Cradley 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 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 meant people were safe and protected from avoidable harm.

This service scored 72 (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. Leaders and staff 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. Leaders encouraged staff to raise concerns when things went wrong. Staff felt there was an open culture, and 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 which 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.

People told us referrals to other services such as those at the hospital were made promptly and followed up if needed. Test results were reviewed on the day they came in by the duty GP and followed up 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. The practice was supported by a safeguarding lead from the primary care network (PCN). This meant staff had a good overview of safeguarding within their PCN area. The system was robust and safeguarding was followed up promptly and reviewed regularly. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures.

The service demonstrated a strong, holistic approach to risk management by working closely with people to understand and manage risks effectively. Care was planned and delivered in a safe and supportive way, enabling people to maintain independence and engage in the activities which mattered most to them. Emergency equipment was readily available, appropriately located and well maintained.

Staff showed a clear ability to recognise when a person’s health was deteriorating and were confident about the actions required. This was further strengthened by the continuity provided by reception staff, many of whom knew patients by name and were able to promptly identify subtle changes in a person’s wellbeing. Patients were routinely given clear advice about risks related to their condition and were supported to understand what action to take should their condition deteriorate.

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.

The building was small and due to an increase in the number of patients using the dispensary the dispensary team had moved into a secure part of the reception area. Staff worked well within the limited space and leaders had a plan and funding in place to add an additional temporary building for the dispensary and admin staff to work in.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked well together to provide safe care which 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. Safe recruitment practices were followed including risk assessments where information was missing from recruitment files. Leaders had been supported by an external human resources organisation to ensure recruitment practices were robust.

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 used an unlocked cupboard located in a patient toilet for the storage of specimens, such as urine samples, awaiting collection by the nursing team. Although specimens were appropriately labelled and bagged, the cupboard was accessible to anyone using the toilet, which presented a potential risk of exposure. Nursing staff collected the specimens regularly; however, this did not fully mitigate the risk to people who may have accessed the cupboard. The practice ordered a new lockable cupboard to be used for this purpose and installed it straight away.

The practice had appointed a designated infection prevention and control lead, and all staff had completed relevant training. Cleaning schedules were in place and were followed.

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. Waste medicines were recorded and disposed of appropriately including medicines returned by patients.

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.

There were suitable processes for staff to follow when dispensing medicines. This included a colour coded system so items which needed additional checks were identified easily. The dispensary had robust processes in place for the safe delivery of medicines to people in the community.

Prescribing was safe and appropriate. Staff took steps to prescribe medicines optimally, including antibiotics. The practice had a programme of regular clinical audits designed to improve prescribing quality, such as audits of repeat prescribing and antibiotic use.

Clinical record searches showed safe prescribing and monitoring. As part of our assessment, a Care Quality Commission GP Specialist Advisor completed searches of patient records. The review identified very few issues in prescribing or the management of long‑term conditions. For example, we found reviews for people with long term conditions such as diabetes and chronic kidney disease had been completed in a timely way.