Bevan Group Practice

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. We assessed all the quality statements in this key question and the service has been rated good. This meant people were safe and protected from avoidable harm. However, there were areas the provider needs to improve, such as recording and acting on safety alerts, lone working and safeguarding arrangements. We assessed all the quality statements in this key question.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Effective processes were in place for monitoring and reviewing safe care and treatment in a positive learning culture. These included managing incidents and significant events. Staff were encouraged to raise concerns and report incidents which were later discussed at clinical staff meetings. However, non-clinical staff incidents were not always discussed with non-clinical staff. The provider had a complaints policy and procedures, and these were in line with recognised guidance. The service learned lessons from individual concerns and complaints and from analysis of trends. We saw that complex incidents and complaints were reflected upon with a learning event analysis, so that learning and improvements could be identified. The service had processes and systems to ensure compliance with the requirements of the duty of candour. The service had a Patient Participation Group and regular meetings took place to gain patient views about their experiences.

There was a system for processing information relating to new patients, including the summarising of new patient notes. There were protocols in place for managing incoming correspondence into the patient’s medical records. Administration clerks were employed to ensure pathology and blood test results were managed in a timely manner. The clinical team reviewed all patient correspondence, and our review of patient records showed that all tasks had been acted upon. Patient referrals to specialist services were documented in the referral systems and patient record. However, these was no additional monitoring in place to ensure the referral had been accepted, patients had attended as requested and the outcomes of the referral had been communicated back to the service. Triage systems and protocols were in place for staff to follow. There were systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment, for example with out of hours providers. Meetings took place with partners to ensure effective monitoring of care continued as people moved between services. For example, monthly Gold Standard Framework (GSF) meetings took place with community partners to monitor the needs of patients on the end-of-life pathway.

Safeguarding systems, processes and practices were developed, implemented and communicated to staff. Policies and procedures were reviewed and up to date and were aligned with other local safeguarding teams. Staff we spoke with were aware of how to identify, report and take action for safeguarding matters or concerns. The service had a designated lead for safeguarding adults at risk and children and staff were aware of this. The service had a register for vulnerable adults but not children and there was insufficient evidence that the register had been reviewed and updated. The out of hours service was informed of relevant safeguarding information. While safeguarding matters were discussed at staff meetings, there were no meetings with local partners, such as health visiting teams, to discuss vulnerable children. At the time of assessment, the registered manager confirmed that recent contact had been made with the local health visitor and so that regular meetings could take place. Partners and staff were trained to appropriate levels for their role. The service had a chaperone policy in place to maintain patient privacy during intimate examinations. Posters were displayed in all consultation rooms and waiting areas.

Staff worked proactively to support patients with the prevention of ill health, for example, recalling patients who were at risk of developing diabetes or referring patients for dietary advice or smoking cessation. Health reviews for these patients included reviewing their current health and providing advice, care and treatment to improve or maintain this and prevent a deterioration. The service encouraged patients to attend for health screening. Parents of children who had not attended for childhood immunisations and people who had not attended for cancer screening, were followed up and encouraged to attend. Our review of a sample of consultation records showed that patients were informed about risks and how to keep themselves safe through safety-netting advice (advice given to patients when the cause of their symptoms, or how their illness will progress, actions to take if their condition fails to improve, changes or if they have further concerns about their health). Patients 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 to a diabetes education course. Patients who were prescribed high risk medicines were called for regular checks.

The service was located in a main purpose-built building and the branch surgery was located in a renovated older building. Both buildings had sufficient rooms to deliver services, with supportive services also in the same premises. The branch surgery had a ramp at the entrance to the building which made the area accessible for people who used wheelchairs. The doors were not automatic and there was a bell and video cameras at the entrance to alert staff if support was needed. Policies, procedures and arrangements were in place to ensure facilities, equipment and technology were well-maintained and to consistently support staff to deliver safe and effective care. Health and safety risk assessments had been undertaken; these were up to date for the main site at Beaconsfield Primary Care Centre but were out of date for the branch surgery at West Bank Medical Centre. This included an up-to-date fire risk assessment, electrical and equipment installation certification for some appliances. Following the assessment the service confirmed a fire risk assessment had been undertaken and an action plan was submitted for any actions required.

There were robust and safe recruitment practices to make sure that all staff, including agency staff, were suitably experienced, competent and able to carry out their role. There were appropriate staffing levels and skill mix to ensure safe and effective staffing and this was monitored by the practice manager. However, feedback from staff was that the workload for reception staff was heavy and at times very stressful. The management team was aware of this, and they told us that actions had been taken in response to this. The service had a main site and a branch surgery. We noted that at times only one reception staff was working at the branch site and sometimes as a lone worker. We discussed this with the provider at the time of assessment and they confirmed that arrangements would be reviewed to ensure that staff would not be working at the practice alone in the future. Systems were in place to ensure staff received good support, supervision and appraisals for their professional development. Staff confirmed they received training appropriate and relevant to their role. They felt supported with their personal development and were given opportunity to learn. Interviews with staff confirmed that meetings took place with non-medical prescribers to review their prescribing practice, such as practice pharmacists and advanced nurse prescribers. However, these meetings were not formally documented and should be.

Infection prevention and control audits were carried out and reviewed, and actions taken where necessary. People were protected as much as possible from the risk of infection because the premises and equipment were kept clean and hygienic. Nurse lead roles had responsibilities around infection prevention and control, and they linked in with other infection control leads in the area. The arrangements for managing waste, sharps and clinical specimens kept people safe. Staff vaccination was maintained in line with current UK Health and Security Agency (UKHSA) guidance, if relevant to their role. There was a system for the service to report infection-related concerns to the relevant agencies (e.g. notifiable diseases).

We saw that medicines including vaccines were stored safely and staff were aware of what to do if a fridge temperature was out of range. Staff had access to emergency medicines and equipment including oxygen and a defibrillator. We noted that Patient Group Directions (PGDs) (written instructions to supply or administer medicines to patients in planned circumstances for example vaccinations) were in good order. Our review of a sample of patient records showed a small number of people had failed to attend the service to undergo the required checks related to their prescribed medicines when they had been invited. Regular medicines reviews were carried out to ensure patient medicines were appropriate to their needs and safe. There was a system for recording and acting on safety alerts, however, the service was unable to demonstrate that all relevant safety alerts had been acted upon. For example, we found that an The Medicines and Healthcare products Regulatory Agency (MHRA) alert for the medicine Citalopram was not being followed as our clinical search highlighted that the prescribing for some patients had not followed this guidance. We discussed this with the service at the time of assessment and they confirmed they had carried out their own clinical search in November 2024 and actions were in progress for the patients identified. Our review of patients who were prescribed high risk medicines showed that a small number of improvements were needed. For example, the service having up to date blood results from shared care agreements with secondary care providers for medicines such as Methotrexate, in line with best practice guidelines. We found the service had built in clinical searches (Arden’s EMIS) on their patient records system which flagged alerts that patients required follow up. We noted that some alerts indicating patients on high-risk medicines needing a 6 monthly follow up had not been acted upon. This was followed up by the service following assessment.