Laurbel 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

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. 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 regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes. There were systems in place to ensure that Medicines and Healthcare products Regulatory Agency (MHRA alerts) were followed. Patients on high-risk medicines were recalled for monitoring in a timely manner. During our assessment we found that safeguarding systems and procedures needed strengthening to ensure there were safe robust systems in place, following our assessment the provider acted on this to ensure potentially vulnerable patients were kept safe.

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. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Staff we spoke with, told us they were confident raising significant events and could inform us of the process that would be undertaken. During staff meetings, the whole team discussed and learnt from clinical issues. Staff felt there was an open culture, and that 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 that improved care for others.

For example a specialised wheelchair was not able to fit through the door to a clinical room. As a result of this, the practice acquired their own wheelchair to ensure accessibility for all patients when attending the practice.

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 offered “new patient appointments” to these patients, this was used to gather as much information as possible and then recorded on the practice’s clinical system.

The service worked with other providers to deliver shared care and when patients moved between services.

Staff understood their roles and had systems in place to manage tasks and test results. Through searches on the practice’s clinical system, we saw that referrals and test results were managed in a timely way.

The service worked with people and healthcare partners to understand what being safe meant to them. However, improvement was required with regard to oversight and monitoring systems. Although the lead GP and safeguarding lead knew the majority of their patients, they did not formally record their safeguarding meetings or have a formal recorded safeguarding list for either adults or children.

Following the assessment we saw evidence that the provider had carried out a search on their clinical system to identify patients with safeguarding concerns and that a formal list had been created and a plan put in place to discuss at their practice meetings which would be recorded. The practice had also arranged additional training for themselves and the other practices that made up their Primary Care Network (PCN) from an external specialist.

We found that staff had a good understanding of safeguarding and how to take appropriate action. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. All staff we spoke with were able to inform us who the practice’s safeguarding lead was.

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. Staff could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

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. The practice provided us with evidence of health and safety risk assessments. Audits had been undertaken and risks identified had been addressed. At the time of our assessment we saw how the practice was being renovated, and an extension was being built to increase the number of clinical rooms available. We saw how this was coordinated in order to protect patients and maintain health and safety compliance whilst building work was taking place. We also saw there was a fire safety policy in place and regular checks were undertaken.

There was a business continuity plan in place which was monitored and reviewed. We saw that all staff had completed mandatory training in fire safety.

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 that met people’s individual needs. Managers made sure staff received training to maintain high-quality care.

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. As part of this assessment, we looked at the recruitment files of 2 members of staff, this included an administrative staff member and a clinical staff member. All files recorded that appropriate recruitment checks had been completed.

We saw evidence that non-medical prescribers had their competencies assessed. Following feedback after our assessment this process was strengthened to contain formally documented discussions with non-medical prescribers in-line with national guidelines.

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 lead (IPC) and all staff had had relevant training. Cleaning schedules were in place and being followed. Risk assessments and audits were completed, and actions taken to mitigate risks. We saw that the practice ran regular handwashing and clinical waste sharps bins audits to monitor compliance.

We saw evidence that the provider had arranged for a private company to assess the practice and complete an audit. Following this an action plan was produced. We saw that actions had been taken following the findings of the audit. The nurse who was the IPC lead was given dedicated time to carry out the role.

We observed the practice to be clean and tidy throughout. As part of our visit, we reviewed a treatment room, consulting room and stockroom. We also reviewed the extension to the property which included 3 additional clinical rooms and a meeting room.

The service 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.

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 followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Searches we ran on the practice’s clinical system identified potentially 15 patients on disease-modifying anti-rheumatic drugs (DMARDs) that had not received the required monitoring within the last 6 months. We looked in detail at 5 patients and found that all 5 patients had been reviewed appropriately. However, documentation could have been improved by recording the day of the week of administration. When this was fed back to the practice it was addressed immediately. We found that all patients prescribed warfarin (blood thinning medicine), had received the required monitoring.

Searches identified that 4 patients from 102 on direct oral anticoagulant medicine (DOACs) required their creatinine clearance checked to ensure they were receiving the correct amount of medication. This was immediately actioned by the practice.

Searches identified that patients with heart failure who were prescribed an aldosterone antagonist (medicine used to treat high blood pressure and heart failure) had received the required monitoring.

Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines which were stored on site.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. We found that there were systems and processes in place to regularly review these.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. This included audits on paracetamol prescribing, patients with chronic obstructive pulmonary disease (COPD) and a lipid management audit.