Manor and Park Group 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

Safeguarding systems, processes and practices had been implemented. Staff had received safeguarding training relevant to their role and understood how to report concerns. Recruitment checks were carried out in accordance with regulations. Safe staffing levels were in place and the provider had recently successfully recruited several new clinical staff into the practice. Staff training was appropriate and up to date and staff had received induction, annual appraisal and clinical supervision. Safe systems, pathways and transitions were in place. Referrals to specialist services were appropriate and monitored and there was a documented approach to the management of test results. Appropriate systems for the safe management of medicines including emergency medicines and equipment and medicines optimisation was in place. However, some processes required review. For example, recording and coding in the clinical system advice given to patients on some high risk medicines, room temperature checks where medicines were stored at the branch site and risk assessment of one emergency drug not stocked. We observed medicines alerts were being actioned appropriately although there was no monitoring overview of these to confirm what actions had been taken on previous alerts. There was a positive learning culture. Staff knew how to identify and report concerns, safety incidents and near misses. The practice learned and made improvements when things went wrong.

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.

Leaders told us they used incidents and complaints to improve systems and processes. Staff understood their duty to raise concerns and report incidents and told us these were discussed in team meetings to identify learning. Staff and leaders were able to share examples of incidents and complaints, learning and improvement. Staff told us they felt able to raise concerns when things went wrong.

People told us that they had opportunities to provide feedback and they knew how to make a complaint. The practice displayed feedback forms in the practice and information on how to make a complaint was available on site and on the practice website.

The practice had a significant event policy and complaints policy which was accessible to all staff members. The practice discussed events and incidents during team meetings and learning was shared with staff. The practice had a duty of candour policy and involved people when managing significant events and errors. The practice had a clear system in place to record and investigate complaints. From the sample of complaint records we reviewed, we found the practice responded to peoples’ complaints in a timely manner. The practice offered apologies to people when appropriate, lessons were learnt from individual concerns and complaints and action was taken as a result to improve the quality of care. The provider held a complaints log which they used to identify themes and trends.

We did not receive any concerns from commissioners or other system partners about delayed referrals or safe systems of care.

Leaders and staff told us that patients could book an appointment to see the same GP for continuation of care if requested. Staff who undertook referrals to secondary care understood the e-referral system and there were appropriate systems in place to prevent delays. Staff had a good understanding of local referral processes and arrangements. Staff told us they attended regular multidisciplinary team meetings where patients who may be vulnerable or those receiving end of life care were discussed and any actions agreed were recorded in patient records.

The provider had appropriate processes in place for referral to secondary care and specialist services. We saw these were completed in a timely manner and there was cover in place when staff who carried out this role were absent. There were clear processes in place for taking action when the practice received letters or discharge summaries from the hospital. Any actions required from these were forwarded to the appropriate person to take action for example, the Pharmacist to change medication. We reviewed the task lists on the clinical system which showed these actions were managed in a timely manner. The service carried out regular multidisciplinary team meetings to discuss patients who may be vulnerable. Minutes were seen where patients were discussed. We observed care records were updated to reflect any decisions made.

We did not receive any concerns from patients about delayed referrals or safe systems of care.

We did not receive any concerns from commissioners or other system partners about safeguarding systems and processes.

All staff had received training in safeguarding children to the appropriate level for their role in line with the Safeguarding Children intercollegiate guidance. All staff had received adult safeguarding training. There was a safeguarding policy in place which was accessible to all staff on the practice’s computer system. The practice held regular safeguarding multidisciplinary team meetings. These were attended by clinicians, lead administrator and district nurses. We saw minutes of these meetings and observed any actions discussed were recorded in individual patient records on their clinical system. Children on the safeguarding register had alerts on their records and their notes were tagged to their guardian.

Staff told us they had received training in safeguarding children and adults. They knew who the safeguarding lead in the practice was and how to raise concerns. Staff told us they attended regular safeguarding multidisciplinary team meetings.

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 provider had appropriate recruitment processes in place. We reviewed 3 personnel files during the site visit and found appropriate recruitment checks had been carried out, including disclosure and barring (DBS) checks. We reviewed the training records and found all staff had received and were up to date with mandatory training and training required for their role. Clinical staff had access to regular clinical supervision and we saw competency checks were being carried out for staff new in roles, for example, the clinical pharmacist. There were regular meetings including clinical meetings and we saw minutes of these.

Leaders told us they had recently recruited to several clinical vacancies in January 2024 and they were now clinically fully staffed. Staff told us they had received training relevant to their role and they had access to clinical supervision where appropriate. They told us they received regular appraisals and that their development and training was discussed in the appraisal. Staff told us they attended regular team meetings. Leaders told us they were supporting staff to develop. For example, an administrator was being supported through the practice manager program.

Some people had reported difficulty accessing services and thought there were not enough staff.

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.

During our clinical searches we found structured medicine reviews were carried out and patients on high risk medications were appropriately monitored. We identified some areas that required review but these related to processes. For example, coding and recording in the clinical record. The practice had systems in place to receive, review and act on medicine alerts although they did not keep a monitoring overview of these.

Staff and leaders told us they had systems and processes in place to support the safe prescribing of medicines. The practice employed 2 clinical pharmacists who supported the GPs in the practice. Prescribing and medicines management were discussed regularly at clinical meetings.

People told us they were appropriately involved in decisions about their care, including their medicines.

During our checks we found all medicines were stored securely throughout the main practice and branch site although the room where medicines were stored in at the branch site was hot and did not have a thermometer to check the room temperature. The practice held appropriate emergency equipment and emergency medicines at the main practice and branch site, with the exception of one medication to treat seizures. The lead nurse had a rational for not stocking this, however, they didn’t have this documented in a risk assessment. Emergency equipment and medicines were checked on a regular basis. Vaccines were ordered and stored in accordance with national guidelines and the practice had systems in place to monitor the temperature of vaccine fridges.

The practice had a policy in place for the management of medicines including repeat prescribing. The practice had systems in place to monitor the appropriateness of non-medical prescribers and clinical supervision was in place. The practice had good systems in place for the safe and effective management of clinical correspondence. Accurate and up-to-date information about people’s medicines was available, particularly when they moved between health and care settings. The practice had up-to-date Patient Group Directions (PGDs) in place for nurses carrying out specific vaccinations and healthcare assistant staff had a good understanding of Patient Specific Directions (PSD’s). All staff administering vaccinations were up to date with refresher training.