Billinge 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 a total of 7 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last assessment in April 2024. Our rating for this key question has improved from inadequate to good. We found that a number of improvements had been made. Safety was prioritised, and staff took all concerns seriously. When things went wrong, staff acted to ensure people remained safe. Managers investigated all reported incidents to reduce the likelihood of them happening again. Staff supported people to live healthy lives and provided them with support and information on their care and treatment. Relevant information was shared with staff and other agencies to enable safe care and treatment to be delivered. The practice was staffed by sufficient numbers of staff across a range of both clinical and non-clinical roles. Appropriate systems and procedures were in place to safeguard people who may be at risk of abuse. The premises were managed safely and infection prevention and control measures were in place. We noted that an area for improvement was improving the security of the premises. The provider had introduced a new clinical governance framework since our last inspection that included improved processes for monitoring patients’ health in relation to the use of medicines. Our review of the clinical patient record system for the sample of patients whose records we looked at showed that care and treatment had been delivered in line with evidence-based guidance overall. We identified some patients who were overdue reviews of health, however these had already been identified and recalled by the provider. An area for improvement we noted was that patient records should indicate the day of administration of methotrexate (a medicine to slow down the immune system and help reduce inflammation).

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.

Representatives from the PPG felt the provider took concerns seriously and proactively made improvements to the service. Ways to provide feedback were advertised at the practice and on the provider website, this included information about how to make a complaint.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed any issues impacting on service provision and learnt from significant events, complaints and safety alerts. Staff felt there was an open culture, and that safety was a prioritised.

The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others. The provider demonstrated that they had taken learning from our previous inspection and had introduced new systems in response to the findings and this resulted in better outcomes for patients in relation to access and the care and treatment provided.

Feedback collected by the provider showed that people felt involved in decisions about care and treatment pathways.

Staff demonstrated that they were knowledgeable about local services that they could refer people to, to support them with their immediate needs and to prevent ill health. Staff understood their responsibilities for monitoring the progress of referrals. They told us how they worked with people who used the service and other agencies to ensure safe systems of care and treatment when people were being supported by other services.

The provider worked with people who used the service and other agencies to ensure safe systems of care and treatment when people were being supported by other services. Feedback from the Integrated Care Board (ICB) was positive. The provider had engaged with the ICB to help them make improvements required and the provider was working with the Primary Care Network to improve services for patients.

Clinicians followed care and treatment pathways for treating and referring people to other services. Processes were in place to ensure referrals to secondary or specialist care were made promptly. People referred under the two-week wait rule for suspected cancer were followed up to ensure they had undergone the required investigations. Following the last inspection the provider had taken action to review the system of tasks (to identify follow up actions) used within the clinical record system. We observed this was up to date which indicated prompt action was being taken to support people who used the service. Correspondence from secondary care such as discharge letters and summaries were processed in a timely manner to ensure people had any follow up care needed. There were systems and processes to share information with staff and other agencies to enable continuity of care and safe care and treatment. Multi-disciplinary meetings were held on a regular basis and included representatives from external health and social care services. These provided an opportunity to discuss and arrange to meet the needs of people with complex needs and those approaching the end of their life. Reception staff had been trained in care navigation to direct people to the most appropriate service or services to meet their presenting needs. This included community services and local health and wellbeing services.

There was no specific feedback from people who used the service about safeguarding.

Staff had a strong understanding of safeguarding and were able to tell us how they would identify people at risk and take action to promote their safety and well-being. They knew who the responsible lead members of staff for safeguarding were. Lead staff were clear about their role and responsibilities.

There was a system to communicate any concerns about people to partner organisations such as district nursing, health visiting and social workers. This included scheduled meetings.

The practice had systems, practices and processes to keep people safe and safeguarded from abuse. There were effective systems to respond when it was suspected that people may be subject to abuse or neglect. Written procedures were accessible and flow charts indicating how concerns were to be reported were displayed throughout the practice. A system was in place to respond to requests for information from the local Multi Agency Safeguarding Hub (MASH) in a timely manner. A risk register was in place to identify vulnerable patients and review their needs and liaise with health and social care professionals as required. Regular meetings were held within the practice where safeguarding was a standing agenda item for discussion. Alerts were added to the patient record system when a person was subject to safeguarding concerns so that all relevant members of the team could easily identify concerns. Systems were in place to ensure staff were suitable to work at the practice. Recruitment checks had been carried out prior to employment, which included a Disclosure and Barring Service (DBS) check at the required level.

There was no specific feedback from people who used the service about involving people to manage risks.

Staff told us how they had been trained to direct people to the most appropriate clinician or service for their need. This included supporting people that may need urgent care and treatment. Staff and leaders told us how they worked proactively to support people with the prevention of ill health, for example, recalling people who were at risk of developing diabetes or referring people for dietary advice or smoking cessation.

A system was in place to direct people to the most appropriate clinician or service to meet their needs. Staff were trained in the management of long-term health conditions such as diabetes and chronic obstructive pulmonary disease (COPD). A system was in place to recall people for regular checks on their health when they had a long-term condition. When people did not attend, they were followed up. People who used the service were referred to services that could provide them with specialist advice to manage their condition and the risk of deterioration. People who were prescribed high risk medicines were called for regular checks. There was a system in place for dealing with safety alerts. People had been made aware of particular risks with regards to medicines in response to medicines safety alerts.

Staff and leaders told us they had reviewed the systems in place to ensure that risks to patients and staff from the premises were identified and addressed. Following the inspection in September 2023 leaders had developed an action plan to demonstrate how they would address the improvements needed to the safety of the premises. At this inspection and at an assessment in April 2024 we found these improvements had been made.

We looked at a sample of areas at the premises. We saw that changes had been made to the premises as a result of the safety assessments carried out. During our observation of the premises, we found that clinical rooms were locked when not in use. However, there were some areas where access was not restricted. The provider faced challenges presented by the ownership of the premises which was impacting on some of the changes they wanted to implement. For example, they wanted to improve the security of the premises with keypads. The provider was trying to resolve the issues presented by the ownership of the premises and in the interim had a documented risk assessment.

Following the inspection in September 2023, leaders had taken action to ensure that assessments of the safety of the premises were in place, comprehensive and up to date. We saw risk assessments had been completed in relation to fire safety, legionella, health and safety and disability access. An action plan had been documented for these risk assessments indicating action taken and a timescale for completing unresolved actions.

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.

There was no specific feedback from people who used the service about infection prevention and control.

Staff told us they were aware of their roles and responsibilities to prevent the spread of infection. Staff knew who the infection prevention and control lead for the practice was. They felt supported in understanding infection prevention and told us they received appropriate training, such as hand washing. Staff who handled clinical specimens knew how to do so safely.

We reviewed a sample of clinical rooms and non-clinical areas and found them to be clean and hygienic. Personal protective equipment was in sufficient supply and located appropriately around the premises. Cleaning schedules were in place and cleaning audits were carried out on a regular basis. Cleaning equipment was stored securely. We noted some mould on the wall of the cleaning cupboard which was brought to the attention of the provider to be addressed.

Procedures were in place to prevent the risk of infection. Staff had been provided with training in infection prevention and control. There was a dedicated infection control lead. An audit of infection prevention and control had been carried out and the Integrated Care Board (ICB) were due to carry out an annual audit. Actions from audits had been addressed. The provider had identified that the current limitations of the building impacted on infection prevention and control. They had taken steps to address this until building works were able to be implemented. For example, there was no sluice facility for cleaning equipment and a workaround had been risk assessed to mitigate infection risks. The arrangements for managing waste and clinical specimens kept people safe.

Patient feedback indicated that access to the service had improved which in turn improved the management of their medication.

Leaders were aware of their roles and responsibilities regarding medicines management. Staff received training and felt confident managing the storage, administration and recording of medicines. Staff managed medicines-related stationery appropriately and securely. Staff followed protocols to ensure people were offered all recommended medicines reviews and monitoring and that they prescribed all medicines safely.

Our observations of the management of medication indicated that improvements had been made. Staff managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. We saw that most checks were carried out weekly (as is recommended by the Resuscitation Council UK guidelines) apart from the anaphylaxis medication. The provider addressed this following the assessment. A risk assessment was in place to determine the types of emergency medication held. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. Patient Group Directions (PGDs) (written instructions to supply or administer medicines to patients in planned circumstances for example vaccinations) were in good order and correctly authorised. Prescriptions were held securely and there was a process for accountability /monitoring of prescriptions which included tracking the serial numbers and location of prescriptions.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. An area for improvement we noted was that patient records should indicate the day of administration of methotrexate (a medicine to slow down the immune system and help reduce inflammation) as indicated in a medicines safety alert. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. There were suitable processes for staff to follow when dispensing medicines. A sample of medication reviews were seen and indicated that these were appropriately documented and covered all the necessary information.

The provider had taken action to improve people’s experience and the safety of medicines prescribing since our last inspection. We reviewed clinical records for people who had been prescribed medicines which required routine monitoring. Our review showed that medicines were managed safely overall and the approach to medicines reflected current and relevant best practice guidance. We found that where patients were overdue a review the provider was aware of this and had taken steps to address this. Prescribing data for the practice showed no particular variation when compared to national averages. There was a programme of regular clinical auditing of prescribing that focused on improving care and treatment.