Dr Berni

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

Feedback from people who used the service indicted that they felt they received safe care and treatment. The provider received few formal complaints but when they did they learned from these and made improvements to the service in response. There was a proactive and positive culture of safety in which concerns about safety were listened to, safety events were investigated, and lessons were learnt to identify any shortfalls, prevent a recurrence, and embed good practice. Relevant information was shared with staff and other agencies to enable safe care and treatment to be delivered. The practice was staffed by sufficient numbers of staff across a range of both clinical and non-clinical roles. The clinical team was well established, and GPs had been given designated areas of responsibilities linked to people's needs, medicines management and governance. Appropriate systems and procedures were in place to safeguard people who may be at risk of abuse. Staff had undergone checks to ensure they were suitable for the role and they had been provided with safeguarding training at a level appropriate to their role. Staff training was appropriate and up to date and staff had received an induction and regular appraisal. The premises were safe and infection prevention and control measures were in place. Patients were protected by the safe prescribing of medicines. There were processes for monitoring patients’ health in relation to the use of medicines including medicines that required regular review. Our review of the patient clinical records system identified a small number of queries with regards to the safe prescribing of medicines. We explored these further with the provider who confirmed that they had recognised these issues and taken action to address them. This included ensuring more comprehensive medicines reviews were carried out, increased searches in response to medicines safety alerts and improvements to the call/recall of patients to undergo checks.

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 listened to and their feedback was acted upon and used to drive improvement. Completed complaint investigations showed the provider sought and considered people’s views, and factored these into the investigation and people received an apology when things had gone wrong.

Staff told us they knew how to identify and report concerns, safety incidents and near misses. Staff told us they were supported to identify their training needs and protected learning time was provided for them to undertake training, learning and professional development. This was within the service and through attendance at locality wide training and educational events.

The service had received low numbers of complaints since our last inspection. We viewed a sample of complaints and found they had been appropriately investigated and responded to and any learning had been shared across the staff team at regular staff meetings and through email. We viewed a sample of records that demonstrated the management of significant events. These showed events had been logged and investigated and the learning shared. The provider demonstrated that they had taken learning from our previous inspection and had introduced new systems in response to the findings and this resulted in better outcomes for patients in relation to medicines management and care and treatment provided to patients living with long term conditions.

The experience of people who used the service as gained in patient feedback, was positive regarding timely and appropriate referral to other services and signposting to other relevant support. Patients felt involved in decisions about treatment pathways and reported prompt follow up care.

Members of the clinical team demonstrated that they were well aware of local services that they could refer patients to in order to support them with their immediate needs and to prevent ill health.

The provider worked with people who used the service and other agencies to ensure safe systems of care and treatment when people were being supported by other services.

There were systems and processes to share information with staff and other agencies to enable them to deliver safe care and treatment. Regular multi-disciplinary meetings were held between the service and other health and social care professionals such as health visitors and social care workers. These provided an opportunity to discuss and arrange to meet the needs of people with complex needs and those approaching the end of their life. Reception staff had been trained in care navigation to direct people to the most appropriate service or services to meet their presenting needs. This may include specialist statutory or community services and local health and wellbeing services. Referrals to secondary or specialist care were made promptly and people referred under the two week wait rule for suspected cancer were followed up to ensure they had undergone the required investigations. This demonstrated how staff managed patient care proactively and effectively. Correspondence from secondary care such as discharge letters/summaries were up to date. The system of tasks (to identify follow up actions) used within the clinical record system was up to date which indicated prompt action being taken to support patients using different treatment pathways. Clinicians followed care and treatment pathways for treating and referring people to other services.

Feedback from people who used the service did not include any concerns with regards to safeguarding.

Staff had a clear understanding of safeguarding and were able to tell us who the responsible lead for safeguarding was. They knew the action to take if they had concerns about a patient’s safety and they told us they would feel confident to take the appropriate action.

Regular meetings were held within the practice where safeguarding was a standing agenda item for discussion.

There were effective systems, processes and practices to respond when it was suspected that people may be subject to abuse or neglect. These included working with partners in a collaborative way as the service worked with other local agencies in response to safeguarding concerns. For example, staff shared information with other professionals such as health visitors where they had concerns about a child’s welfare. Designated members of the team provided timely reports to the local Multi Agency Safeguarding Hub (MASH) when requested. The provider held a register of people for whom there was a safeguarding concern and this was reviewed and updated on a regular basis. Alerts were added to the patient record system when a person was subject to safeguarding concerns so that all relevant members of the team could readily identify concerns. We noted that alerts were not always added to the records for immediate family members. The provider agreed to address this with immediate effect. Staff had been provided with safeguarding training at a level that was appropriate to their roles and responsibilities. This is intended to provide staff with an understanding of how to recognise, raise alerts and manage safeguarding concerns. Systems were in place to ensure staff were appropriate to work in the service. Recruitment checks had been carried out prior to employment and all staff had been required to show proof of an up to date Disclosure and Barring Service (DBS) check at the required level.

Feedback from people who used the service indicated that they were provided with a good level of information about their condition enabling them to make informed decisions about care and treatment and any associated risks.

Staff told us they worked proactively to support people with the prevention of ill health, for example, recalling people who were at risk of developing diabetes or referring people for dietary advice or smoking cessation.

Staff were trained in areas to support people who lived with long term health conditions. For example, diabetes or asthma. Staff arranged for people to be called in for regular checks on their health when they were living with a long term condition or managing a health issue. When people did not attend they were followed up. People who used the service were referred to services that could provide them with specialist advice to manage their condition and the risk of deterioration. For example, referral to a dietician or for a diabetes education course. We saw examples of consultation records were people who used the service had been provided with safety netting advice (information given to people when the cause of their symptoms, or how their illness will progress, is uncertain and about the actions to take if their condition fails to improve, changes or if they have further concerns about their health in the future). However, we also noted some examples where this information had not been documented. Providing safety netting information enables people to be aware of and manage risks. People who were prescribed high risk medicines were called for regular checks and were advised to carry warning cards for medicines where this was advised. People had been made aware of particular risks with regards to medicines in response to medicines safety alerts. There was a system in place for dealing with safety alerts. However, we did note an example of a historic alert that had not been fully acted upon in a timely manner. The provider told us they had implemented a process to review all safety alerts at the time of the assessment and this was in progress. The provider confirmed the action they had taken for the specific people we had discussed. The plan included a wider scale approach to managing the alerts with a designated pharmacist leading this area of work.

Staff told us in discussions and feedback forms that they were satisfied with the health and safety arrangements in the service.

The service was located in a former two storey residential property that had been converted and extended to provide the facilities required for the intended purpose. A lift was available for access to the first floor. There were sufficient rooms available to accommodate/host additional services. The environment was safe and designed to meet people’s needs. The premises were clean and contained the appropriate facilities to support infection prevention and control. Medicines and vaccines were stored securely and they were readily accessible to staff who required them.

Staff had been provided with training in health and safety related topics such as fire safety, health and safety awareness, infection control and manual handling. Staff had designated roles linked to health and safety and they were responsible for a range of regular checks. Regular checks were carried out on the premises, facilities and equipment provided. The provider was looking to make further improvements to enable people who were physically disabled to more easily access the service by providing an automated door at the entrance to the premises. Equipment used to deliver care and treatment was suitable for the intended purpose and checked regularly. There were effective arrangements to monitor the safety and upkeep of the premises. Health and safety related risks had been assessed and systems were in place to prevent accidents and an unhealthy working environment. The last health and safety risk assessment was dated May 2024. Regular, documented health and safety checks were also carried out on the environment. A fire risk assessment was in place dated April 2024 and actions identified for improvement had been addressed. Fire fighting equipment and an alarm system were in place and serviced/checked regularly.

People spoke positively about staff working at the service. The NHS Friends and Family Test results were positive, and comments left by people using the service indicated high levels of satisfaction with members of the staff team. The results of the National GP Patient Survey showed people were satisfied with the care and treatment they received, they felt listened to and treated with care and concern.

The service was supported by suitable numbers of qualified and experienced staff, who told us they were well supported in their roles. The team told us they worked well and effectively together to meet people’s needs. Staff told us in discussions and in feedback forms that they felt there were enough staff to provide safe, high quality care. They also felt there were appropriate arrangements in place for covering staff sickness, absence and vacancies. Staff told us they had received training appropriate and relevant to their role. Staff were clear about what the expectations of training were and they were supported to keep up to date with training and professional development with protected learning time. Training was provided within the service and through attendance at locality wide training and educational events. Staff told us they felt well supported in their day to day work and in managing outside challenges when they occurred. For example, they felt the provider was flexible and accommodating of working patterns and hours worked where this was required.

The service was supported by a stable clinical team who could work flexibly to support each other when required. There was minimal use of temporary staff across the practice. This lends itself to choice for patients but also for consistency where required. We looked at the recruitment records for a sample of staff. These showed recruitment practices were carried out in line with requirements. All new staff underwent an induction programme and were required to undertake mandatory training within an appropriate timescale. Staff received the support they needed to deliver safe care. This included; being given clear instructions as to their role and the limitations of this, being given clear information on the lines of accountability of the team, being provided with a system of appraisal and support for professional development. Systems were in place to manage poor performance where required.

We reviewed feedback from people using the service from several sources, including complaints and patient surveys, and did not see any concerns raised regarding the cleanliness at the practice.

Staff told us they were aware of their roles and responsibilities to prevent the spread of infection.

People who used the service were protected from the risk of infection because the premises and equipment were kept clean and hygienic. Personal protective equipment was in good supply and located appropriately around the premises. Cleaning schedules were in place and cleaning audits were carried out on a regular basis. Cleaning equipment was stored securely and in line with best practice.

Procedures were in place to prevent the risk of infection. Staff had been provided with training in infection prevention and control. There was a dedicated infection control lead. A regular audit of infection prevention and control procedures was carried out and a larger scale audit was carried out periodically. Actions identified for improvement in the last wide scale audit had been completed. Additional regular audits were carried out related specifically to minor surgery procedures.

We reviewed feedback from people using the service from several sources, including complaints and patient surveys and we did not see particular concerns raised with regards to people’s medicines.

The provider had taken action to improve people’s experience and the safety of medicines prescribing since our last inspection. The governance of medicines had been improved and people were being monitored more closely through more timely health checks and more robust medicines reviews.

During our on-site assessment we saw that medicines, including vaccines were stored safely. Staff were aware of what to do if a fridge temperature was out of range. Staff had access to emergency medicines on each floor of the building including oxygen and a defibrillator. These were regularly checked for stock availability and to ensure they were in date. Patient Group Directions (PGDs) (written instructions to supply or administer medicines to patients in planned circumstances for example vaccinations) were in good order and correctly authorised. Prescriptions were held securely and there was a process for accountability /monitoring of prescriptions which included tracking the serial numbers and location of prescriptions.

The quality of medicines reviews was not always consistent to include all the appropriate elements of a structured review. The provider advised that this is an area in progress and that structured medication reviews are now exclusively done in a dedicated appointment by the Primary Care Network (PCN) led or practice pharmacist to ensure all required aspects of the review are covered. A protocol was in place for managing the repeat prescribing of medicines. The majority of prescriptions were sent electronically to people’s dedicated pharmacist.

We reviewed clinical records for people who had been prescribed medicines which required routine monitoring. Our review showed that medicines were managed safely overall and the approach to medicines reflected current and relevant best practice guidance. An area for improvement we noted was linked to the prescribing of teratogenic drugs. The provider confirmed that they had recognised this and had taken steps to improve in this areas prior to the inspection. They told us that regular searches had been introduced for all people who were prescribed teratogenic drugs and the people concerned had been notified of the risks involved. The provider confirmed that all historic safety alerts linked to medicines had been checked to ensure they had been actioned effectively. Prescribing data for the practice showed no particular variation when compared to national averages.