PU), expected average 0.91%, practice average 0.98%.