Hodford Road 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 under the previous provider, we rated this key question as Inadequate. At this assessment, the rating has changed to Good.

This service scored 63 (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 described staff as patient and understanding. Patients we spoke with during our on-site assessment explained how the practice would ask for their views. Managers promoted an open culture and staff felt confident speaking up and raising concerns. During staff meetings, complaints and significant events were discussed, encouraging shared learning and continuous improvement. Complaints were recorded and investigated and when things went wrong, staff apologised and provided support. However, we reviewed evidence of complaints and found responses to complainants were not always consistently recorded.

There were processes for staff to report incidents, near misses and safety events which included a significant event protocol and log, which included details and outcomes appropriately.

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 patients. The practice utilised online systems to allow visibility of patient bookings and enable flexibility in managing care pathways within their Primary Care Network (PCN). Managers regularly engaged in meetings within their PCN to review and plan safe care. The practice had a process and designated members of staff to record and manage referrals on a weekly basis.

The service did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that.

Safeguarding policies were in place and accessible to staff and the practice maintained safeguarding registers. All staff members had completed relevant safeguarding training for their roles. Staff members we spoke with were able to identify safeguarding concerns, who the safeguarding leads were at the practice and explain the process for reporting.

The practice could not show evidence of meetings being held with external health professionals or relevant agencies to discuss safeguarding concerns. We reviewed a limited number of internal meeting minutes provided by the practice, however, these did not contain evidence of safeguarding concerns being discussed.

The practice did not routinely add alerts on systems for household members of children on safeguarding register. We observed a record of a patient who was missing an alert on the system.

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 with the exception of 7 items, for example portable suction equipment. Risk assessments had not been completed for these items.

The storage of resuscitation equipment was not kept together in one box, bag or trolley. However, following our assessment, the practice had stocked and stored all suggested equipment. Staff had completed basic life support and sepsis training, and could recognise a deteriorating patient and knew of actions to take. Patients felt involved and were advised on risks related to their condition and actions to take if their condition deteriorated. Results from the national GP patient survey indicated that 71% of respondents said they had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses. This was higher than the local average of 64% and national average of 69%.

The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

During our on-site assessment, we observed that patient files were kept in a room which was unlocked and accessible by patients. This was in an area which was only designated for staff with appropriate signage, however, there were no physical measures to restrict patient access. Following our inspection, the practice provided assurances that the room would be kept locked and secured. We observed there was no oversight of the waiting room as this was located separately from the reception. This meant that staff may not immediately be aware if a patient became unwell while waiting. Following our inspection, the practice told us it had placed a safety mirror to allow visibility of the area. Additionally, we observed that the reception area did not have any door or barrier which meant the reception areacould be easily accessed by the general public. Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits, including fire safety and legionella testing, had been undertaken and risks identified had been addressed. 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. However, they did not always make sure staff received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The practice had policies for appraisals and safe recruitment practices including Disclosure and Barring (DBS) and registration checks. However, during our on-site assessment, we reviewed a sample of recruitment records and found that this was not complied with. We found proof of identity and DBS documentation was not available for one locum doctor. This was later provided during our assessment and was subsequently held by the practice in the relevant staff file. We also noted that employment references were missing for most staff. Appraisals had not been completed for most staff at the time of our assessment. Following our inspection, the practice told us that this had now been completed.

There were a range of clinical and non-clinical roles within the practice. Training records were complete for all staff and the practice maintained oversight to ensure training remained up to date and relevant.

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 (IPC) lead and staff had relevant IPC training. Risk assessments and audits were completed, and actions taken to mitigate risks. Cleaning schedules were in place and followed. Premises were clean and well-equipped to support effective infection prevention and control.

The service made sure that medicines and treatments were safe and met people’s needs, capabilities and preferences. They involved people in planning, including when changes happened. The practice appropriately monitored patients on high-risk medicines and patients with long-term conditions.

We carried out remote clinical searches of patient records as part of our assessment to review if the practice was assessing and delivering care and treatment in line with current legislation, standards and evidence-based guidance. The practice had a high-risk medicines protocol and medicines management policy.

We saw evidence in our clinical searches that monitoring of patients prescribed Disease-Modifying Anti-Rheumatic medicines (DMARDS) was completed appropriately (medicines used to stop or slow down the damage caused by the progression of inflammatory disease). We found that all of these patients had been followed up appropriately for their blood test monitoring.

We reviewed patients who were prescribed ACE inhibitors or Angiotensin II receptor blockers (medicines used to lower blood pressure) in our clinical searches. We found 268 patients were prescribed this medicine. Of these 268 patients, 16 were identified as having outstanding monitoring. We reviewed 5 of these patients and noted that 4 of the patients had been contacted recently to arrange monitoring and that the practice needed to contact 1 patient to arrange monitoring. The practice told us that it would review this patient.

We reviewed a Medicines and Healthcare Products Regulatory Agency (MHRA) alert relating to Aldosterone antagonist (a diuretic medicine used in the treatment of high blood pressure or heart failure) and found that the practice had appropriately actioned this alert. The practice had a central alerting system policy and told us that patient safety alerts were disseminated to clinical staff at the practice when received.

We reviewed patients who were elderly and on oral non-steroidal anti-inflammatory (NSAID) medicines (medicines used to relieve pain, reduce swelling and bring down high temperatures) in our clinical searches and found 19 patients where no medicine which reduces the amount of acid in the stomach was prescribed. We reviewed 5 of these patients and found that all of these patients required a review to ensure this medicine was considered. The practice told us that it would review these patients.

We noted that the practice had a higher than average rate of prescribing of hypnotics (medicines used to treat insomnia and other sleep disorders). The practice told us it limited prescriptions to a month at a time for patients on a regular prescription. The practice stated that it would request reviews and contact patients where they did not attend reviews. The practice would reduce the quantity of medicine to two weeks supply where reviews were not attended. During our on-site assessment, we saw that emergency medicines were checked regularly and found them all to be in date.