EMC 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.

This is the first inspection for this service since its registration with CQC. However, the provider has remained the same. Under the previous registration they were rated good on 13 March 2020. This key question has remained Good.

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 complete honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always 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. During staff meetings, the whole team discussed and learnt from events. 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. When concerns were identified, they acted quickly to manage risk.

There were 3 significant events recorded in the previous 12 months, and the provider had systems in place to review these as part of an annual significant event analysis (SEA) review. They used comprehensive analysis to recognise trends or themes. Those we sampled had been reviewed, analysed and shared in line with policy. Significant events were discussed with staff to enable actions to improve patient safety, quality of care, and operational effectiveness. For example, we saw following a medicine error the provider discussed the concern within the clinical group as well as the wider partnership to minimise risk of reoccurrence. Staff were offered time to reflect and consider additional learning.

There was a system to record and investigate complaints. Information reviewed demonstrated that people had opportunities to provide feedback, and they knew how to make a complaint. Lessons were learnt from individual complaints and shared with the practice team to improve the quality of care. Information on how to provide feedback was available in the practice and on their website.

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.

There were systems in place for processing information relating to new people. 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.

People who had received care in hospital had follow up appointments and medicines reviews. There was a range of structured meetings in place including full team meetings, clinical meetings and management meetings. These meetings were used to support safe systems by facilitating discussion and providing oversight in areas such as safeguarding, palliative care, and clinical and operational matters.

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 understood by staff, all of whom were appropriately trained in safeguarding procedures. Staff had access to a designated safeguarding lead for adults and children. The practice maintained a register of vulnerable individuals, and we saw registers were routinely reviewed and relevant information was shared effectively within the team. Staff responded proactively to concerns, implementing actions and learning in collaboration with partner organisations such as during multi-disciplinary team meetings.

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

People told us that they received advice regarding how to manage their conditions. An example was a person with weight management concerns told us they had spoken to the doctor about related health issues. They had been assessed for weight loss medicines and were happy with the outcome.

Staff could recognise a deteriorating patient and knew of action to take. They were trained in sepsis awareness, anaphylaxis, cardiopulmonary resuscitation (CPR), and basic life support training. People were advised on risks related to their condition and actions to take if their condition deteriorated.

Reception and administrative staff who handled calls to the practice and arranged appointments with the clinical team were aware of potential red flag symptoms. They knew when to notify a GP or other clinicians with concerns about a patient who may be acutely unwell and/or deteriorating. Staff had been provided with training in health and safety related topics such as fire safety, basic life support and resuscitation training.

The practice listened to patient feedback and used it to identify areas for improvement and, made appropriate changes to enhance the quality of care provided. Patient feedback was obtained during face to face contact, online, surveys and through written feedback boxes in the waiting areas.

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

There were some gaps in the risk oversight of the care environment, as not all risks had been identified through existing audit processes. We found that there were no stair guards in a reception area so people could climb and fall. The provider told us that this was due to building works at the site in Hobmoor Road, and that they were awaiting the end of the works to replace. However, this did not mitigate against the risk of people in the service during the works and risk assessments had failed to address this.

Thermometers were not available in rooms holding emergency medicines. This meant the medicines could be subject to extreme high or low temperatures that could affect their efficacy.

Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken.

The premises were clean and in reasonable condition. There was a business continuity plan in place which was monitored and reviewed.

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 a range of clinical and non-clinical roles within the practice. We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. During our assessment, we reviewed five staff files and found safe recruitment practices were followed and maintained. We found clinical supervision was recorded and staff told us they felt supported in their role.

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.

The practice had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks. We found that chemicals were stored safely and that contaminated spill cleaning kits were available, and staff knew how to use them. Staff had been immunised to protect them from contaminated spills and accidental exposure to bodily fluids.

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

As part of our assessment, remote clinical searches were conducted by a GP Specialist Advisor. Clinical searches identified that protocols were followed to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

The clinical searches also identified 331 people who had hypothyrodism (underactive thyroid). Of these people 4 out of the 5 did not have Thyroid Function Tests (TFT) monitoring completed within the last 4 months. We also found that people who had been prescribed aldosterone antagonist (ACEI/ARB) for chronic heart or kidney issues were not always reviewed in a timely manner. We sampled the records of 5 out of 9 people and found that they had not been monitored. However, we saw that the service had attempted to get the patients into the service without success. They had made telephone calls and sent text messages and were proactively engaging with them to encourage uptake. The service had a policy for people who failed to attend including reducing prescription dates to encourage attendance. We also saw that the service was performing well in reviewing people with Diabetes and those using Warfarin (a blood thinner).

We also found that items were missing from the emergency medicines kit, including blood pressure monitor, Oxygen saturation monitor and a sharps bin. This could have negative consequences on the health of people who needed emergency support in the building, by staff not being able to quickly find the instruments required to check oxygen saturation or blood pressure in a timely manner.The provider told us that the items were in doctor’s bags for home visits. They agreed that all emergency equipment needs to be available within the emergency medicines kit to enable staff to access the correct equipment in emergency situations.

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 regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. 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 lower than local and national averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment, however these audits did not always highlight concerns around TFT and ACE inhibitors.