Castletown Medical Centre

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

At our previous inspection in August 2023 the practice was rated Good at providing safe service. At this assessment we have rated the practice as requires improvement for providing a safe service. We found that staff training, and recruitment records were incomplete. Patients were being referred to extended access services as due to lack of trained staff, the practice could not provide a full range of services. We undertook clinical searches on the practices clinical system, which were mostly positive.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received no specific feedback directly from patients in this area. However, we saw there was a system for recording and acting on patient safety alerts. Our clinical searches of the practice system showed that actions were taken in terms of reducing the prescribing and managing of these medications, however discussions of risks to taking these medications were not recorded as discussed with patients.

Feedback from staff regarding significant events was mixed. Some staff said they knew how to raise these and attended meetings where they were discussed, others did not comment about this, and some staff told us they were only shown how to add incidents and events to the local Safeguard Incident & Risk Management System (SIRMS) when our assessment was announced. There were no specific concerns raised regarding complaints. Leaders discussed with us examples of significant events and complaints.

The practice leaders provided us with a copy of their significant events and complaints policy. We saw some examples of significant events which had been actioned and learning outcomes documented and examples of complaints which had been investigated. We saw 3 examples of minutes of practice meetings however, there was no documentation of significant events or complaints being discussed at these meetings.

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.

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

We received no specific feedback from patients in this area. However, we found that there were insufficient qualified, competent, effectively trained and skilled staff deployed at the practice. This therefore raising concerns for peoples experience of care at the practice.

Staff feedback told us that there were not enough staff working at the practice, particularly a lack of clinical staff and there was a high staff turnover. The employment records showed that all but 2 of the staff employed had worked at the practice for less than 3 months. Staff said they had not received enough training or guidance. Some staff told us they had to teach themselves how to use the clinical system at the practice. The provider told us they did not employ a permanent practice nurse. Staff had fedback to us that this had been a challenge for the practice. This meant patients had to sometimes be refferred to extended access services for cervical screening and urgent phlebotomy as they could not always provide these services. The latest cervical screening performance showed the practice at 74.3%, when the target was 80%. The lead GP was trained to deliver child immunisations as there was no nursing capacity to carry this out.

We saw that training records were incomplete. In particular there was a lack of safeguarding and basic life support training for staff. Two members of staff out of 8 had completed either adults or child safeguarding training and there were no records of staff having received basic life support training. There was no central record to manage training. Following our assessment the practice sent us some training certificates by email, for 4 members of staff, almost all of which were completed after our site visit. However, we were unable to formally confirm this training with staff. Therefore gaps in training remained. We saw that from staff induction forms only 2 were fully completed. Six were either incomplete or only the identity details completed or there was no record of 1. The provider told us that staff had received some sepsis awareness training at induction. This was not recorded on at least 6 of 8 induction forms. Recruitment procedures were not established or operated effectively. Disclosure and barring checks (DBS) were not effective, checks had not yet been obtained for all staff and there was no rationale held for this. Some references had not been obtained for staff. There were gaps in records of job offer letters and job descriptions. There was not an effective employee immunisation programme. Only 1 member of staff had a record of immunisations. Staff had raised concerns with us about the provider not giving them a contract of employment. On the day of our assessment the provider asked staff to sign their contracts whilst we were on site. They then told us that these had been signed on the day the staff commenced employment or in the days after this. There were no contracts of employment available for staff who were not at work on the day of our assessment.

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.

We received no specific feedback from patients in this area. However, we had some concerns regarding monitoring of patient’s medication which would affect their experience of care.

As part of our assessment we interviewed the clinical lead GP and practice pharmacist. They were able to explain to us systems for the appropriate and safe use of medicines, including medicines optimisation the practice had.

We looked at Patient Group Directions (PGD’s) as part of the assessment. We found that 2 PGD’s from February and April 2024 had no authorising manager. We saw there were 2 PGD’s from April and July 2024 which had expired. The practice held appropriate emergency medicines, risk assessments were in place to determine the range of medicines held, and a system was in place to monitor stock levels and expiry dates. There was medical oxygen and a defibrillator on site and systems to ensure these were regularly checked and fit for use. Vaccines were appropriately stored, monitored and transported in line with UKHSA guidance to ensure they remained safe and effective.

We carried out remote searches of clinical records as part of our assessment to check how the practice monitored patients’ health in relation to the use of high-risk medicines. We found that patients mostly received appropriate monitoring at the required intervals. For example; Our clinical searches highlighted 6 patients prescribed methotrexate which is an immunosuppressant medication. A sample of five of those patients showed they had received the required monitoring. Clinical searches highlighted 61 patients prescribed direct oral anticoagulants (DOACs) which are a type of anticoagulant medication. A sample of five of those patients showed that there was no robust evidence of systematic recall to monitor these patients.

From the medicines optimisation (prescribing) data which is received by CQC from the NHS business services authority (NHSBSA) we saw that the practice data was higher with national prescribing or two outcomes and in line with another indicator, for example; Percentage of antibiotic items prescribed that are Co-amoxiclav, Cephalosporins or Quinolones from 1/4/23 to 31/3/2024, expected average 7.8%, practice average 11% Number of antibacterial prescription items prescribed per Specific Therapeutic group Age sex Related Prescribing Unit (STAR PU), from 1/4/23 to 31/3/2024, expected average 0.86%, practice average 1.26%.