Private GP Clinic Ltd

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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 5 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good. We found the practice had a culture of openness and support when things went wrong. The learning and development needs of staff were assessed, and they were supported to deliver care and treatment safely and to an appropriate standard. However, the provider had failed to identify some of the risks we found during our assessment including those relating to recruitment checks and lack of peer review for a radiographer working with the practice. We shared this with the provider who took immediate action in response to the feedback.

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.

We have received 3 'Give feedback on care' submissions related to this assessment. Patients reported that they had sufficient time during their consultation and felt actively involved in decisions about their care and treatment. Patients were given the opportunity to provide feedback after their appointment and were aware of the process for making a complaint if needed.

Staff and leaders told us that significant events were investigated, and learning was shared with all staff. There were clear management and accountability arrangements. Staff understood their role and responsibilities, including when and how to raise concerns and near misses. Minutes of meetings demonstrated that all staff were kept up to date with any changes to guidelines and best practice.

We found there were systems and processes to share information with staff and other services to enable them to deliver safe care and treatment. There were monthly clinical, and all staff meetings and minutes of the meeting were disseminated to all staff members. Complaints and significant events were appropriately recorded, and lessons were learnt and shared to improve care. We noted there were appropriate referral pathways to make sure that patients’ needs were addressed.

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.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

Staff informed us that the premises were fit for purpose and provided a conducive environment for providing clinical care. Interviews with staff indicated that there were trained fire marshals designated for each site.

We observed the premises were clean and tidy. Clinical waste was appropriately managed and there were arrangements in place for regular waste collection. Panic alarms were fitted in each room across all sites, and all staff understood how to respond to the alarm.

There were systems in place to monitor the safety and upkeep of the premises. Regular checks were completed by the provider to ensure the environment and equipment was safe for people to use. The practice had a range of risk assessments in place for their 6 sites, related to fire, premises, legionella and related actions were appropriately identified and completed. There was a record of portable appliance testing and medical equipment was calibrated.

Patient feedback suggested staff had skills, knowledge and experience to deliver effective care, support and treatment.

Staff told us they were encouraged to learn and develop and there was a thorough induction programme for all new staff. We saw evidence that a member of nursing staff was supported to progress to her registered nurse degree while working with the service. Through our discussions with staff and managers, they demonstrated they had the experience, capacity, and capability to ensure high quality care.

There were processes for staff to have regular appraisals, one to one meetings and clinical supervision. However, there was no peer review or clinical audit in place for the radiographer working with the practice, in line with professional body guidance. We shared this information with the provider who indicated there were plans in place to address this. We found that staff were trained to appropriate levels for their role. Recruitment checks were generally carried out in accordance with regulations, however we found recruitment records for 4 staff members did not adhere to the practice policy and their full employment history, references, training records, and Disclosure and Barring Service (DBS) information were not in place as per the practice policy, prior to their employment. There was a lack of oversight in maintaining records for these staff. This was raised with the provider during the onsite assessment and immediate steps were taken to ensure that all appropriate checks were carried out. We saw evidence that DBS checks for those staff had been applied for within the duration of our assessment but had not been returned.

The arrangements for managing waste and clinical specimens kept people safe. Feedback from patients did not indicate any concerns regarding infection control.

Interviews with staff indicated all staff had completed the infection prevention and control training relevant to their role.

There were good standards of infection control in place for all sites. Infection prevention and control (IPC) audits were in place for all sites. However, there was an ineffective system in place to manage reusable instruments used for one procedure provided by the practice. We found that a local dental practice was providing decontamination services to the provider, including transportation of contaminated instruments. This was raised with the practice during the assessment, and as a result, they updated their policy to discontinue the use of reusable instruments for all future procedures.

Policies and procedures were available to staff which provided guidance and information on infection prevention and control (IPC) practices. The practice had acted on any issues identified in infection prevention and control audits.

People’s feedback in relation to the safe management of their medicines was limited. The practice had a travel vaccination service that was well managed and coordinated.

We were told by staff they had access to safety and medicines alerts. There was regular review of prescribing practices, supported by clinical supervision.

We found that staff had the appropriate authorisations to administer medicines and vaccinations, including Patient Group Directions and Patient Specific Directions. Appropriate emergency medicines were held at each site and were checked regularly. Systems were in place to ensure the temperature ranges of fridges used to store medicines were monitored and recorded daily. The practice ensured controlled drugs were stored safely and securely with access restricted to authorised staff. However, recording of controlled drug usage was not in line with requirements. The administration of controlled drugs to individual patients was not accurately recorded within the controlled drugs register.

There was regular review of prescribing practices, supported by clinical supervision, for clinicians. The practice had a programme of targeted quality improvement and used information about care and treatment to make improvements. The practice shared their audit action plan which demonstrated audits to that had been completed in the last 12 months. We found there was a lack of a clear protocol for the preparation and administration of local anaesthetic for varicose vein procedures. This was raised with the provider during the assessment who took some initial steps to improve the relevant protocols and guidance available to staff. The provider had failed to set out their approach to identifying and managing potential local anaesthetic toxicity. There was a lack of risk assessment and protocol to support the observation, recognition and treatment of local anaesthetic toxicity and the management of a deteriorating patient