Clare House

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 have rated the practice as Good for providing safe services because: The practice had a culture of reporting and investigating incidents and significant events. Learning from the investigations was shared with staff and systems and processes reviewed and developed to improve services. There were systems and processes to monitor patients prescribed medicines which required additional monitoring.

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 who used the service were supported to raise concerns and there was a link on their website which enabled people to raise concerns, as well as in writing and by telephone.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, learning events were discussed and action was taken to prevent reoccurrence. Staff told us that it was a learning organisation and responsive to people’s feedback. Staff were aware of what constituted a significant event and could describe the process to report such incidents.

Learning events which had a positive outcome were also recorded and used to underpin learning. For example, a patient fainted in the reception area, staff were able to call for assistance and appropriate care and treatment for the patient was provided. This demonstrated that the procedure for managing an emergency situation worked well. The practice had a system in place for identifying and acting on significant events. Significant event (learning event) and complaint meetings were held to discuss events that had occurred. When learning was identified, this was arranged for relevant staff members and shared with other staff. A debrief protocol was in place to support staff wellbeing and ensure actions had been taken when needed. The provider had a range of policies and procedures which supported learning from safety events. These included the complaints policy and significant event policies. Staff were able to access these on the computer system and we saw there were links to relevant guidance on how to handle information of concern. This included identifying when a complaint could also be investigated as a learning event. Minutes from meetings were circulated to all staff via email to ensure that those not able to attend in person were informed of any actions that needed to be taken. The practice had a system to manage medicines safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA). The prescribing team ensured alerts were actioned and information disseminated to clinicians.

Comments made on the NHS website by patients included that GPs listened to worries and concerns and appropriate tests were carried out, which reassured the person. Other comments included that people felt safe knowing that their condition was managed well and referrals to other services were made in a timely manner.

A log was maintained of all referrals made to secondary care and other services. This included two- week wait referrals for suspected cancer. We saw that a priority rating system was used and all referrals were followed up to check they had been sent, received and acted upon. People were given advice on what to do if their condition worsened or they had not heard from the service the referral was made to in the expected timeframe. The practice aimed to provide continuity of care for patients with long term conditions or multiple healthcare needs. GPs told us they mainly managed the overall care of these patients and worked with other clinicians in the practice, such as practice nurses who undertook long term condition annual reviews. The practice worked with the primary care network (A PCN is a group of GP practices working closely together, aligned to other health and social care staff and organisations, such as diabetic and learning disability specialist nurses ). Audits were carried out on clinical records completed by advanced care practitioners, such as paramedics, and we saw that where improvements were needed, support was given to ensure all relevant information had been documented.

The clinical pharmacists had recently started to review all hospital discharge letters and was building relationships with pharmacies in the area. Workflow audits were carried out on handling of tasks, letters requiring action, test results and progress with scanning of documents. The practice had a structure in place to monitor the volume of workflow against staffing levels and factors which might influence delays, such as staff sickness. There was a process in place for managing test results, which included cover if the usual GP or nurse was off. A review was undertaken monthly of any unactioned test results and appropriate action was taken. The practice had undertaken a continuity of care audit in October 2024, to establish whether their usual GP process was working. The practice was using this data to promote continuity of care and to assist with booking appointments with the same GP. There were effective systems and processes to enable the practice to follow up on referrals, blood test results and workflow. Action was taken when needed to minimise risk and make sure patients received appropriate care and treatment.

The percentage of respondents to the GP patient survey who responded positively to the overall experience of their GP practice was 85.3%, which was in line with expected scores. Reviews from the NHS website included that patients felt safe, were reassured when concerned and involved in treatment decisions.

Staff knew who the safeguarding lead for the practice was. Staff could describe the actions they would take if they suspected a patient was at risk of harm. Meeting minutes demonstrated that vulnerable patients were discussed with community staff and specialist clinicians who were able to offer extra support. Staff said time was protected for completing safeguarding reports and attending meetings when needed. Staff said if they were concerned about a patient they knew they were able to make a referral without having to speak with the safeguarding lead.

Minutes of safeguarding meetings demonstrated that concerns were discussed with other relevant agencies, such as community nurses, social services and local schools when relevant.

Safeguarding policies and procedures contained information on actions staff should take and included relevant contact numbers. The practice maintained a safeguarding register and made sure patients and their families were coded correctly, to ensure staff were aware of the situation. Training records demonstrated that all staff had received safeguarding training to the appropriate level for children and adults as required by national guidance. The safeguarding lead had protected time each week to review safeguarding concerns to enable them to provide advice. Safeguarding concerns were routinely discussed in daily huddles.

The percentage of respondents to the GP patient survey (01/01/2023 to 30/04/2024) who stated that ‘during their last GP appointment they were involved as much as they wanted to be in decisions about their care and treatment was 98.7%’ which was above the expected score of 90.3% . (Positive variation).

Staff explained the procedure for acting on safety alerts and the checks they would make to ensure action was taken. Patients had been provided with information on risks associated with a medicine prescribed for patients with type 2 diabetes. However, this was not accurately recorded on their medical records.

There was a system for recording and acting on safety alerts. Staff understood how to deal with alerts. We looked at the practice response to a safety alert about patients with type 2 diabetes being prescribed medicines to lower their blood sugar and the need to inform patient of potential risks. The practice had 315 patients who were prescribed these medicines and 156 of patients had not had the risks discussed. We sampled 5 records and found that 3 patients had not been informed of risks. The remaining 2 patients had been commenced on the medicine by secondary care and there was evidence that risk had been discussed, but not effectively recorded in the records. For example, 1 patient record show that a practice nurse had held a discussion, but did not document this specifically in the notes. After clinical searches had been completed the practice sent us information which demonstrated that all patients had been reviewed, but there were inconsistencies with coding records. Amendments were made to the coding of records and a plan put in place to carry out regular audits in relation to this safety alert.

Staff had received training on health and safety, this included fire safety, emergency procedures and reporting of accidents or incidents. Staff told us they were aware of their responsibilities and could describe what actions they would take.

The main location and the branch site were maintained and free from clutter. Emergency lighting was in place and the indicator light showed it would work when needed. There was clear signage to show that CCTV cameras were operational outside the main location and in the internal corridors and waiting area. Staff had two computer screens and headsets to use when calling patients on the telephone.

The practice carried out a range of health and safety risk assessments, which included fire safety. There was a procedure to follow when opening the premises and closing it at the end of the day. This included ensuring all fire exits were unlocked and checks of emergency equipment, such as ensuring the defibrillator battery was charged. A lone working policy and risk assessment were available to support staff who worked alone. Electrical equipment was tested to ensure it was safe to use and measuring equipment was calibrated to ensure it was accurate. Records showed that regular checks and servicing of fire extinguishers and the fire alarm system were made to ensure they were in working order. Fire drills had been carried out six monthly and we found that the buildings had been evacuated within safe timeframes. Policies covering health and safety were routinely reviewed and updated when needed to reflect current guidance..

Comments made on the NHS website showed that patients were satisfied with the care and support they received. We looked at comments made since January 2024. Feedback included: GPs being efficient; a paramedic providing a thorough examination of a person who used the service and was knowledgeable; and clinicians clearly explaining procedures and ensuring people understood what was happening. Responses received from feedback on care submission made to us since July 2023 included that staff were responsive to peoples’ need and clearly explained plans for care and treatment.

Staff were given protected time for training and development. Examples of development opportunities included management courses; courses on specific conditions, such as asthma management; non- medical prescribing; and practice nurse courses. GPs carried out minor surgical procedures, such as removal of skin lesions and carpel tunnel operations. They confirmed they had received the appropriate training and updates, and their practice was audited for areas such as post operative infections. Nurses said they had time for revalidation and clinical supervision to enable them to maintain their professional qualifications. A staff wellbeing survey carried out in July 2023 showed that staff considered they worked together well as a team. The practice was also a training practice and said they were in a position to offer jobs to newly qualified GPs. They also trained paramedics in primary care and had just started to support nursing students with training placements. Staff said that they had completed an induction programme which included time spent om training the practice considered was necessary. They said that induction plans were role specific and included time for completing training; shadowing other roles in the practice; meeting with their line manager.

Recruitment checks were carried out in accordance with regulations (including for agency staff and locums). Staff vaccination was maintained in line with current UK Health and Security Agency (UKHSA) guidance relevant to role. We looked at a sample of recruitment records and found that all information as required in the regulations was evidenced and recorded. The practice was continuing to work with staff to obtained up to date vaccination records and we saw information had been requested. The practice’s training policy provided information what was mandatory, such as chaperone and sepsis training and the timescales for refresher training. The policy also detailed the need for an annual appraisal alongside a personal development plan. The practice had a structured induction and training process in place. This included training considered mandatory by the practice and additional training according to the member of staff’s role. Mandatory training was delivered via a 12 month rolling programme which included refresher training. Training completion was monitored during supervision and appraisal sessions and action taken if a member of staff had not completed all required training. Appraisals covered clinical work as well as staff performance and development. Staff had access to regular appraisals, one to ones, coaching and mentoring, clinical supervision and revalidation. They were supported to meet the requirements of professional revalidation.

Six patients who provided feedback said they considered that the practice was visibly clean and tidy. One person specifically commented about hand hygiene procedures being adhered to.

Staff were aware of who the lead nurse was for infection control, who was a member of the local infection control network in the area. The lead nurse was supported by a GP lead and health care assistant, and updates were provided to all staff members in practice development afternoons. We spoke with the lead nurse who described regular audits undertaken at the main location and the branch site, this included the designated theatre used for minor surgery. Copies of audits received from the practice showed that when needed action was taken. No concerns had been identified with the theatre; however, minor issues were identified with the ability to clean chairs at both sites and security of sharps bins, used to dispose of used needles. These issues had been addressed and improvements made. Staff said they were able to access policies and procedures related to infection control on the computer system. They also confirmed that they had received infection control training as part of their induction, with annual refresher training. Records we saw confirmed this.

Spillage kits were available for use and staff had received training in handling specimens safely and infection control. There were supplies of personal protective equipment in consulting rooms and handwashing facilities. The premises at both sites were visibly clean and tidy. An isolation room was available if a patient was suspected of having an infectious disease, and this could be accessed via a separate entrance.

The infection control policy referenced relevant guidance, such as the Health and Social Act 2008 Code of Practice on infection control. The policy set out the staff responsibilities and frequency of audits to monitor infection control processes, such as hand hygiene audits. Evidence was provided which demonstrated that audits were carried out in line with the schedule and appropriate actions had been taken when needed. There were suitable systems and processes in place to assess and manage the risk of infection. Regular audits were carried out on the environment and staff infection control practices. Routine checks were maintained on the water systems to ensure there was no sign of Legionella (a bacteria which can cause breathing problems) and the temperature of hot and cold water was tested and we saw that temperatures were within recommended ranges to prevent Legionella occurring. Single use instruments were available for clinical procedures.

People told us they were happy with the prescription experience as it was fast and there was a designated desk for handling prescriptions which was separate from the reception area. This assisted in reducing queues at the main reception desk, and it was staffed by a member of the prescription team.

Staff and leaders told us they had systems and processes in place to support the safe prescribing of medicines. Leaders told us they had met nationally set targets and we saw an example of this for prescribing of antibiotics. We spoke to staff who explained the policy around the cold chain process ( a way of ensuring vaccines are transported and stored safely). Staff and leaders told us they met regularly to review their prescribing, and the management of patients receiving high risk medicines and medicines which require monitoring.

Blank prescription stationery was kept securely in a locked cupboard and an audit trail was maintained of its use. The practice held emergency equipment and emergency medicines at the main practice and branch sites and they were checked on a regular basis. Risk assessments were done to determine the list of emergency medicines to be stocked. Clinicians who were non- medical prescribers (healthcare professionals who are not doctors or dentists, who have an advanced qualification in prescribing) had their prescribing audited routinely to ensure medicines prescribed were necessary, correctly prescribed and followed up when needed. Where shortfalls were identified in prescribing practices, such as not ensuring that blood tests had been completed, this was highlighted to the non-medical prescriber and rechecked to ensure action had been taken. Medicines stock was appropriately managed and expired medication was safely disposed of, and appropriate records maintained. We viewed a sample of Patient Group Directions (a written instruction for the supply and administration of a licensed medicine to a group of patients), and found they were authorised by a qualified prescriber such as a doctor in line with national guidance. There was a system for recording and acting on safety alerts. The cold chain policy set out the roles and responsibilities staff should take to maintain the cold chain of vaccines. Staff checked the temperature of the vaccine fridge twice a day when the practice was open and recorded this, in addition there were data loggers inside vaccine fridges. If there was a failure in the cold chain, data could be obtained to determine how long the fridge had been outside of the optimum temperature and appropriate action could be taken. Stock in vaccine fridges was audited monthly, along with records of fridge temperatures, to ensure the cold chain was maintained and vaccines were within their expiry dates and safe to use.

There was a range of policies and procedures in place for medicines management and prescribing. These included policies and standard operating protocols on prescribing principles; actions to take when a patient had had a hospital admission; adverse reactions; prescription management; and controlled drugs. We noted there was a planned programme of review for policies and procedures to ensure the information in them was up to date, relevant and in line with current guidance. Appropriate authorisations for staff to administer medicines were in place, including Patient Group Directions (a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition) or Patient Specific Directions (a written instruction from a doctor or other independent prescriber for a medicine to be supplied or administered to a named patient). The practice were in the process of changing their recall system, so that patients were invited for a medicine review during their birthday month, the changeover was due to be completed in March 2025.

Prescribing data from the period 01/07/2023 to 30/06/2024 showed that prescribing of medicines such as antibiotics and strong painkillers were managed appropriately. We carried out clinical searches on patient records and found: Patients who were on medicines which needed regular monitoring had not always received appropriate monitoring. Our searches showed all 20 patients on a disease modifying medicine had not had the required blood tests prior to prescriptions being issued. We sampled 5 records and found that 3 patients were still under secondary care for their treatment and monitoring. Information was provided which showed that 2 patients showed blood tests had been arranged. The practice had 2354 patients on heart medicines which needed blood tests and blood pressure reading to be carried out. Of these 119 patients had not had the required monitoring within recommended timescales. We sampled 5 patient records and found that 3 patients had been sent text reminders to have the monitoring carried out. One of the patients had not received any reminders to attend for monitoring and the other patient had not responded to invitations for blood tests. We discussed these findings with the practice and they explained that they were in the process of changing the review system so that patients were invited for a review in their birthday month. A reminder was sent to the patient who had not received any reminders and an appointment was arranged. The other patient was contacted by a GP to request them to attend for the required monitoring.