Bay Medical Group

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 all quality statements in this key question. At our last inspection the practice was rated requires improvement in safe. This was because systems and processes to ensure safe care was treatment were not always operating effectively, the provider had not always identified all risks, and they could not always demonstrate how they ensured that they had taken required remedial actions in a timely way. During this assessment, we found that some of the required improvements had been made. However, our rating for this key question is still requires improvement overall. We identified a breach of the legal regulations in relation to safe care and treatment. Some equipment was past its expiry date, infection prevention and control had not been effectively monitored, and there were some risks within medicines optimisation. We also found improvements to governance were required.

This service scored 59 (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 felt staff treated them with compassion and understanding. Representatives from the PPG felt the provider took concerns seriously and proactively made improvements to the service.

Managers told us they encouraged staff to raise concerns when things went wrong. They said that some significant events were discussed on the site they were raised, and for some there was a larger discussion. However, they said that a disadvantage to having such a large GP practice was that it was difficult to get everyone together for discussions. We received mixed feedback from staff. Although some said they attended meetings where significant events were discussed, some said they were only aware of significant events if they were directly involved in them, and others said the practice did not share incidents, significant events and learning with staff.

A new system had been put in place for incident reporting in March 2024, and the policy was updated at this time. The policy gave information on how to report incidents and how they may be dealt with, but it did not give full details about the whole process and how learning would be actioned and monitored. The policy stated, “Larger incidents may be discussed during a Quality, Safety and Governance (QSG) meeting”. QSG meetings were attended by some GP partners and managers. We saw that significant events had been discussed in the July 2024 meeting, but had not been discussed in the 2 meetings prior to that (in April and June 2024). Significant events were collated onto a spreadsheet. However, significant events were also raised from some complaints, and these were not included on the spreadsheet. We discussed 2 serious significant events which had been raised from complaints. These were due to be discussed with the team in a meeting in October 2024. The practice had been aware of 1 of these since August 2023, but relevant staff at the practice had not been involved in discussions about what went wrong and if there was any learning from the significant event.

When people moved between services, there was a plan in place for what happened next, who would do what and all the practical arrangements were in place.

Managers and staff could explain how people moved between services. Staff understood their responsibilities for monitoring the progress of referrals.

Partners had no specific feedback on this area.

Shared care requests were adhered to in conjunction with the policies and protocols put in place by the practice.

People felt safe and supported to understand and manage any risks.

Safeguarding concerns were discussed within teams, but not all staff were aware of who the safeguarding leads were within the practice.

Partners had no specific feedback on this area.

There were systems, processes and practices to make sure people were protected from abuse and neglect within the practice, but these were not always effective. The practice provided us with their ‘Bay Medical Group Safeguarding Adults Policy’. This was version 5 and had last been reviewed in October 2021. It was due to be reviewed in October 2023 but this had not occurred. The lead GP for safeguarding adults, named in the policy, was not named as being in attendance or having given their apologies, in the recent safeguarding meeting minutes the practice supplied us with. The policy did not name a deputy lead. We were provided with the ‘Bay Medical Group Safeguarding Children Policy’. It was unclear if this had been due to be reviewed in October 2023 or January 2024, but the review was overdue. The policy referred to Clinical Commissioning Groups (CCGs). Integrated Care Boards (ICBs) replaced CCGs in July 2022. The policy stated that all GP practices should have a safeguarding lead and a deputy lead. There was no named lead or deputy in the policy. Following the assessment, the practice informed us that the policies had been provided by the ICB. They told us they had asked the ICB for updated versions but had been told to use the old policies while they were under review.

We saw examples of people who had not contacted the practice when their condition had not improved. There was no monitoring of people who had been told to contact the practice.

There was a balanced and proportionate approach to risk that supported people and respected the choices they made about their care. For example, managers told us that people were able to request home visits to meet their care needs.

During our assessment we saw that people who were very unwell when they contacted the practice were prioritised. However, systems to monitor people who had seen a GP but may need a follow up appointment were not always adequately monitored.

Staff and leaders told us about how the environment was monitored to keep people safe. We asked how they managed the calibration of equipment. Staff told us the equipment from each room was taken into one room when it was due to be calibrated. Following the assessment the practice told us some items are sent off when due to be serviced, and for some items staff receive reminders about the process and where to leave them to be serviced/calibrated.

We saw equipment that had not been calibrated at 3 of the 5 sites we visited. On 1 site, the patient toilet that was signed as a disabled toilet did not have an emergency cord or call button. The pads on 1 of the defibrillators had expired. There was a sticker on the outside of the defibrillator stating “Needs new pads”. A new set of pads was on the emergency trolley but had not been attached to the defibrillator, so it was not ready for use in an emergency. We saw that weekly checks were carried out, and a tick had been put against the box for ‘defibrillator pads’ each week, indicating that they were in date. The check sheet included a space for the expiry date, but this had been left blank.

The practice had health and safety, fire and premises risk assessments and actions plan in place to keep the environment safe for people. However, risk assessments had not highlighted uncalibrated equipment and the lack of an emergency cord in the disabled toilet. There was no system in place to ensure that all relevant equipment was safe to use. Actions required following previous fire risk assessments had been actioned. The practice had started to have estates meetings with the site managers to discuss any issues and improvements that may be needed.

People felt they had considerate support delivered by competent people.

Staff and leaders told us staff received the support they needed to deliver safe care. This included supervision, appraisal and support to develop, improve services and where needed, professional revalidation.

Staff received training appropriate and relevant to their role. We saw that staff had annual appraisals and also mid-year reviews. There was a documented induction process for new staff to the practice or those who changed roles. Clinical staff also had regular supervision sessions and an appraisal. When locum clinicians worked at the practice they were provided with written guidance.

People were not fully protected from the risk of infection because premises and equipment were not always clean and hygienic.

Not all staff knew who the infection prevention and control lead for the practice was. Staff received training on infection prevention and control. Staff who handled clinical specimens knew how to do so safely.

We visited all 5 sites as part of the assessment, and we observed issues relating to infection prevention and control at each site. We found stock past its expiry date at 2 sites. At 2 sites there were plugs on chains at the clinical room hand wash basins, and some sinks had overflows. Not all taps on hand wash basins were elbow or motion activated. Some radiators were rusty, and we saw the base of a clinical waste bin was rusty. Guidance from December 2023 removed the requirement for sharps disposal units to be disposed of after 3 months. However, we saw 2 sharps disposal units, on 2 different sites, that had been open since 2020. We observed a cracked plastic drawer unit next to an examination couch, and a tear on an examination couch. On 2 of the sites, we found dusty areas in clinical rooms. The manager at 1 site looked into this and told us it was not included on a cleaning schedule. These are all infection control risks.

Roles and responsibilities around infection prevention and control were not always clear. The approach to assessing and managing the risk of infection was not effective. The practice supplied us with infection prevention and control audits. These were not always dated and did not always detail which site they related to. Some audits had not identified issues found during this assessment. For example, although rust spots on some radiators were highlighted, the radiator with the most significant rust was not highlighted. Also, audits had not highlighted plugs being present in the hand wash basins. The QSG had discussed replacing taps with long arm mixer taps and this was being considered. The lead nurse for infection prevention and control had arranged for the link nurses from each site to meet regularly to discuss issues. This was a new system that started in April 2024. A rolling programme of audits had been put in place and meeting minutes confirmed these were being discussed, with the system being formalised throughout the sites. The lead nurse had started giving new staff more thorough training on infection prevention and control and this was being rolled out to all staff. They explained they were on a learning curve and the systems and processes would be reviewed and amended if required.

Staff did not always involve people in reviews of their medicines or help them understand how to manage their medicines safely.

Staff received regular training on medicines management, and felt confident managing the storage, administration and recording of medicines. Staff managed medicines-related stationery appropriately and securely.

We saw staff managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. They stored medical gases, such as oxygen, safely and completed required safety risk assessments. We found medicines in a drawer that had been prescribed to people. Staff told us they should have been disposed of as they were no longer required.

The provider had systems to manage and respond to safety alerts and medicine recalls. Staff followed processes to ensure most people prescribed medicines with specific risks received recommended monitoring. At our previous inspection, in October 2023, our clinical searches identified a large number of patient records where a clinician had entered ‘medication review’. There was no evidence of what was discussed at the review, whether the person was spoken with, or confirmation of relevant tests being checked for ongoing safe prescribing. At this assessment our clinical searches found this had not improved. The Registered Manager told us they had a lot of medication reviews to carry out and there was no protected time for recording these. At our previous inspection, in October 2023, our clinical searches identified that for people prescribed Methotrexate (a medicine used to treat autoimmune conditions), the prescriber had not recorded which day of the week the medicine should be taken. A medicines safety update in 2020 advised prescribers to inform people what day methotrexate should be taken and record this in their records. At this assessment our clinical searches found this had not improved. The process for authorising nurses to administer certain medicines was not effective. We saw examples of nurses being added to Patient Group Directions (PGDs) without GPs authorising them. Some PGDs had the dates overwritten, and on some, nurses had not signed the PGD sequentially. A nurse told us they had checked the PGDs the day before our site visit and made some changes as they realised they were incorrect.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. There was a programme of regular clinical auditing of prescribing that focused on improving care and treatment.