Siam Surgery

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• 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

This key question has been rated as good. We looked for evidence that people were protected from abuse and avoidable harm.

The practice had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and support to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.

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 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.

Care home representatives gave examples where practice leaders had listened to feedback and had worked together to try to resolve issues. We received no specific feedback from people regarding their experiences for this quality statement.

All staff we received feedback from advised they knew how to identify and report concerns, and were informed of learning as a result. Staff gave a range of examples of improvements made following incidents and complaints that improved care for others. These included information governance reminders and increased awareness of advising people about the potential side effects of medicines.

Managers encouraged staff to raise concerns when things went wrong and ensured staff were supported. Concerns were anonymised to promote transparency and staff confidence in raising issues. There were processes for staff to report incidents, near misses, safety events and complaints. Systems were in place to investigate these events, review what went well and what could have been done better, identify learning, and make any improvements required. Learning from incidents and complaints resulted in changes that improved care for others.

Practice staff worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They worked with other providers to deliver shared care when people moved between services.

People and care home representatives gave positive feedback about the registration process and timely, appropriate referrals being made. Partners provided positive feedback regarding safe systems for integration between people, the practice and other professionals.

There were systems in place for processing information for people registering at the practice. This included for example, homeless people and asylum seekers, refugees and other migrants. The practice had a backlog of summarising people’s medical records due to the volume of new people registering. They had completed a risk assessment and had for example, increased summarising staff and prioritised urgent medical records to reduce the risk. Monitoring arrangements were in place.

Protocols were in place to manage the flow of work within the practice. Arrangements were in place to ensure required actions were reviewed and authorised by an appropriate clinician. We reviewed the pathology and tasks lists on the clinical system which showed they were managed in a timely way. Monthly audits of the work of non-clinical staff were undertaken by practice leaders, for example, to monitor that people’s correspondence was processed correctly and in a timely way. Any issues identified were discussed and learning undertaken.

Staff told us they had the information they needed to deliver safe care and treatment. Referrals and test results were managed in a timely way.Staff who were involved in making referrals were clear about their role and checks were in place to ensure referral requests had been actioned. For example, tasks and audits were used to monitor people referred for suspected cancer had attended their appointment. The practice had fail-safe systems to ensure all cervical cytology results were received from samples sent. However, we noted for 1 clinician, samples sent in June did not have an outcome recorded. We raised this with the practice leaders who confirmed on the site visit that results had been received for all people who had a sample sent in the previous 3 years. They had strengthened their oversight arrangements and had a new policy in place which had been discussed with relevant staff.

Practice staff 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. Staff shared concerns quickly and appropriately.

The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. This included for example, monthly multidisciplinary face to face meetings with health visitors to discuss all safeguarding concerns for children aged under 5. Multidisciplinary safeguarding meeting for vulnerable adults were held regularly. Safeguarding discussions also took place during clinical meetings.We reviewed minutes of these meetings and people’s needs were discussed and reviewed, and actions agreed and followed up. Arrangements were in place for discussions and actions to be added to people’s clinical record.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. Staff who we received feedback from told us they were confident to report any concerns and knew who the practice safeguarding lead was. Staff gave examples of how they supported vulnerable people, for example home visits to people who may be at risk. The practice had a domestic abuse champion. Arrangements were in place to follow up vulnerable people who had not attended for their appointment, which included for example, secondary care appointments.

We received positive feedback from partner agencies regarding safeguarding arrangements.

Practice staff 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.

People who provided feedback for this assessment had no specific views or concerns in this area. Care home representatives told us practice clinicians informed and helped people, their carers and family, as appropriate, to understand any risks with their treatment. People knew how to obtain support and advice if their health was worsening.

There were effective arrangements for supporting people to identify, mitigate and manage risks. People were advised on risks related to their condition and actions to take if their condition deteriorated. Arrangements were in place for staff to identify, assess and manage people whose health was deteriorating, and for managing medical emergencies. Staff had completed basic life support and anaphylaxis training relevant to their role. Staff told us they were able to access emergency medicines and equipment easily.

Emergency medicines and equipment were available and maintained, but the documentation of the checks made, was not always clear. The provider acted and improved their system, so all checks were completed monthly and recorded on 1 spreadsheet to improve clarity and oversight. There was a risk assessment for emergency equipment which was not stocked.

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

Arrangements were in place to ensure the premises were maintained. Ongoing checks, for example fire safety, electrical safety, and equipment calibration, were completed. A range of health and safety risk assessments, which included for example, home visits, flu clinics, and IT failure, had been undertaken and risks identified had been addressed or minimised. The practice had a business continuity plan which had been updated and was currently being reviewed.

All staff we received feedback from told us they had suitable and sufficient equipment to undertake their work and were satisfied with the health and safety arrangements in place. Staff had received fire safety and health and safety training.

During the site visit, we observed fire exits were clear and fire safety equipment easily available and checked by an external company. We checked an action identified in the fire risk assessment and found it had been completed.

Practice staff used technology securely and effectively and conformed to relevant digital and information security standards with arrangements in place for the confidentiality of data management. Staff had completed training in information governance. Staff gave examples of how they ensured people’s confidentiality and demonstrated they took information security seriously.

Practice leaders made sure there were enough qualified, skilled and experienced staff who received effective support, supervision and development. They worked together to provide safe care that met people’s individual needs. Feedback from people and care home representatives was positive in relation to the knowledge, skill, care and treatment provided by clinical staff.

Safe recruitment practices were followed in line with the practice’s recruitment policy. Appropriate recruitment checks were carried out which included Disclosure and Barring Service (DBS) checks for all staff. The practice’s chaperone policy detailed the specific roles and responsibilities of chaperones. All chaperones were clinicians who had received training for this role.

The professional registration of clinical staff was checked at recruitment and on an ongoing basis. All new staff received an induction, adapted to their role. Leaders met with staff regularly to complete performance reviews and a sample of records we reviewed confirmed this. People’s feedback was requested for each clinician following a clinic appointment, for example, as part of the performance review for new staff.

The practice was able to demonstrate staff had the skills, knowledge, and experience to carry out their roles.Staff who were responsible for long term condition reviews, childhood immunisations and cervical screening had completed training, and their competency was checked on an ongoing basis. Arrangements were in place for the clinical oversight of staff working in extended roles, which included those who prescribed medicines. There was regular, documented review of their practice, supported by peer review and protected time for case discussions. A duty GP was available for clinical advice and support, for example to discuss home visits and post home visit support.

Practice staff assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. We received no specific feedback from people regarding their experiences for this quality statement.

The practice had a lead nurse for infection prevention and control (IPC), who had IPC lead training and attended the Integrated Care Board (ICB) IPC forum meetings. Staff we received feedback from, knew who the IPC lead was, had received appropriate training and could describe the systems in place for safely dealing with clinical specimens and spilt bodily fluids. Policies and guidance were available for staff and staff had completed training, which included during induction, relevant to their role.

A range of IPC audits were completed, for example safe care of equipment, safe management of the care environment and room cleaning audits. An annual IPC audit completed in March 2025 had an overall score of 94% compliance. Audit results were shared at clinical meetings to encourage staff with positive findings and remind staff of areas for improvement. We checked a sample of identified actions and found these had been completed.

During our on-site visit, we observed the practice to be clean and tidy. We saw documented checks of cleaning and arrangements in place to effectively communicate with the cleaning company and resolve any issues.

The practice obtained an immunisation history for all staff upon employment. A risk assessment was in place for 1 staff member who was not able to obtain this information.

Practice staff 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. The majority of the feedback from people, including care home representatives was positive in relation to medicines management.

Medicines were stored securely and those which required cold storage were appropriately kept within temperature monitored fridges, which were serviced. Staff regularly checked the stock levels and expiry dates of all medicines. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. Staff had acted to ensure prescription stationery was managed appropriately and securely, and had a new policy in place. Patient Group Directions (PGDs) were in place to allow the nurse to give vaccinations without a prescription, and these had been appropriately authorised for use.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. Our remote clinical searches showed people received the recommended monitoring when prescribed medicines by the practice. For example, we completed a clinical search for 1 immunosuppressant medicine, and 1 search for a medicine for heart failure and found all people had received appropriate monitoring.

The practice had effective systems to manage and respond to safety alerts and medicine recalls. There was evidence that safety alerts had been actioned, and people received the correct information about any risks associated with their medicines. We reviewed 1 alert, where people prescribed certain diabetes medicines must be informed about important signs and symptoms of side effects and when it would be necessary to seek medical advice. We found all people had been informed of the risks. A pop-up alert had been added to prompt prescribers and ensure the appropriate code was added to the record. For another remote clinical search, the provider demonstrated they had acted to ensure the appropriate documentation would be completed by secondary care. The practice planned to add a pop up for staff to check a signed agreement was in place.

We completed 2 remote clinical searches which reviewed medicines usage. We searched for 1 medicine used to provide quick relief from asthma symptoms, which should not be automatically prescribed on a repeat prescription, as overuse was linked to a higher risk of asthma complications. Some people were prescribed this medicine on repeat. At the site visit we saw this medicine had been taken off repeat and issues limited, with a system to review people who requested more. Our second search was for a medicine to treat osteoporosis (a bone disease that causes bones to become weak and brittle). At the site visit the Registered Manager confirmed 2 people we identified, had been referred for a recommended test and would be reviewed following receipt of the results.

The practice governance system had identified a backlog of medicine reviews. Practice leaders had agreed to complete medicines reviews in line with the person’s date of birth, with arrangements to ensure urgent medicine reviews were completed and appropriate clinicians undertook virtual and face to face reviews. They had increased GP capacity for this work. Monitoring arrangements were in place.

We reviewed a range of prescribing indicators. The practice were within the expected range for prescribing some medicines, however hypnotic and some antibiotic prescribing was above the expected level. The practice were aware of this and were actively trying to reduce this. They advised they were engaged with the Integrated Care Board (ICB) and Clinical Pharmacists were working to reduce prescribing in these areas.