Albany Surgery

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 looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

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.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong.

Staff were actively encouraged and appreciated for raising concerns about safety and providing ideas to improve services. Staff felt part of a team where they could contribute towards safety and improvement. We were told the primary response is always to learn and continuously improve the service.

During staff meetings, the whole team discussed and learnt from clinical issues. Staff felt there was an open culture, and that safety was a top priority. 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.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Referrals to secondary care, including urgent referrals for suspected cancer, were managed promptly and appropriately followed up. The service also carried out audits of the referrals to ensure adherence to best practice and continuous quality improvement. During our remote clinical searches, we reviewed workflow and correspondence including communications from secondary care, such as discharge summaries, and the evidence seen demonstrated these were processed efficiently to ensure continuity of care.

There were systems for processing information relating to new people who use the service. The service worked with other providers to deliver shared care and when people moved between services. Referrals and test results were managed in a timely way.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. There were designated safeguarding leads who attended multi-disciplinary meetings, where safeguarding was a standing item on the agenda.

The service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Emergency equipment was available and maintained. The ‘Duty Doctor’ (a GP handling urgent and same-day appointments) was available to support the receptionists by providing guidance to medical queries and helping prioritising people’s needs. Staff we spoke with provided examples of co-ordinated responses between clinical and non-clinical staff to manage medical emergencies.

Staff could recognise a deteriorating patient and knew of action to take. People were advised on risks related to their condition and actions to take if their condition deteriorated.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Facilities, premises and equipment were designed and used to meet the needs of all people who use the service.

Records showed fire alarms were routinely tested, and the service had appointed their own fire marshals to direct people in the event of a fire. Staff completed fire training and completed regular fire drills which included an evacuation of the building.

Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan which was monitored and reviewed, all staff were aware of where this was kept and what to do in an emergency.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were an appropriate number of staff with a mix of skills to deliver safe care, leaders were able to demonstrate how they reviewed staff rotas to address demand and how they covered busy periods such as annual leave and staff sickness.

The continuing development of staff skills, competence and knowledge were recognised by managers as being integral to ensuring high quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills, and share best practice. For example, a staff member told us they had attended a menopause course which benefitted people’s care. Clinicians were able to attend conferences to enhance their continuing personal development.

Succession planning is embedded within the service workforce strategy. Potential future vacancies were identified early, and the skills required for key roles were reviewed regularly to ensure the service was prepared for planned and unplanned changes.

Staff training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Safe recruitment practices were followed.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

During the onsite visit, we observed the environment and equipment to be visually clean. Cleaning schedules were followed and the service met with the external cleaning company regularly to discuss any identified issues.

The service had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were available and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

Clinical waste procedures were followed by staff, and there was a process to record staff vaccinations in line with national guidance.

The service made sure medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines.

Staff managed prescription stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Medicines including controlled drugs were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs.

Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider 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 recommended monitoring. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was in line with local and national averages.

As part of our inspection, a set number of clinical record searches were undertaken remotely. We reviewed the records of 5 people who were prescribed methotrexate (a medicine for treating autoimmune conditions). We found 2 people had not been monitored in line with national guidance. However, on discussion with the service this was due to both being treated within secondary care (at the local hospital).

For the people who were affected by a medicine safety alert “topiramate” (a medicine used to treat epilepsy and prevent migraine headaches), our search identified 11 people who had not been contacted and informed of the risks. We looked at 5 records and found all had been contacted but there was no formal risk assessment in place as per national guidance. The service immediately contacted the people affected and amended their process for reviewing this safety alert.

We reviewed a sample of Patient Group Directions (PGDs) (a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition) and Patient Specific Directions (PSDs) (a written instruction from a doctor or other independent prescriber for a medicine to be supplied or administered to a named person). We found they had been completed correctly in line with guidance.

Prescribing data for, hypnotics (medicines that promote sleep) and gabapentinoids (medicines prescribed for treatment of epilepsy, neuropathic pain or generalised anxiety disorder but with risk of misuse or dependence) were in line with national averages.