What is the Quality of Facilities at Sheldon Medical Centre

Positive

"• Although some steps were being taken to improve cancer screening uptake the practice had not assessed how effective this had been and were unable to demonstrate if this had been effective."

Positive

"The practice manager explained that they were working with a breast screening and health promotion nurse from University Hospital Coventry and Warwickshire NHS Trust in order to try and improve breast cancer screening rates."

Positive

"Furthermore there was no evidence to demonstrate if the practice had recognised bowel cancer screening rates as an area for improvement and we could not see how steps had been taken to try to improve this."

Positive

"However breast and bowel cancer screening rates were below average and although some steps were being taken to improve uptake the practice was unable to demonstrate if this had been effective."

Positive

"• Patients spoke highly of the care provided by the GP and the practice nurse and receptionists were described as friendly and helpful."

Positive

"Patients spoke highly of the care provided by the GP and the practice nurse and receptionists were described as friendly and helpful."

Positive

"• Where a patient’s mental capacity to consent to care or treatment was unclear the GP or practice nurse assessed the patient’s capacity and where appropriate recorded the outcome of the assessment."

Positive

"The practice nurse operated an effective failsafe system for ensuring that test results had been received for every sample sent by the practice."

Positive

"The practice manager explained that they were working with a breast screening and health promotion nurse from University Hospital Coventry and Warwickshire NHS Trust in order to try and improve breast cancer screening rates."

Neutral

"However we found that previously when the practice nurse was absent from the practice a full nursing service was not provided during this period."

Neutral

"However we found that when the practice nurse was previously absent from the practice a full nursing service was not provided during this period."

Neutral

"• The practice nurse was the infection control lead."

Neutral

"For instance the practice manager explained that nurses from the main practice at Arran Medical Centre would be utilised in the event of the practice nurse being absent from the practice."

Neutral

"We saw that the nurse attended study days for updates on immunisations and cervical screening the practice nurse also engaged with local nurses at quarterly nurse meetings facilitated by the clinical commissioning group CCG."

Neutral

"This included access to a male GP at Arran Medical Centre as the GP and nurse at Sheldon Medical Centre were female."

Positive

"Areas in which the practice did best related to convenience of appointments the helpfulness of reception staff and the nurse was good at giving patients enough time during their appointment."

Positive

"The practice nurse discussed systems in place to record consent including implied consent."

Positive

"The practice nurse was responsible for undertaking any relevant assessments of patients with long term conditions and patients were able to book in at a time that suited them for an appointment with the practice nurse."

Positive

"The practice nurse had recorded fridge temperatures on a daily basis and the temperatures recorded were within nationally accepted guidelines."

Positive

"The practice nurse was knowledgeable about the cold chain and the actions to take to ensure cold chain requirements were met."

Neutral

"Additional staff include a business manager and a practice nurse female."

Neutral

"During our visit we spoke with a range of staff including a GP nurse practice manager and administration staff and we spoke with patients who used the service."

Neutral

"The practice nurse had extended knowledge in safeguarding."

Neutral

"The practice nurse recalled an incident where they dealt with a safeguarding concern in the practice."

Neutral

"Medicines Management We discussed medicines management with the practice nurse and GP."

Neutral

"A PGD can act as a direction to a nurse to supply andor administer prescriptiononly medicines POMs to patients using their own assessment of patient need without necessarily referring back to a doctor."

Neutral

"The practice nurse confirmed that she was the lead for infection control."

Neutral

"The practice nurse showed us records to demonstrate that they had received the necessary immunisations to comply with legislation."

Neutral

"The practice nurse told us that they attended a monthly learning set for practice nurses organised by the clinical commissioning group CCG."

Positive

"The audit also highlighted some inconsistencies in the information stored on the practices patient record system and the system used for blood monitoring in secondary care as an action point clinicians strengthened their data entry process to ensure a current and accurate reflection across the two systems."

Positive

"Monitoring risks to patients There were some arrangements in place for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs."

Positive

"Management monitoring and improving outcomes for people The practice used the information collected for QOF and national screening programmes to monitor outcomes for patients."

Positive

"Governance arrangements • Staff across the practice had key roles in monitoring and improving outcomes for patients."

Positive

"This is due to other issues identified with regards safe systems and processes monitoring risks to patients and the arrangements to deal with emergencies and major incidents."

Positive

"For instance we saw records of an audit aiming to ensure that all patients prescribed a specific high risk medicine were up to date with therapy and blood monitoring checks."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"• There were some arrangements in place for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs."

Positive

"Management monitoring and improving outcomes for people The practice carried out reviews as part of the Quality and Outcomes Framework QOF."

Positive

"Learning and improvement from safety incidents The practice had a system in place for reporting recording and monitoring significant events incidents and accidents."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Positive

"We saw minutes of multidisciplinary meetings which took place on a quarterly basis regarding those patients with end of life care needs."

Positive

"Staff also told us that any patients who required end of life care were telephoned upon discharge from hospital."

Positive

"We were provided with audit information regarding complaints infection prevention and control and significant events."

Neutral

"We looked at how infection prevention and control procedures were managed at the practice."

Positive

"Following our inspection the provider clarified that the emergency medicine was not needed in the practice however no formal risk assessment was provided to support how risk was managed in the absence of the emergency medicine used to treat pain."

Positive

"Following our inspection the provider clarified that the emergency medicine was not needed in the practice however no formal risk assessment was provided to support how risk was managed in the absence of the emergency medicine used to treat pain or signs and symptoms of arthritis."

Positive

"However no formal risk assessment was provided to support how risk was managed in the absence of the emergency medicine used to treat pain."

Positive

"Shortly after our inspection the practice shared records to demonstrate that they had recorded this as a significant event records highlighted that the expired medicine had been appropriately disposed of and learning shared."

Positive

"However there was no assurance given to indicate if the emergency medicine had been replaced."

Positive

"Although this was recorded as a significant event there was no assurance given to indicate if the emergency medicine had been replaced."

Positive

"• Following our inspection the provider clarified that the emergency medicine was not needed in the practice and was therefore not replaced."

Positive

"• We saw that in most cases medicines were prescribed in line with national prescribing guidelines however we found that in one case there was continued prescribing of a specific opiate medicine with no rationale in the patient’s record."

Positive

"However we found that in one case there was continued prescribing of a specific opiate medicine with no rationale in the patient’s record."

Positive

"Exception reporting is used to ensure that practices are not penalised where for example patients do not attend for review or where a medicine cannot be prescribed due to a contraindication or sideeffect."

Positive

"For instance we saw records of an audit aiming to ensure that all patients prescribed a specific high risk medicine were up to date with therapy and blood monitoring checks."

Neutral

"We bought this to the attention of the management team; they explained that the medicine would be replaced as a priority."

Neutral

"We looked at the storage of medicines in medicine refrigerators."

Neutral

"We were told that the PPG met every three months at the practice and a member of staff acted as chair person made notes and gave feedback to the practice manager and GPs."

Positive

"We saw that the practices palliative care was regularly reviewed and discussed as part of the MDT meetings to support the needs of patients and their families."

Positive

"• Multidisciplinary team MDT meetings and palliative care meetings took place on a quarterly basis."

Positive

"Multidisciplinary team MDT meetings and palliative care meetings took place on a quarterly basis."

Positive

"The practice had three patients on their palliative care register."

Positive

"Multidisciplinary meetings were held on a quarterly basis to manage and monitor the care delivery treatment and support of patients receiving palliative care."

Positive

"The practice had a palliative care register and had quarterly multidisciplinary meetings to discuss patient and their families care and support needs."

Positive

"Staff were aware of the number of people on the palliative care register."

Positive

"Alert systems were in place so that staff would be made aware if a patient on the palliative care register telephoned in order that staff could prioritise their call."

Positive

"For instance we saw that a recent significant event was recorded with regards to a medical emergency that occurred in the practice records indicated that staff acted appropriately to manage the emergency and this was reflected on during a practice meeting."

Positive

"We looked at the medication available for use by staff in a medical emergency situation."

Positive

"There was a health and safety policy and the practice had risk assessments in place to monitor fire risk and the safety of the premises."

Positive

"Effective staffing • The practice had an induction programme for newly appointed members of staff that covered topics such as safeguarding fire safety health and safety infection Are services effective?"

Positive

"The practice had not undertaken a legionella risk assessment a germ found in the environment which can contaminate water systems in buildings although this had been highlighted as an issue for action in a recent health and safety risk assessment."

Positive

"We saw a sample of risk assessments completed such as health and safety and fire risk assessments."

Positive

"Health and safety information was displayed for staff to see and there was an identified health and safety representative."

Positive

"The need to complete a legionella risk assessment was highlighted as an area for action in a recent health and safety audit undertaken."

Positive

"We saw that the practice had a detailed health and safety policy."

Positive

"The GP partners and the practice manager form the practice management team and they are supported by a team of eight staff members who cover finance operations admin reception cleaning and secretarial duties."

Positive

"• We observed the premises to be visibly clean and tidy and we saw that cleaning specifications and completed records were in place to demonstrate that the practice and medical equipment was frequently cleaned."

Neutral

"We saw there were cleaning schedules in place which recorded the tasks to be completed."

Neutral

"Signed cleaning records demonstrated the cleaning undertaken."

Neutral

"The cold chain refers to the process used to maintain optimal conditions during the transport storage and handling of vaccines starting at the manufacturer and ending with the administration of the vaccine to the patient."

Positive

"A COSHH assessment would be completed to identify those substances and activities where there may be exposure to hazardous substances which may damage health."

Positive

"We saw that criminal records checks via the disclosure and barring service DBS had been undertaken on staff who act as a chaperone."

Neutral

"We saw details of a clinical audit regarding the use of gliptins a medication that can be used to treat diabetes and an audit regarding the use of high dose inhalers."