The Loughton 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 Good. At this assessment, the rating remains the same.

The practice demonstrated a positive approach to patient safety, had effective processes to manage safety alerts and acted on these appropriately. There were effective systems for monitoring people’s health and reviewing medicines, and staff responded appropriately when issues were identified. The practice was performing in line or above local and national averages for most required indicators, specifically those relating to medicines. Staff understood how to identify and report incidents, and there was evidence that safety concerns and incidents relating to patient care were investigated appropriately, with learning used to reduce the risk of recurrence. Safeguarding arrangements were strong. Staff understood their responsibilities, had received appropriate training, and demonstrated a good understanding of how to recognise and respond to concerns. Recruitment processes and ongoing checks ensured staff were suitable for their roles.

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 practice 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. People felt supported to raise concerns and felt staff treated them with compassion and understanding.

People and their carers were provided with information about how to make comments or complaints. This information was available at the surgery and on the practice website. There was a system to record and investigate complaints and, when things went wrong, staff apologised and gave people support.

The practice provided records for significant events logged during the last 12 months. We found these were recorded and investigated appropriately. Learning was shared throughout the practice which resulted in improved care for others.

A process for handling safety alerts was in place and followed. This meant staff were aware of alerts and able to action necessary changes, to keep people safe.

The practice worked with people who used the service and healthcare partners to establish and maintain safe systems of care. The practice had systems and processes in place to share information with staff and other agencies to enable them to deliver safe care and treatment. The service worked with other providers to deliver shared care when people moved between services.

Members of the staff team were aware of local services and support networks that they could refer people to for support and to prevent ill health. Reception staff had been trained in care navigation to direct people to the most appropriate service or services to meet their presenting needs. Regular multi-disciplinary meetings were held where the needs of people with more complex conditions or those approaching the end of life could be discussed.

Clinicians followed care and treatment pathways for treating and referring people to other services.Referrals to secondary or specialist care were made promptly, and people referred under the 2-week wait rule for suspected cancer were followed up with appropriate safety netting processes in place. Correspondence from secondary care such as discharge letters and summaries were processed quickly and effectively. People could request a chaperone if they wished and there was information to alert them to this in the waiting room and in clinical rooms.

The practice worked to safeguard people from the risk of abuse. This included working with partner agencies. The practice had systems and processes in place to respond when it was suspected that people may be subject to abuse or neglect. Staff had been provided with safeguarding training at a level that was appropriate to their roles and responsibilities. Staff had a clear understanding of safeguarding and knew who the designated safeguarding lead was. They knew the action to take if they had concerns about a patient’s safety and they told us they would feel confident to report concerns. Alerts were added to the patient record system when a patient was subject to a safeguarding concern so that all relevant members of the staff team could easily identify this. Feedback from people who used the service did not include any concerns with regards to safeguarding.

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. Information was also available online to help people understand their long-term conditions and how to manage them. The care and treatment provided was safe, supportive and encouraged people to remain healthy and do the things that mattered to them.

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

The service was located in a building that had been completely re-designed and re-furbished by the current partners to ensure that it met the needs of people using the service, staff and colleagues from partner organisations. The premises were clean and contained the appropriate facilities and processes to support a safe environment. The provider detected and controlled potential risks in the environment. Leaders made sure equipment, facilities and technology supported the delivery of safe care. Regular checks were carried out on the premises, facilities and equipment provided. Contracts were in place to ensure the premises were clean and well maintained. Health and safety related assessments and procedures to manage health and safety were in place. This included fire safety. Staff had been provided with training in health and safety related topics such as fire safety, infection control and manual handling.

The practice had installed underground heating in the car park to minimise the risk of trips and falls and car accidents in icy conditions. There was a business continuity plan in place to provide guidance for dealing with any major disruption to the service, for example an IT failure; the practice had installed a generator on site to mitigate the risk of a power failure and to minimise the risk of disruption to people’s care and treatment.

The practice 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. Protected learning time took place regularly and meetings with staff were relevant to practice business such as incidents, safety alerts, safeguarding, complaints and actions for improvement.

Safe recruitment practices were followed.

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 cleaning schedules available, which outlined how staff should clean the building and its equipment. The service demonstrated how these were monitored for completion to maintain oversight of cleaning arrangements. During our onsite visit, the service's premises and a sample of equipment reviewed were noted to be visibly clean. The service’s infection prevention and control lead conducted regular risk assessments and audits to ensure compliance and took action where necessary to mitigate any identified risks. Staff had completed relevant training in infection prevention and control. Appropriate arrangements were in place to manage clinical waste.

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

As part of our assessment, a CQC GP specialist advisor undertook clinical record searches. This compared the practice’s procedures around prescribing and medicines management to recognised standards for three different medicines. We found that all people who were prescribed these medicines were monitored and assessed in line with guidance.

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. All people with long-term conditions were recalled for their annual review and assessed using templates that reflected national guidance for disease management.

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 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 provider had effective systems to manage and respond to safety alerts and medicine recalls.