Harraton 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 requires improvement. At this assessment, the rating has changed to good.

This service scored 62 (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 reported that staff treated them with compassion and understanding. Managers promoted a culture of openness and encouraged staff to speak up when things went wrong. Clinical issues were discussed as a team during staff meetings, creating opportunities for shared learning.

The provider had a structured process for recording and investigating incidents and complaints. When things went wrong, staff apologised and provided support to those affected. Learning from incidents led to changes that improved care. For example, following an incident where a sample was incorrectly labelled, staff were reminded to check and double-check samples prior to submission. The incident was used as a learning opportunity to reinforce the importance of accurate sample handling and labelling.

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 service worked with other providers to deliver shared care, including during patient transitions between services. Referrals and test results were managed in a timely and structured way. For example, 2-Week Wait (2WW) referrals were overseen by a designated staff member, who ensured all referrals were processed within 48 hours—typically on the same day they were received. A weekly review was conducted to monitor referral progress and confirm that patients had received appointment dates, providing an additional safety net to prevent delays and ensure appropriate follow-up. Our review showed that this system was effective in maintaining timely referrals and minimising the risk of patients being lost to follow-up.

Safeguarding arrangements required improvement. The safeguarding policy did not accurately reflect current roles, including the named deputy. Adult safeguarding concerns were addressed individually when needed; however, regular adult safeguarding meetings were not in place to provide structured oversight. Records reviewed showed that regular safeguarding children’s meetings were held.

However, the service had systems in place to identify and respond to safeguarding concerns, and there was evidence that individual concerns were shared appropriately with relevant partners when required.

Staff were able to tell us who the safeguarding lead was in the practice and how to raise concerns. They told us they received training in both safeguarding adults and children and records reviewed confirmed that this training was up to date.

The practice had a chaperone policy in place, ensuring that chaperones were available to provide reassurance and to help mitigate risk for both patients and staff.

Disclosure and Barring Service (DBS) checks were undertaken when required.

The service worked with people to understand and manage risks holistically, providing care that was safe, supportive, and aligned with individual needs.

We saw examples of multidisciplinary team (MDT) meeting minutes that identified frail patients and outlined actions taken to support them. Discussions were documented, and outcomes were used to inform care planning and reduce avoidable hospital admissions. The MDT included representatives from social prescribing, adult social care, a frailty nurse from the Primary Care Network (PCN), community nursing, and, where appropriate, the Carers Centre and Age UK. Any staff member could refer patients, and a GP from the practice attended the meetings to support clinical decision-making.

Emergency equipment was available and maintained. Staff were able to recognise a deteriorating patient and knew what action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

Staff received training in Basic Life Support and anaphylaxis management to ensure they could respond effectively in emergencies.

The service did not always detect and control potential risks in the care environment.

At Springwell House, the fire alarm, emergency lighting, and fire extinguishers were last serviced 29 April 2024 and were slightly overdue at the time of assessment. The delay had been followed up with an explanatory email, and a quote for servicing had since been approved. Also, the key for the vaccine fridge had been reported lost; however, the room could be securely locked to maintain safety.

At Harraton Surgery, the cleaning cupboard was not secured with a lock, but the practice manager showed evidence that a suitable lock had been obtained and confirmed that arrangements were being made to have it fitted.

There were systems in place to support the management of environmental safety. Health and safety risk assessments and audits had been completed, and identified risks were addressed. A business continuity plan was in place and regularly reviewed. Fire drills were carried out monthly at both sites, along with routine fire walkarounds to ensure compliance with safety procedures.

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 and staff were working within their agreed areas of competence. Safe recruitment practices were followed.

Some staff told us they felt additional staff would help further ease workloads. The practice manager informed us they were looking to recruit an additional nurse and advanced nurse practitioner (ANP) to support service capacity.

Learning and development were managed through 1-to-1 meetings, where individual needs were assessed, and training was tailored accordingly. During these meetings, staff members discussed their development goals, and plans were adapted to support their growth. For example, one team member had completed care coordination training, and another had undertaken spirometry and ECG training and was due to begin a Trainee Nursing Associate programme in September, with full support from the practice.

The service did not always assess or manage the risk of infection effectively. There was no robust processes in place to ensure that all staff (clinical and non-clinical) were protected from infection through appropriate routine pre-exposure immunisation. This was not in line with guidance issued by the UK Health Security Agency, as outlined in the Green Book: Immunisation Against Infectious Diseases.

Following the assessment, the provider began arranging blood tests to check immunity for all staff whose vaccination status could not be confirmed.

The practice 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. However, at Harraton Surgery, best practice for cleaning equipment storage was not always followed.

A review of clinical records highlighted some gaps in documentation and clinical coding that could impact medicines monitoring and care planning. For example:

Heart Failure Medicines (Aldosterone Antagonists): 5 of 12 patients had no recent blood tests (Urea and Electrolytes) recorded in the clinical system. These medicines required regular monitoring. The practice later confirmed that some tests had been done in hospital but not uploaded to their clinical system. Follow-up actions were taken, and appropriate appointments were arranged to ensure ongoing monitoring.

Possible Missed Diabetes Diagnoses: 8 patients had 2 high blood sugar readings (HbA1c), which could have indicated diabetes. In 3 of the 5 records we reviewed, the diagnosis had not been correctly coded.

Anti-inflammatory Medicines in Older People: 49 of 165 patients on NSAIDs (non-steroidal anti-inflammatory drugs) or antiplatelets were not prescribed a PPI (proton pump inhibitor), a medicine that helps protect the stomach lining. In the 5 cases we reviewed, clinical reasoning was appropriate but not clearly documented.

Staff regularly checked stock levels and expiry dates for medicines and vaccines. We observed that emergency medicines were present, in date, and stored appropriately; however, records to demonstrate these were checked on a regular basis were not being kept at the time of inspection.

The provider had effective systems in place to manage and respond to safety alerts and medicines recalls. Staff followed protocols for prescribing high-risk medicines and ensured that patients received the necessary monitoring in line with clinical guidance.