Baslow Health Centre

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• 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 8 quality statements from this key question. Our rating for this key question is now good. We found safety was a top priority, and staff took all concerns seriously. When things went wrong, staff acted to ensure people remained safe. Leaders investigated all reported incidents to reduce the likelihood of them happening again. Systems were in place to safeguard vulnerable people, ensure that medicines were prescribed safely, to maintain a safe environment and effectively train staff to carry out their roles.

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.

People felt supported to raise concerns and that staff treated them with compassion and understanding. A representative from the Patient Participation Group felt the provider took concerns seriously and proactively made improvements to the service. For example, the practice had updated their telephone system to improve access to the service.

Leaders encouraged staff to raise concerns when things went wrong. Staff were aware of the process for reporting significant events and complaints and of the need for duty of candour when an incident affected the care of a patient. Staff felt that there was an open and supportive culture and that leaders treated safety as a top priority.

Processes were in place for staff to report significant events, 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 significant events and complaints resulted in changes that improved care for others. The provider reviewed significant events and complaints to identify any trends and acted on their findings.

Feedback received by the Care Quality Commission was very positive regarding pathways for providing care and treatment for people. People gave examples of how clinicians had collaborated with them in their care and treatment. Care and support were planned and organised with people and with collaboration with partners that ensured continuity of care.

Feedback from staff and leaders demonstrated a strong awareness of the potential risks to people transitioning through care pathways. For example, staff were aware of their responsibilities in following up people that failed to attend appointments such as childhood immunisations. Clinical and non-clinical staff were aware of actions to take if they encountered a deteriorating or acutely unwell person.

The practice provided weekly ward rounds to people that lived in a care home to ensure continuity of care and a joined-up approach to safety. A representative from the home a named a GP that provided brilliantly effective care and that the practice always responded on the same day they made requests for a person to be reviewed.

Systems were now in place to ensure that Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Decisions were made in line with relevant legislation and copies were appropriately stored in peoples’ electronic records. There was appropriate clinical oversight of referrals, admissions, discharges and test results. On the day of our assessment there were no outstanding test results or documents awaiting processing.

Staff and leaders had completed safeguarding training at a level appropriate to their role. There was a strong understanding of the actions to take if they witnessed or suspected abuse and who the safeguarding leads within the practice were. Staff attended regular safeguarding meetings with internal and external partners such as the community matron and district nurses.

The Integrated Care Board had carried out a review of the safeguarding systems within the practice and concluded that appropriate systems were in place to protect people from abuse.

Effective processes and practices were in place for reviewing the care and treatment of children and vulnerable adults at risk of abuse. Appropriate action was taken when people were found to be at risk. Alerts were added to the records of people with a known safeguarding concern and relatives living in the same household. There was a multidisciplinary approach to managing safeguarding concerns.

Indicators from the 2024 National GP Survey showed that 99% of respondents felt involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. This was above the national average of 91%. Feedback received by the CQC showed that people were informed about risks and how to keep themselves safe.

Staff were now aware of where emergency medicines and equipment were kept. Staff described an incident where a person required emergency treatment. Everyone worked very effectively as a team which resulted in a positive outcome for the person. Staff involved people in managing risks for example, prompts to follow up on 2 week wait referrals for potential cancer.

Systems were in place to support people to be as involved as they could be to understand and manage risks to their own health, safety and well-being. This was demonstrated through our remote clinical searches which looked at medication reviews, prescribing and adherence to medicine alerts. Emergency equipment held within the practice did not include portable suction and a risk assessment to mitigate this risk had not been completed. Following our assessment the provider forwarded evidence to us that a suction unit had been purchased. Emergency medicines were in place and a risk assessment had been completed to determine medicines to stock in the practice. However, the risk assessment did not include the actions to take in the absence of intramuscular analgesia. Medicines to use in the treatment of seizures, which had been identified in the practice’s risk assessment, were not available within the practice or dispensary on the day of our assessment. Following our assessment the provider updated their risk assessment and sent evidence that the 2 required medicines had been purchased and were available in their emergency medicines.

Leaders and staff considered the environment to keep people safe. Regular fire safety drills were completed. During a clinical emergency, the practice staff had effectively worked together to successfully treat a seriously ill person. There was a suite of risk assessments which staff had access to on the practice’s risk register. Staff were satisfied with the health and safety arrangements within the practice.

People were cared for in safe environments. Where potential risks were identified, action had been taken. For example, there was a system in place for steaming chairs, that were not wipeable, until they could be replaced. Facilities, equipment and technology were well-maintained and supported staff to deliver safe and effective care. We found that signage around the practice was written on yellow paper to direct people with a learning disability or visual impairment.

Risk assessments were in place to mitigate risks within the premises. For example, fire, legionella and oxygen. There was also a system of carrying out regular safety checks such as gas and electricity safety and calibration of medical devices. There were effective arrangements to monitor the safety and upkeep of the premises.

Feedback received by the CQC from people that used the service showed that people were very positive about the service provided by staff. They described staff as kind, caring, knowledgeable and stated staff gave them all the time they required to discuss issues.

There were enough staff to provide safe, high-quality care. The systems and rotas in place ensured adequate staffing levels during sickness and busy periods. Staff had completed the required essential training and were given protected time to do this. They received annual appraisals and supervision when required. Staff groups were now supported by regular team meetings and monthly all teams’ meetings.

There were robust and safe recruitment practices to ensure that all staff working in the practice and its dispensary, including agency staff and volunteers, were suitably experienced, competent and able to carry out their role. The practice’s recruitment policy now included all of the required recruitment information as legally required. Practice nurses now held regular team meetings. Systems were now in place to ensure staff had received appropriate healthcare immunisations. Where evidence of immunity was not available, risk assessments had been completed to mitigate potential risks. There was a system in place for monitoring that staff had completed all of the required training to safely carry out their role.

We did not receive any feedback from people regarding the cleanliness of the practice.

Staff now received infection prevention and control (IPC) training and they felt that systems were in place to ensure IPC arrangements were sufficient to protect staff and people that used the service. Practice nurses had systems in place to clean equipment used in the care of patients, for example ear syringing equipment. The IPC lead carried out regular hand washing audits and an annual IPC audit of the premises. Where issues had been identified they had been addressed or were in the process of being addressed.

The practice was visually clean and tidy on the day of our assessment. Staff had access to personal protective equipment and that clinical waste was stored and disposed of appropriately. We observed damp patches on the ceiling of one of the consultation rooms however, the provider was aware of this and had arranged for this to be repaired on 2 November 2024.

An infection prevention and control (IPC) audit had been completed in February 2024. The audit had identified cracks in one of the ceilings. A date had been arranged for this to be repaired by an appropriate person. The IPC audit had not identified that the seats within the practice were not wipeable however, a risk assessment had been completed to mitigate potential risks until the chairs could be replaced. The provider updated their IPC audit immediately after our assessment. Risk assessments had been completed to manage other potential IPC risks such as legionella and the absence of immunisation to potential healthcare acquired infections in staff.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. We received feedback from a patient who was positive about the service the dispensary provided and stated that dispensers were approachable and welcoming. A representative from a care home where the practice provided care and treatment told us that repeat prescriptions were always dealt with within a timely manner.

Staff received regular training on medicines management, and felt confident managing the storage, administration and recording of medicines. Staff working in the dispensary had received appropriate training and competency checks to carry out their roles. Staff followed protocols and standard operating procedures to ensure they prescribed and dispensed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Staff that delivered immunisations in peoples’ homes were aware of the processes to follow when transporting vaccines. Staff had the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions). There was a system in place for acting on medicine alerts and sharing learning from national guidance.

Staff working in the practice and its dispensary managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Staff showed how they disposed of expired or unwanted medicines that people had returned. There was a process for monitoring peoples’ health in relation to the use of medicines including medicines that required monitoring. We found that these systems were highly effective in maintaining the safety of people prescribed these medicines. Whilst systems were in place to record prescription stationery received into the practice, there was no system to track their movement throughout the practice. Immediately after our assessment the provider sent us evidence to demonstrate that systems had now been put in place.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established and highly effective processes to ensure people prescribed medicines with specific risks received the recommended monitoring. There were suitable processes for staff to follow when dispensing medicines. There was a policy in place to support the maintenance of the cold chain when storing vaccines, however, it did not include guidance on maintaining the cold chain during the transportation of vaccines. Following our assessment, the provider sent us evidence that the policy had been updated.

Clinicians followed national guidance to ensure medicines were appropriately prescribed to optimise care outcomes, for example antibiotics, medicines to induce sleep and medicines to improve low mood. National prescribing data supported this. For example, the number of antibiotics prescribed by the provider for the treatment of uncomplicated urinary tract infections was significantly lower than the national average.