Hill Top 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 assessed all the quality statements from this key question. Our rating for this key question is Good. We found the practice took concerns seriously. If things went wrong, staff acted to ensure people remained safe. Managers investigated reported incidents to reduce the likelihood of them happening again. Staff were able to share an example of a recent significant event, action taken and learning. Staff were confident in responding to safeguarding concerns and had received the level of training relevant to their role. Recruitment checks had not been carried out in accordance with regulations, which had potentially placed people at risk of harm. Staff felt there were enough staff employed to provide safe, high-quality care and had access to essential training and development opportunities to support them in their work. Systems for the safe management of medicines, including emergency medicines and equipment and medicines optimisation were in place and regularly reviewed. Our clinical searches identified some minor omissions in the oversight of the monitoring of patients with long term conditions. However, the practice took immediate action to mitigate any potential risks to these patients.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people felt supported to raise concerns and felt their concerns were taken seriously, listened to and acted upon to make improvements.

Staff were encouraged to raise concerns when things went wrong. They told us that significant events, complaints and patient feedback was shared and discussed during meetings held. Staff felt there was an open culture and understood their duty to raise concerns and report incidents, and most were able to share examples.

The provider had 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, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

Information was available to patients to support NHS England’s Accessible Information standards.

Staff told us they had been in receipt of information governance training and safeguarding children and adults. They reported pop-up alerts and read codes were used as a safety net and referrals were discussed between the secretaries and the clinical team.

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 standards.

We found the practice maintained their policies procedures to enable safe systems, pathways and transitions for patients. Staff received training from induction which included the practice documents and referrals workflow. An electronic record was maintained with clinical oversight of all urgent referrals to assure the practice that all appropriate actions taken were timely. A protocol for the management of test results was in place to ensure they were reviewed and managed appropriately. Abnormal results were reviewed by a GP and a task sent to administration staff to recall patients were identified. Staff had access to patient safety alert information

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

Staff told us they had access to the provider’s safeguarding policy, were trained to the appropriate level in accordance with their role and demonstrated a clear understanding of safeguarding. They knew who the designated clinical and administrative safeguarding leads were and those who deputised in their absence. Staff told us there were systems to identify vulnerable patients and they were in regular contact with their safeguarding health visitor and had reconciled their safeguarding register.

We did not receive any feedback from partners in relation to safeguarding.

Safeguarding systems, processes and practices were developed, implemented and communicated to staff. The practice worked with the local safeguarding team and provided reports when requested for example, child protection conferences. Arrangements were in place to follow up young children who were not brought for their appointment, for example immunisations.

A few patients had reported to the practice issues in relation to referral processes. The practice investigated these via their significant event process and action was taken immediately. Following a significant event analysis review the practice mitigating actions and systems were strengthened.

Receptionists told us they were aware of actions to take if they encountered a deteriorating or acutely unwell patient and had been given guidance and training on identifying such patients. They were able to share examples of how they had responded to medical emergencies and the action taken.

The practice was equipped to respond to medical emergencies (including suspected sepsis) and staff were suitably trained in emergency procedures.

Staff spoken with acknowledged they were all responsible for ensuring a safe environment and told us they had received training in safe working practices. They confirmed they had no concerns in relation to health and safety.

The practice was housed in 2 separate buildings, the main administration building had a patient waiting area, a reception area, toilets, 4 consulting rooms, and a kitchen. Patient lift access was provided to the first floor providing a kitchen, meeting room, managers office and secretaries office. There was a pharmacy attached to the building. We observed a few environmental areas that posed a potential risk to patients, staff and visitors. For example, there was a rippled carpet on the first-floor landing area of the Annex building. The practice manager (PM) noted this for their maintenance and renewal log and to risk assess. We saw a wooden child stair gate on the landing area to protect young children from being able to access the stairs and window blinds which the practice demonstrated had cleats on order. The reception area air conditioning was awaiting repair and in the interim period the practice had put portable fans in place. In areas where fans were in place the practice manager assured us that these would be risk assessed.

Records were held of the completed health and safety risk assessments and any mitigating actions taken following the identification of any risk. Fire marshals for the practice had been in receipt of fire safety training. Records were held for fire drills undertaken. However, the staff who had attended recent fire drills were not named on the log. The practice manager advised this would be actioned. A fire risk assessment had been recently completed by an external company. In response to its findings the practice had put measures in place to reduce risk to patients and staff whilst contractors completed the outstanding work required.

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

Staff told us that workforce planning and recruitment had taken place and considered adequate numbers of staff were employed with the right skillsets to meet patient’s needs. They confirmed they had received an induction to their work and were provided with training and shadowing opportunities with experienced staff members.

The practice had recently recruited two new reception staff and 2 healthcare assistants. We sampled 4 staff files and found significant omissions in the safe recruitment of staff employed. These included not obtaining full employment histories, Disclosure and Barring Service (DBS) checks and references prior to start dates and satisfactory information about any physical or mental health conditions which were relevant to their ability to carry on or manage their work. The practice was in the process of obtaining the required documentation for a locum nurse, who was due to work at the practice shortly. Evidence of staff induction was available on the staff files we sampled; however, this was not role specific. Our findings were acknowledged by leaders at the time of our site visit and action was taken to improve recruitment practices. The practice manager has since attended an external training course on safer recruitment practices and updated the practice recruitment policy. They told us learning would be shared with the management team to ensure full understanding and compliance and all policies and procedures would be strictly adhered to.

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 and had received training. They were able to advise of the designated IPC practice leads and told us they had no concerns in relation to the cleanliness of the practice. The designated leads told us they had carried out an audit in June 2024 and all identified actions had since been addressed.

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. Arrangements were in place for maintaining cleaning standards and schedules were maintained. The provider took immediate action in response to some minor infection, prevention and control omissions we identified during our site visit.

The practice employed a cleaning contractor. Cleaning schedules were in place and maintained. The infection, prevention and control (IPC) lead and deputy had implemented and actioned IPC audits. The inspection team identified a small number of areas for improvement, for example, the need to initial the cleaning schedules, mop heads storage in one cupboard and a cleaning product potentially hazardous to health was not locked away. Once brought to the practice managers attention these were actioned immediately. We were assured the cleaning contractor would be made aware of the required changes. Staff immunisation history was available for all 1 but staff file we sampled. 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.

There had been 4 medicine related complaints made by patients to the practice. Two complaints related to communications regarding their repeat medicines with other providers, namely, secondary care and community pharmacy. One related to an electronic diagnosis coding issue and the other related to the time waiting for their prescription to be signed. In all instances the complaints were investigated reviewed and actioned with information provided to the patients on the outcome.

Staff confirmed they had access to medicines management, repeat prescribing and storage policies. Clinical staff told us they received training on medicines management, and felt confident managing the storage, administration and recording of medicines. Staff managed medicines-related stationery appropriately and securely. They followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

Staff managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. We saw the practice ensured medicines were stored safely and securely with access restricted to authorised staff. Blank prescriptions were kept securely, and their use monitored in line with national guidance. There was medical oxygen and a defibrillator on site and systems to ensure these were regularly checked and fit for use. Vaccines were appropriately stored, monitored and transported in line with UKHSA guidance to ensure they remained safe and effective. We saw the fridge temperature logs were of whole numbers which staff ringed to the closest number when recording the fridge temperatures. This in theory was acceptable as the risk lies when below 2c or above 8c. However, this meant that the fridge temperatures were not actual readings but approximations to the nearest number. We discussed this with the leadership team for their consideration. We saw that the fridge data logger showed some episodes of above 9c for short periods of time. For two of these episodes, we could not locate the corresponding evidence as to the reasons and investigations in to why, such as re stocking fridges. This was reported to the practice team during feedback for actioning. Following our site visit the practice carried out an investigation and shared their findings and the action taken to improve fridge temperature monitoring.

The practice had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received the recommended monitoring.

The practice pharmacist and pharmacy technician completed audits on medicines requiring regular monitoring and reported findings and patients requiring a monitoring recall or review. There was a process for the safe handling of requests for repeat medicines and evidence of effective medicines reviews for patients on repeat medicines. The practice monitored the prescribing of controlled drugs. (For example, investigation of unusual prescribing, quantities, dose, formulations and strength). The practice had taken steps to ensure appropriate antimicrobial use to optimise patient outcomes and reduce the risk of adverse events and antimicrobial resistance.