Resilience Medicine Clinic Ltd

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• 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 six quality statements in the safe key question and found areas of good practice. The service had a safe learning culture and were able to raise incidents and significant events appropriately. Staff referred to and communicated effectively with other services and had the necessary arrangements to safeguard their patients and staff. Leaders at the service took a balanced and proportionate approach to safely involve patients to manage risks and conducted safe and robust procedures to ensure they recruited and maintained safe and effective staff. The prescribing of medicines and treatments were safe, and the service worked with statutory and regulatory bodies to ensure they were adhering to good practice. We also saw the governance

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service undertook patient surveys requesting patients experience at the practice, although specific questions were asked about learning culture. The evidence reviewed did not show any concerns about people’s experience regarding learning culture. The service had arrangements in place to allow patients the opportunity to provide feedback on the quality of care received.

Staff we spoke to were aware of how to raise incidents and the importance of doing so. Staff we spoke to detailed how learning from incidents was shared with relevant staff members. Leaders detailed how they supported processes in place and staff members as required when doing so.

The service had an adequate system in place for recording and acting on significant events. a system was in place for reviewing, investigating and escalating matters if an incident required it to do so. Adequate processes were in place to learn and share lessons and themes to improve safety and quality of service. The service had an effective mechanism in place to disseminate patient safety alerts to relevant staff members.

The service requested feedback from patients to review the quality of care provided. Although the service did not question patients directly about pathways and transitions, the majority of patients were satisfied with the service. As interactions with patients happen off-site, we did not speak to any patients on the day of the assessment.

Staff referred to, and communicated effectively with, other services when appropriate. Staff told us that they requested summary care records via an electronic secure system from a patients’ NHS GP prior to a consultation with the patient and prior to initiating any medication.

Partners did not provide feedback about safe systems, pathways and transitions as part of this assessment, therefore we did not review this evidence category.

There were systems and processes to share information with staff and other agencies to enable them to deliver safe care and treatment. This included a shared care protocol that allowed information to be shared and received securely and in regular multidisciplinary meetings.

Staff told us about how they would identify and escalate potential safeguarding concerns. We were informed about a safeguarding incident they dealt with in line with their policy to ensure the necessary care was taken. We found they had a clear understanding of safeguarding procedures and were aware of the end-to-end process of safeguarding procedures. Staff were aware of the safeguarding lead and evidenced literature around the practice to signpost them to support.

During our assessment we found the provider had systems and processes in place to ensure patients were safeguarded from harm. This included an updated safeguarding policy with relevant details, maintaining safeguarding audits and having a safeguarding lead. At the time of the assessment, we examined the safeguarding training records of all staff members and found there was no safeguarding level 3 training for one of the consultants. However, the training was completed with evidence provided the day after the assessment.

The provider had arrangements in place to allow patients the opportunity to provide feedback on the service received. Patient feedback showed patients were happy about their involvement and understanding of any risk involved. The evidence we reviewed did not show any concerns about people’s experience of involving people in managing risks. The way the service managed feedback showed the views of people were listened to and considered.

Staff informed us they took a balance and proportionate approach to risk when considering patient care. Quality improvement audits were carried out on a regular basis. Most staff had completed relevant training and the provider had systems in place to ensure they have oversight on this.

Clinicians had access to patient information to enable them to deliver safe care and treatment and systems were in place to share information with a patient’s GP and other healthcare agencies to help manage risks. We reviewed eleven patient records (including patient consultations) and found they were written and managed securely and in line with current guidance and relevant legislation.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Results from the services in-house survey shows that patients were happy with the skill and experience of staff. Evidence we reviewed did not show any concerns about people’s experience regarding safe and effective staffing arrangements.

Leaders at the service spoke about how, due to the size and speciality of their organisation, candidates for staffing vacancies may be personally known to leaders at the service. Therefore, a streamlined process is followed which still includes safe and robust recruitment procedures, such as checking a clinicians GMC register, confirming the candidate is currently working in an NHS position ( in line with their own policy) and ensuring DBS, identity and qualifications are checked prior to employment.

The service had robust and safe recruitment practices in place to make sure staff were experienced and competent to carry out their specific role. Prior to employment, leaders at the service ensured new staff carried out necessary recruitment checks such as a collecting a DBS check, photo identification the correct level of training. Leaders maintained a staff training matrix to ensure they were aware of completed and overdue training.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients were involved in decisions about their care and treatment and provided with information about possible treatments prior to their initial consultation. This was evidenced in records of discussions between patients and their prescriber and supported by feedback from patients collected in an in-house patient survey. If a patient did not consent to information sharing, they were advised they would not be able to access certain medications. Patients were signposted to other more suitable services where it was in their best interests.

Leaders worked with statutory and regulatory bodies to ensure they were adhering to good practice principles in relation to prescribing cannabis based medicinal products (CBPMs). Staff could describe the risks involved when prescribing medicines that were dependence forming and staff were able to describe the process for enabling complex prescribing decisions to be reviewed by peers.

Whilst we reviewed patient records off-site, we did not carry out any observations on-site and are therefore cannot score this section.

We reviewed 9 patient records and saw they included details of patient identification, consent to treatment, medical history, and detail of GP communication. The service had a policy regarding information sharing with a patient’s own GP but we saw this was not being followed consistently by all clinical staff. However, we did not see any patients being placed at increased risk because of this. Audits had identified the need for improvement in medical record keeping and leaders had implemented an action plan in this area. During our remote clinical searches, we saw older documents were not always appropriately labelled on the medical record system. More recent documents were labelled with enough detail to enable clinicians to find what they need. We also saw an issue with the medical record form where the patient’s answers were visible, but the question being asked was not. Leaders at the service told us that they would review this process.