Cuckoo Lane 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

We looked for evidence that people were protected from abuse and avoidable harm. We assessed all 8 of the quality statements from this key question. At our last assessment we rated this key question as good. At this assessment, the rating has remained the same.

This service scored 78 (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 strong proactive and positive culture of safety, based on openness and 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 service took concerns seriously and proactively made improvements to the service. For example, they had worked to support patients’ digital access and provided unverified data that confirmed increased use of the NHS app, by 75% of patients. The leaders informed us there was a designated information technology lead at the practice that provided digital support and assistance.

We found leaders encouraged and rewarded staff for raising concerns about safety and ideas to improve and the value of learning was continually demonstrated and reinforced by leaders. During staff meetings, the whole team discussed and learnt from clinical issues. The service had processes for staff to report incidents, near misses and safety events. Staff felt there was an open culture, and that safety was a top priority, we saw learning from incidents discussed in regular meetings and daily huddles. 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. The service worked with other providers to deliver shared care. 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 patients. The leaders explained they had oversight of the workflow tasks to ensure they were all responded to promptly. On the day of the assessment, we did not find any delays in the patient workflow tasks.Referrals and test results were managed in a timely way and a designated member of the team had oversight for them.

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.

The service had a system to highlight vulnerable adults, children and household members on their medical records. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. Staff explained they had a system to follow up with children who were not brought to appointments and A and E attendances to identify any patterns in line with the practice’s policy.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The service had a duty clinician every day who was available for advice and support as necessary. All staff had completed basic life support, and anaphylaxis training relevant to their role. Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take.

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

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 in place which was monitored and reviewed. We observed fire exits were clear and fire safety equipment was easily available and regularly checked by an external company. The service had completed legionella, and fire risk assessments.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. We found the service recognised the continuing development of staff skills, competence and knowledge was integral to ensuring high quality care and leaders encouraged staff on professional development. There was evidence the service upskilled staff to create additional capacity, skills and experience to meet the needs of patients and create a more flexible workforce. For example, the phlebotomist had received training and support in areas of interest, including medical secretary, IT and was supported in progressing towards the role of assistant practice manager. Similarly, the practice nurse was undertaking her prescribing training to further develop in their role.

In addition, all clinical staff were highly skilled, qualified and experienced. The Advanced Nurse Practitioners (ANP) had the skills and competency to assess a variety of patients and so ANP and GP appointments were undifferentiated. Leaders and management monitored for any gaps in skills and encouraged and arranged for additional training. The service is the first non-GP led practice to be formally approved as a training provider in Northwest London. They were praised for encouraging staff and trainees to further develop.

There were a range of clinical and non-clinical roles within the service. They worked together well to provide safe care that met people’s individual needs. Management had a range of processes in place to ensure staff employed were suitably competent and experienced. Induction processes were tailored to roles. Safe recruitment practices were followed. We found training was up to date, learning needs and development of staff was managed regularly and appropriately. The service had structured appraisal system and records we saw reflected this. Leaders told us staff turnover was low.

Staff felt there was an open culture, and confirmed they had daily, weekly and monthly meetings where they discussed incidents and learning. We saw from the staff survey that all staff were positive about receiving support and development in their roles.

The service ensured that facilities and equipment were safe, and that equipment was maintained according to manufacturers’ instructions. 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 service had a designated infection, prevention and control lead and all staff had received relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The service made sure that 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. As part of our assessment, we conducted a series of remote clinical searches of patient records. These searches identified a small number of patients were not up to date with monitoring. This was due to personal lack of engagement with the service despite prior attempts by staff which was evident on the system. Following feedback relating to the clinical searches we analysed during this assessment, the service made sufficient arrangements to ensure the patients were followed up. Medicines were stored securely and at appropriate temperatures. 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 service had effective systems to manage and respond to safety alerts and medicine recalls. 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. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.