Sunnybank Medical Centre Also known as Affinity Care

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

During this focused assessment we found that the practice provided safe care and treatment for patients. Following the last inspection of the service in December 2022, the provider was rated requires improvement for the provision of safe services. This was due to concerns regarding the review and monitoring of patients in receipt of high risk medicines and medication for long term conditions, and the failure to fully action safety alerts. During this assessment we saw that the provider had made significant improvements, which included establishing processes for the review and monitoring of patients in receipt of high-risk medicines, and for patients who had long-term conditions. Processes had also been put in place which ensured that patient safety and medicines alerts had been effectively assessed and actioned. Finally, whilst the work had not been fully completed, we also saw that the provider had made progress in establishing the vaccination and immunisation status of staff involved in the care and treatment of patients. We saw that safety issues were managed effectively and had high level oversight via a dedicated Quality and Safety Group which reported to the Board of Directors. We saw that the provider had developed and implemented comprehensive clinical supervision processes and had improved their approach to learning after incidents and significant events, which enhanced safety within the practice.

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 received only limited feedback regarding people’s experience related to the learning culture at Sunnybank Medical Centre. One patient had contacted us as they felt that the provider had not acted on previous complaints made to them in the past. During this assessment we reviewed a sample of complaints, and saw that these had been effectively investigated and outcomes fedback to the complainant.

We heard from the provider and staff that they had processes in place to improve quality and safety based on learning. This included concerns and complaints raised by patients and incidents raised by staff. This was supported by a programme of other improvement activities such as clinical and non-clinical audit. Staff told us that they knew how to identify and report significant events and incidents, and felt that when raised these had been investigated and actions taken to improve services or prevent recurrence as a result. They also told us that learning was regularly shared with them at team meetings and during one-to-ones. Staff said that they felt comfortable to raise concerns with leaders and managers, and felt there was a supportive no-blame culture within the organisation. Leaders told us that there was oversight of learning events such as incidents and complaints, and these were discussed at quarterly meetings of their Quality and Safety Group, who in turn reported to their Board of Directors. Staff were aware how to record and handle patient complaints. They told us that, if possible, they would attempt to resolve complaints immediately, but if this was not possible, that they would be formally recorded for further action.

The provider had put policies and processes in place for complaints, significant events, and quality improvement. Staff told us that the provider used incidents, complaints and quality improvement activities, such as audits, as opportunities for learning and service development. We saw over the previous 12 months that the provider had recorded 147 incidents and events, and 29 complaints. We saw that complaints and incidents were investigated, and that any themes or learning were identified and used to improve services. For example, we saw that communication from the provider to a patient had caused them some concern due to the detail it contained. The provider had reviewed this, and examined if they could have identified if there was potential to reduce the impact of the initial communication. The provider had processes in place which ensured that reflection and shared learning from events had been undertaken prior to closing each incident. Learning was shared across the organisation in several ways and included a quarterly quality and safety bulletin, via meetings, and when required by individual discussions with staff. The provider had effective oversight of both learning events and complaints, and these were discussed at a Quality and Safety Group which met quarterly, and which in turn reported to the organisation’s Board of Directors. We saw that as well as individual complaints and incidents, that the Quality and Safety Group looked to identify emerging trends.

We saw no indication of concern in this area.

Leaders, managers and staff told us that they worked with others to develop and maintain safe and responsive systems of care for patients. The provider informed us that all staff were required to use a standardised referral process and template to facilitate this. Clinical updates were given at specific sessions to train clinical staff in the use and navigation of this template, as well as giving specific clinical updates on how to manage particular conditions, including when to make referrals. Updates were given each year for respiratory disease, cardiovascular disease, diabetes and cardiometabolic disease as these clinical risk areas aligned with particular health needs and outcomes within the practice population. Leaders and staff told us that measures were in place to monitor referrals, in particular those related to cancer 2-week waits to track the progress of the patient following referral.

We received no feedback from partners and stakeholders regarding safe systems, pathways transitions for the provider.

The provider had detailed processes for managing pathways and transitions of patients through their care and treatment. The provider used a standardised referral process and template which was managed by their local Integrated Care Board. This ensured that any changes to referral pathways were consistently updated to match local guidelines and service capabilities. The provider also had other processes in place to assess and support patients who had been discharged from hospital, or who required changes to their medication following secondary care treatment. The provider held weekly and monthly meetings where vulnerable patients were discussed, and their needs assessed. If required, patients with more complex needs were allocated to the provider’s internal home visiting and support team.

We did not receive any feedback and saw no indication of concern in this area.

We heard from leaders, and saw evidence to support this, that systems, processes and practices had been developed and implemented by the provider to ensure that patients were safeguarded and protected from harm, abuse, exploitation or neglect. We heard from staff that they had in the past raised concerns regarding patients, and worked closely with others to keep people safe. Staff told us that they had received safeguarding training appropriate to their role and this was corroborated when we checked staff training records.

We received no feedback from partners and stakeholders regarding the provider in respect to safeguarding.

The provider had established processes to identify, record and action safeguarding concerns. This included the development of safeguarding policies and procedures, and the establishment of regular weekly and monthly safeguarding meetings where safeguarding concerns were discussed. Safeguarding also had senior management oversight via the internal Quality and Safety Group. Both children’s and adult’s safeguarding policies had recently been reviewed in 2024. Staff training, and support materials for locums ensured those working in the practice knew how to manage safeguarding concerns. The provider had nominated safeguarding leads and deputies to oversee and manage safeguarding. Children’s safeguarding documentation and record keeping had been subject to an audit, which in the case of Sunnybank Medical Centre had shown improved performance over time.

Patient feedback from the 2024 National GP Patient Survey indicated that patient satisfaction with how the practice worked with them to manage their care and treatment was generally in line with local and national averages. For example, 87% of respondents reported that they were involved as much as they wanted to be in decisions about their own care and treatment during their last general practice appointment compared to local and national averages of 91%. In addition, 95% of respondents felt the healthcare professional they saw had all the information they needed about them during their last general practice appointment compared to a local average of 91% and a national average of 92%.

We heard from leaders, managers and staff that as part of care delivery they worked closely with patients to help them understand, and manage risks so that their needs and care decisions were better met. For example, staff told us how they worked with patients and/or carers regarding their future care planning wishes and needs. We saw evidence in 5 Recommended Summary Plan for Emergency Care Treatment (ReSPECT) records we checked which supported this. We were told that staff from the practice worked with other care and health professionals to review and deliver appropriate patient care and treatment. Staff we interviewed told us that they were aware of how to identify, intervene and support a patient should they feel that the patient’s health was deteriorating whilst in the practice, and confirmed to us that emergency procedures were in place should this be required. The practice had a duty doctor available to support emergencies, and those in acute need.

The provider had processes in place to involve people to manage risks. We saw that medicines reviews had been effectively conducted and carried in them necessary detail, and clinical records showed evidence of inputs from patients and other services. In addition, patients whose treatment carried with it some risks were informed of these risks by the provider.

Leaders and managers told us that they had put in place health and safety management processes which ensured the safety and wellbeing of patients, staff and visitors to the practice. We were sent evidence which supported these statements and showed that necessary risk assessments had been undertaken. Staff informed us that they had undertaken required mandatory training in respect of health and safety, such as annual fire safety training. Staff told us that they had no concerns related to health and safety in the practice.

We saw that both the main location and branch site were generally in a good structural condition. From records sent to us, and observations on the day, we saw that equipment was maintained and serviced regularly, stored safely and was suitable for use. For example, fire extinguishers had recently been serviced, and clinical equipment had been calibrated to ensure that it operated correctly. We noted that the external paving slabs outside the main entrance to the Cowgill branch surgery were in need of repair. Some slabs were uneven, and there were large gaps between slabs which could be a trip hazard. We raised this with the provider who informed us that they would rectify this.

The provider had management processes in place which gave assurance that health, safety and wellbeing requirements were met. For example, we saw that health and safety risk inspections had been undertaken in 2023 and 2024, and a fire safety risk assessments had been undertaken in 2023. When issues had been identified in health and safety assessments, we saw that the provider had taken action to resolve them. For example, the fire risk assessment for Sunnybank Medical Centre had identified an issue with a fire door which was unable to be closed fully. This had been reported and action taken to fix it. Fire drills had been carried out, as was regular testing of fire alarm systems. The provider had emergency medicines and equipment on site. From checks made we saw that these were sufficient for the needs of the practice.

We did not receive any feedback and saw no indication of any concern in this area.

Leaders and managers told us that staffing levels were actively monitored, and that rotas were in place which ensured that there was the right mix of staff with the necessary skills on duty to deliver safe and effective care. When staff left the practice on retirement, or when moving to other roles, we saw that recruitment had been undertaken to replace these staff. For example, we were told that 4 staff had recently been recruited to the nursing team to make up numbers following the loss of some staff. These new staff had undergone induction and were receiving additional training which allowed them to fulfil their new roles. If further capacity was required, the provider used agency or locum staff. New and existing staff told us that they felt well supported, and found senior leaders and managers friendly, approachable, and willing to advise and support them when they asked for help or advice.

The provider had developed and adopted a recruitment policy. This though was found to be out of date, as it was due for review in June 2023. We saw that most recruitment and necessary checks had been conducted in accordance with guidance and regulations. Human resources records were rather difficult to access, however we were informed that the provider was due to move over to a new integrated system in the near future which would reconcile HR records in one place and ease access. Records were up to date for newly appointed staff, and we were assured that necessary checks were in place. We saw that the provider had made some progress in respect of gaining assurance that staff had received the necessary vaccinations and immunisations to safely deliver their roles, but that further work was still required. Induction processes were in place for newly appointed staff including locums. For example, the practice had developed detailed preceptorship (structured transition to guide and support newly appointed staff) for healthcare assistants. The provider had also developed processes to manage clinical supervision. We found this approach to give high assurance that non-medical prescribers, newly qualified GPs, and other relevant staff received the level of support, supervision, and assessment required to give assurance that the care and treatment they provided was done competently, safely and effectively. Newly qualified prescribers and physician associates had a dedicated GP mentor to support them in their role. There was an allocated debrief GP available daily and a system in place to ensure appropriate support and oversight. For example, debriefs for all patients prior to them leaving the practice initially, then a move to end of surgery debriefs when staff member and supervising clinician are comfortable to do so. The provider had developed a template within the clinical system in which any changes or additional information could be recorded by the supervising GP.

Patient feedback informed us that there were no indications of concern regarding the cleanliness and hygienic operation of the main and branch site.

Interviews and feedback from staff indicated to us that they had a good understanding of infection prevention and control (IPC). However, leaders told us that update training regarding managing needlestick injury risk was overdue, and this was planned for the near future. Both clinical and non-clinical staff told us they were aware of how to raise IPC concerns, and who to contact when they identified issues. Staff told us that they were confident that when IPC concerns were raised these would be addressed. Staff we spoke with were aware of the safe handling processes to be used when receiving clinical specimens from patients.

We found the practice premises and equipment to be clean and hygienic, which protected people from the risk of infection. There were minor issues around the buildings which needed attention such as damaged plasterwork, but this had been recognised and measures put in place for repair. We saw within training records that staff had received annual infection prevention and control (IPC) training. Cleaning schedules and records were in place, and there were sufficient cleaning materials within the cleaners cupboards to undertake routine cleaning tasks.

There was an effective approach to assessing and managing the risk of infection. The provider had developed an Infection Prevention and Control (IPC) Policy which was due to be updated in the near future. We saw that an IPC lead had been appointed by the provider, and that IPC audits had been undertaken. IPC audits contained action plans for required improvements. For example, issues relating to high level cleaning standards had been reported and improvements to cleaning these areas made. At the time of our assessment cleaning standards were seen to be good. The provider had contracts with external companies to support good IPC, this included a cleaning contract which was subject to monitoring, and a clinical waste contract. We saw that IPC had effective oversight and was discussed at the quarterly Quality and Safety Group meeting, which in turn reported to the Board of Directors.

We saw no general indication of any concerns in this area.

Leaders and managers told us that clinicians involved patients in assessments and reviews, and discussed the level and support patients needed to manage their medicines safely. This was confirmed when we spoke with prescribers and members of the pharmacy team, and also when we examined medical notes during our remote clinical searches. Clinicians told us that they discussed prescribed medication with patients which allowed them to understand their treatment, and any risks associated with the use of these medicines. The provider told us that medicines updates and new guidance was discussed regularly at team meetings, or cascaded electronically to staff to keep them up to date. Clinical staff met regularly, and best practice guidance was discussed at meetings. The provider told us that they had measures in place to inform clinicians of patient and medicines safety alerts, and we saw that these had been discussed at team meetings. Staff confirmed to us that they were kept informed of changes to guidance, and key issues. The provider told us that they had measures in place to support individual clinicians through post sessional debriefing sessions, and had an open-door policy whereby those requiring advice could approach a more senior clinician for help. Both leaders and staff informed us that oversight measures were in place for the clinical supervision of staff which included assessments of consultations and prescribing practice.

Findings from our searches of the practice's clinical records evidenced that the practice had systems and processes in place to ensure patients were recalled and attended regular monitoring as required. However, we did find issues with the process for the follow up of asthmatic patients after they had been issued rescue steroids. After we raised this with the provider, they informed us that they had changed their existing operating protocol so that moving forward a clinician booked an asthma follow-up with patients within 2 to 7 days of an asthma exacerbation episode when rescue steroids had been prescribed. The provider conducted bi-monthly audits as a failsafe to ensure patients requiring high-risk medicines monitoring had all relevant checks conducted. Staff from the practice demonstrated an awareness of medicines and patient safety alerts. There were systems and process in place to ensure these were acted upon and we saw evidence of appropriate action having been taken during our clinical searches. The practice had robust systems in place to ensure non-medical prescribers had access to appropriate support and guidance, along with systems and processes to ensure appropriate supervision and monitoring. We saw how the practice had made improvements to the process for recording and acting upon learning events including medicines related incidents. This included mechanisms to ensure that learning, reflection and sharing of information was completed prior to learning events being closed.

The provider had in place measures for the management of medicines. This included processes for repeat prescribing, patient reviews and monitoring, authorisations to administer medicines, and antibiotic stewardship. The provider undertook medicines improvement activity, and had undertaken regular prescribing and medicines audits. For example, the provider undertook bi-monthly audits as a failsafe to ensure patients who required monitoring checks to be undertaken had had these carried out. When a patient had not complied with requests to attend monitoring appointments the provider had support processes to promote attendance such as regular recalls and issuing shorter prescriptions. Since our last inspection in 2022 the provider had made improvements to their processes for receiving, recording, and acting upon patient and medicines safety alerts. Enhanced processes had also been put in place to improve the learning, reflection, and sharing of incidents and significant events, which included those in relation to medicines. Medicines optimisation work had high level management oversight, and was reported to the Board of Directors via the provider’s Quality and Safety Group. Reported measures included high risk medicines monitoring, medicines usage, medication reviews, antibiotic prescribing, and patients safety and medicines alerts.

We saw that the provider took steps to ensure that clinicians prescribed medicines appropriately to optimise care outcomes. For example, when we examined prescribing data, we saw that it was in line with national and local averages, and in the case of antibiotics including co-amoxiclav, quinolones and cephalosporins showed significantly better prescribing practice than local and national averages. The provider had a programme of clinical audits in place which supported safe prescribing and medicines optimisation, as well as implementing clinical supervision processes which helped ensure clinicians delivered effective and safe consultations. Outcomes were closely monitored by the internal Quality and Safety Group, and reported to the Board of Directors. We saw that the provider had acted on patient and medicines safety alerts.