Spinney Hill 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

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 84 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a strong proactive and positive culture of safety, based on openness and complete honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

The practice encouraged a genuinely open culture for all concerns raised by staff and patients which were highly valued as being integral to learning and improvement. People felt supported to raise concerns and felt staff treated them with compassion and understanding. The practice staff were proactive at trying to support patients with all concerns to better support patients’ journeys, including any non-medical issues. The practice encouraged a culture of trying to make patients day better, and solve the patients issues as quickly as possible. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service which included their feedback. Managers encouraged staff to raise concerns when things went wrong. Learning from incidents and complaints was thoroughly analysed and investigated and resulted in changes that improved care for others. Regular detailed staff meetings discussed learning events, included wider discussions and the provider was proactive at reviewing incidents at all levels to identify any learning. This learning was then often shared with the wider Primary Care Network (PCN) or wider Integrated Care Board (ICB) if necessary to support innovation across the locality. Staff felt there was an open culture, and that safety was a high priority. The provider had processes for staff to report incidents, near misses and learning events. There was a system to record and investigate complaints, and when things went wrong staff apologised and gave people support.

The service always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

There was a dedicated team of admin staff to ensure that patients were supported moving between services safely. There were systems in place for processing information relating to new patients which was up to date. The service worked with other providers to deliver shared care and when patients moved between services. Correspondence was dealt with in a timely manner and reviewed and actioned by appropriate staff to ensure patients care and treatment remained safe. There was a clear process to ensure referrals and test results were managed in a timely way. A process had been implemented for urgent referrals to identify the administration team to track and audit the referral and ensure that the referring clinician reviews the outcome and support the patient appropriately. This includes supporting any new cancer diagnoses but also encourages following up the patients who may need further investigations. This process had enabled the practice to support patients during interim periods whilst they were awaiting further secondary care appointments. The practice often created and adapted clinical templates to ensure patients care was consistent and in line with best practice guidance. We saw evidence following learning incidents that these templates were often adapted to ensure safety. Some templates the practice had developed and designed for patient safety had been used across Leicester, such as a diabetic pathway, to ensure all patients were receiving safe care. The practice was passionate about ensuring patients pathways encouraged the best care for patients.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. Patients were regularly reviewed by the safeguarding lead and information was discussed when relevant with the wider team. We saw evidence of Multidisciplinary teams (MDTs) with vulnerable patients where relevant healthcare professionals would plan actions to support patients. Reviews of these patients were often holistic and considered additional support requirements of these individuals and were recorded within the patient record to ensure other healthcare services were aware of ongoing discussions. We saw evidence during the clinical searches of social services and community nursing team working with the practice to support vulnerable patients. The practice had a safeguarding administration team to review information received from external sources. This team had identified some gaps where safeguarding information had not been appropriately escalated to the practice in a timely manner which had been raised locally for awareness and to highlight and improve gaps in information sharing of safeguarding across Leicester.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The practice held appropriate emergency equipment and medicines which was regularly reviewed and maintained. A system had been implemented to ensure all staff knew their role within a medical emergency to ensure it was dealt with effectively. Any medical emergencies within the building were recorded as learning events, with a report being written and immediately being put onto the patient record. Staff could recognise a deteriorating patient and knew of actions to take. The practice had a duty doctor each day to support with any patients who needed urgent action. Staff had been trained to recognise symptoms which may need urgent medical attention, and the practice had designed an information sheet for staff which was seen at all telephone stations to provide support and ensure patients were getting the correct support. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. We saw safety netting information clearly documented within patient records.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The practice had systems to ensure oversight of the premises was maintained properly. We saw appropriate health and safety and fire risk assessments had been completed and the practice had clearly documented actions plans for any risks which had been identified and had been addressed. At the time of our inspection, the branch site had been closed for renovation work and had just reopened. The premises checks had been appropriately booked in following the reopening to ensure the site was properly maintained. There was a business continuity plan in place which was monitored and reviewed. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

The service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

There were a range of clinical and non-clinical roles within the practice that worked together to support patients. There were systems to ensure staff training was up to date, learning needs and development of staff was managed appropriately. Staff were proactively supported and encouraged to acquire new skills and complete further training to advance their skills and promote career growth. A number of staff had worked at the practice for a long time, with some being promoted to higher positions with the support of the practice. There was a robust process for ensuring staff were working within their agreed areas of competence. The practice completed regular consultation audits on all patient facing roles to ensure documentation, prescribing and treatment plans were correctly carried out within the practice. This was clearly documented and where learning was identified this was shared with the practice to promote knowledge. The practice also completed regular audits on non-clinical staff such as administration staff who were dealing with documentation that needed reviewing and updating to ensure that staff remained competent in their role. Safe recruitment practices were followed for all staff reviewed, and well managed.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The practice had a designated infection, prevention and control lead and all staff had had relevant training. Regular infection control audits were completed within the practice with smaller spot checks completed during interim periods to ensure standards remained high. Risk assessments and action plans were completed following audits to monitor remedies. At the time of our inspection, there were some actions which had not been completed due to awaiting building renovations – such as carpeted clinical areas and basins which were not in line with standards. However, the service had been risk assessed, and the practice had taken steps to ensure those areas were not used for certain appointments. Cleaning schedules were in place and followed with regular meetings and feedback given to contracted cleaners from the infection prevention and control lead.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

During our review of the clinical system, we saw medication reviews being done by GPs and pharmacists which reviewed patients’ compliance, ensuring monitoring was up to date, ensuring side effects were managed and identifying any additional lifestyle support that patients required. We found that some patients were overdue medication reviews which the practice was aware of and had put in place additional GP support to complete the outstanding reviews. The practice had processes in place to ensure medicines were appropriately prescribed and monitored to reduce risk to patients. We saw there were processes in place to support patients taking high risk medicines to ensure monitoring checks had been completed and patients were invited to attend for checks to ensure prescribing was appropriate. People knew what to do if their condition did not improve or if they experienced any unexpected symptoms. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. We saw that the number of antimicrobials issued by the provider was lower than local and national averages. We saw evidence of the practice monitoring patients who requested medicines too frequently to ensure their treatment was appropriate. Medicines were stored securely and at appropriate temperatures and we saw evidence of the practice sending patients information on correct storage of medicines at home. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. The provider had effective systems to manage and respond to safety alerts and medicine recalls. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment in relation to medicines, which showed improvement.