Wellington Medical Practice

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At the last assessment we rated this key question as requires improvement. At this inspection the rating has changed to good. At our previous assessment, we found that opportunities to raise, investigate and learn from significant events had been missed. For example, some complaints had not been raised as significant events for learning and development to help improve patient care. We found that the quality of the record keeping varied. Some records lacked detail of the action taken to mitigate risks and the learning outcomes were not always noted to improve quality. At this assessment, we found the management of complaints had improved. Complaint records we sampled had been dealt with in line with the practice complaints procedure, apologies provided and complainants informed of the escalation process. The opportunities for learning from complaints and significant events were taken and shared. Trends and measures had been identified to mitigate the risk of recurrence. Improvements had been noted in staff recruitment processes to ensure the required information was held for each person employed. Processes were in place for monitoring patients’ health in relation to the use of medicines. However, some improvements were required, including the need to ensure structured medicine reviews were completed.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were encouraged to raise concerns when things went wrong. During the practice meetings the team discussed and learnt from significant events, complaints and patient feedback. Staff felt the practice had made a good start in the development of a more open culture. Staff understood their duty to raise concerns and report incidents, and most were able to share examples.

The provider had improved processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, apologies were offered. Leaders had considered the oversight of the learning from incidents documentation. Systems in place included the analysis of any identified trends with measures to mitigate the risk of recurrence.

Information was available to patients to support NHS England’s Accessible Information Standard (AIS). The Standard is expected to benefit everyone with information and/or communication needs relating to a disability or sensory loss.

Staff and leaders told us they had been in receipt of information governance training and safeguarding children and adults. They reported pop-up alerts and standardised clinical codes were used as a safety net and referrals were discussed by the clinical team. Handovers to the out of hours service were managed by the GPs.

We did not receive any feedback from partners in relation to this quality statement. Information was available to patients to support NHS England’s Accessible Information Standard (AIS).

The practice maintained policies and procedures to enable safe systems, pathways and transitions for patients. Staff induction training included practice workflow. Electronic records were maintained with clinical oversight of urgent referrals to ensure that appropriate actions taken were timely. A protocol for the management of test results was in place to ensure these were reviewed and managed appropriately. Abnormal results were reviewed by a GP and patients recalled. GPs had access to patient safety alert information. Shared care and partnership agreements were in place with relevant parties.

We did not receive any feedback about people’s experiences in relation to safeguarding.

Staff told us they had access to their safeguarding policy and were trained to the appropriate level in accordance with their role. They demonstrated a clear understanding of safeguarding and knew who the designated clinical and administrative safeguarding leads were and of their deputising arrangements. Staff told us there were systems to identify vulnerable patients including children transitioning from child to adult services. There were regular discussions between the practice and other health and social care professionals. For example, health visitors, school nurses, community midwives and social workers, to support and protect adults and children at risk of significant harm.

No information of concerns had been received in relation to safeguarding from partners, such as Healthwatch Telford and Wrekin and the local Integrated Care Board (ICB).

Safeguarding systems, processes and practices were developed, implemented and communicated to staff. The practice had a specific staff member who assisted with ensuring their safeguarding adults and children's registers, were up to date. The safeguarding lead GPs provided reports when requested for example, child protection conferences. Staff had received up to date training at the level required for their roles.

We did not receive any feedback about people’s experiences in relation to this quality statement.

Staff were trained in basic life support and receptionists were aware of actions to take if they encountered a deteriorating or acutely unwell patient. Since our last assessment a new triage system had been introduced to book patients in with the most appropriate clinician. Clinical support was available for reception staff should they have any concerns. Staff we spoke with were aware of the location of the practice emergency medicines and equipment.

An inventory of emergency medicines held was maintained. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Oxygen was stored safely. Emergency equipment was checked daily, and a random sample of equipment we checked were found to be in date. The practice had a policy in place for emergency procedures.

Staff we spoke with told us they were trained in emergency procedures such as fire safety. They told us their induction process had included details of actions to take to promote fire safety and fire checks were carried out within the practice. Members of staff had attended additional training for their role as a fire marshal.

We observed that the facilities and premises were appropriate for the services being delivered. We found that the practice was clean, tidy and well maintained. The practice had made reasonable adjustments when patients found it hard to access services. There was a ramped access for patients with mobility difficulties, dexterity or musculoskeletal conditions and patients with pushchairs. Consulting rooms on the first floor were accessible via the stairs, and a passenger lift. Reception staff asked patients if they needed to be accommodated on the ground floor when booking appointments.

A fire risk assessment had been completed, and the provider had obtained quotes for the completion of works required as identified by this assessment within the recommended timescales. The locking of waste bins had been actioned, as had the removal of combustible storage from under desks and reduced extension lead usage. The practice had developed an action plan for the recommendations made in the fire risk assessment and were aware of the timescales and potential risks. Control of Substances Hazardous to Health Regulations (COSHH) risks assessments were in place. Staff had completed fire training to support their own safety, and the safety of patients, in the event of a fire. Fire safety drills had been undertaken. The provider had systems in place for the oversight of a safe environment.

We did not receive any specific feedback about people’s experiences in relation to safe and effective staffing.

Staff and leaders told us workforce planning and safe recruitment had taken place. Most of the staff we spoke with considered there to be adequate numbers of staff with the right skillsets employed to meet patient’s needs. They confirmed they had received a role specific induction and were provided with training and shadowing opportunities with experienced staff members. Staff with extended roles were in receipt of documented clinical supervision and competency reviews.

We sampled five staff files and found these were in line with expectations. There was 1 omission in that not all staff had received satisfactory information about any physical or mental health conditions which were relevant to their ability to carry on or manage their work. The practice acted on this information during the site visit. The recruitment folders were well organised and ordered. They included evidence of staff interview notes, immunisation history or a risk assessment, a generic health and safety staff induction as well as role specific shadowing. Disclosure and Barring Service (DBS) checks had been undertaken prior to commencement in role, staff had satisfactory references in place. Staff skills experience and qualifications had been verified including Home Office documentation and visa check.

We did not receive any feedback about people’s experiences in relation to infection, prevention and control (IPC).

Staff told us they had access to an infection, prevention and control (IPC) policy, appropriate personal protective equipment and had received training. They were able to advise of the designated IPC practice lead and had no concerns in relation to the cleanliness of the practice.

The areas of the practice we reviewed were visibly clean on the day of our site visit. Staff had access to adequate supplies of personal protective equipment. Staff were aware of the systems and processes to follow to ensure clinical specimens were handled safely in their role. The cleaning schedules were not signed in 1 room which we brought to the providers attention for actioning during our site visit. We saw that the clinical waste was appropriately secured in an outside storage area, and the staff had effective systems for clinical specimen management.

The practice held a copy of their latest IPC and hand hygiene audits. There were systems in place to support staff with infection, prevention and control (IPC). The practice employed a cleaning contractor. Staff immunisation history was available and where gaps were identified a risk assessment had been completed and referral made to their appointed occupational health team. Staff had completed infection prevention and control training and were aware of the systems and processes to follow to ensure clinical specimens were handled safely in their role.

An analysis of the practice’s significant events showed that 6 of the 24 significant events related to the prescribing of medicines. Not all care home patients had been involved in their medicines reviews.

Leaders told us there was a system for recording and acting on safety alerts. Clinical staff we spoke with understood how to deal with these. Leaders told us alerts on the electronic patient records were used to inform staff when patients were prescribed high risk medicines. When patients did not engage with medicine reviews, leaders told us there were systems in place to address this. A non-medical prescriber told us there were regular reviews of their prescribing practice supported by clinical supervision and auditing of the effectiveness of their consultations and prescribing.

Medicine reviews were carried out by both GPs and pharmacists. Our remote clinical searches found medicine reviews had not always contained detailed notes in those that were checked within the last 3 months. We found that repeat prescriptions were signed by an appropriate clinician before they were issued to patients.

There were policies in place to support medicines, management. For example, the monitoring of patients prescribed medicines that required monitoring and the management of Medicines and Healthcare products Regulatory Agency (MHRA) alerts. Our remote clinical searches showed processes were in place for monitoring patients’ health in relation to the use of medicines. However, improvement actions were required in medicine review consultation notes. These included discussions held with the patient, patients prescribed 12 plus inhalers per year and ensuring that women of childbearing age prescribed specific medicine to treat epilepsy were counselled on and advised on contraceptive support, as per current guidelines. We found 22% of patients prescribed a specific group of anticoagulant medicines and 4 out of 7 patients on a medicine used to treat mood disorders such as mania and bipolar disorder were overdue their monitoring. This was fed back to leaders for actioning.

National prescribing data showed that the practice was effective in ensuring that antimicrobial prescribing optimised patient outcomes and reduced the risk of adverse events and antimicrobial resistance. The practice had audits and quality improvement plan actions (QIP) in respect of medicines optimisation provided by the Integrated Care Board (ICB) to which the outcome would be evaluated in March 2025.