Dr Mehboob Bhatti Also known as Sutton Road 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

At our last assessment, we rated this key question as inadequate. At this assessment, the rating has changed to good.

The service was rated inadequate in the safe key question in the previous inspection. We found improvements had been made in all of the areas of concern. Improved systems were in place, for example, for the safe management of patients on high-risk medicines, patients with long term conditions and patient safety alerts.

Safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. People were always safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. When people raised concerns about safety and ideas to improve, the primary response was to learn and improve continuously. There was strong awareness of the areas with the greatest safety risks. Solutions to risks were developed collaboratively. People were supported to make choices that balanced risks of harm with positive choices about their lives. Leaders ensured there were enough skilled people to deliver safe care that promoted choice, control and individual wellbeing. We identified some concerns regarding the provision and accessibility of emergency medical equipment and some issues with the accessibility of the premises. The provider responded immediately where possible and has subsequently put in place plans to address the longer-term issues which will require building work.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Since the previous inspection the provider had embedded 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 felt staff treated them with compassion and understanding.

During our last inspection we identified a lack of clinical oversight at the practice in which staff were not able to identify appropriate incidents and situations from which they could learn. At this inspection we found that managers had improved oversight of clinical events and they encouraged staff to raise concerns when things went wrong. The provider had recorded 10 significant events in the previous 12 months and kept a log of these to help identify and analyse themes or trends. 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. Learning from incidents and complaints resulted in changes that improved care for others.

The provider 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 and ensuring they had the correct clinical codes applied to their records to support continuity of care. The provider took action following our previous assessment to review and restructure systems for reviewing test results, correspondence and referrals. They had implemented clear lines of responsibility and communication which ensured letters and test results were actioned in a timely way. The provider ensured that everyone who required a referral to a specialist was seen face to face for a full clinical assessment before the referral was made which had improved the quality of referrals. Administrative staff had oversight of urgent 2 week wait referrals maintaining a tracking system to ensure that people received an appointment and attended. The provider worked with other providers to deliver shared care and when people moved between services.

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.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The provider maintained a register of vulnerable people and acted on concerns working in partnership with other organisations. A designated safeguarding administrator maintained the practice registers and recorded minutes of the safeguarding meetings held every 2 months with the safeguarding lead GP and members of the wider multidisciplinary team such as Health Visitors. The provider registered people residing in local temporary accommodation and was Iris accredited. Iris is a general practice-based domestic violence and abuse (DVA) training, support and referral programme. The provider used electronic flags on the clinical system to identify people with safeguarding issues and their family members to ensure people’s safety was protected.

The service did not always work well with people to understand and manage risks. Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take. People were advised on risks related to their condition and actions to take if their condition deteriorated. The provider had implemented the use of record keeping templates for all clinical staff which had improved the quality of record keeping, including “safety-netting”. Safety-netting is information given to a patient or their carer during a consultation, about actions to take if their condition fails to improve or changes.

During our assessment we identified missing emergency equipment and absent signage for the automated defibrillator. Emergency equipment checks were reliant on the practice nurse, with no designated cover. The emergency trolley was too small to allow quick access to equipment and was stored behind a combination‑locked door that several staff struggled to operate, creating potential delays in an emergency. Some risk assessments for emergency medicines were also insufficient.

We raised these concerns with the provider. They ordered the missing equipment and signage during the assessment, confirmed plans to replace the trolley and door lock and withdrew the deficient risk assessment. They ensured the medicine was stored appropriately and updated the policy to assign the practice pharmacist as cover for emergency equipment checks.

Two anaphylaxis kits were available on the emergency trolley. These contained an injectable medicine to treat people experiencing a severe allergic reaction. National guidance states that due to the risk of anaphylaxis during vaccinations, kits should be available in the room where vaccinations are administered. Although the practice nurse knew where the kits were and could access them quickly, they were not kept in the room during vaccination clinics. When we raised this with the provider, they implemented a system to ensure a kit was available in the nurse’s room for vaccination clinics.

The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

At the last inspection we saw that cleaning equipment, which included mops, a bucket, a broom, boxes on the floor and other items were being stored in the room where the boiler was located. At this inspection this was no longer the case.

Contracts were in place to ensure the premises were maintained. An appropriate range of risk assessments and audits had been undertaken and risks identified had been addressed. The practice did not have a specific fire risk assessment document. However, the important factors had been assessed in other documents they provided including a fire inspection checklist, a fire exits and escape routes risk assessment and the health and safety risk assessment. There was a suitable range of fire safety equipment available, which had been serviced at timely intervals, fire exits were clearly marked and free from obstruction and annual fire drills showed that evacuation plans were effective. There were trained fire marshals and staff knew who they were. At the time of our assessment the fire door into the reception area was propped open, which contravenes fire regulations. Staff closed the door when we made them aware of this. The door was wooden with no glass panel to be able to see who was on the other side and presented a risk to people who could open the door into someone exiting the room. We raised this with the provider who acknowledged the problem and advised that plans were in place to extend and upgrade the premises in the next 12 months which would include automatic doors into the reception area.

There was a business continuity plan in place which was monitored and reviewed

The provider was located in a large, converted 2 storey building which had been in use for many years. There was a patient car park at the front of the building. All clinical rooms were on the ground floor, with offices and staff areas on the first floor accessed by stairs. Access to the building was via a ramp. People had to pass through 2 manual doors to reach the reception desk. Wheelchair users could not access the reception without assistance. At the time of our assessment there was no way for people to summon assistance from outside the practice. Following our assessment the provider installed a doorbell at an appropriate height.

Seating in the waiting area consisted of long bench-style seats with wipe clean upholstery. There were no chairs with arm rests for people with limited mobility. However, after we raised this with the provider they ordered some suitable chairs the same day.

There was no hearing loop in the reception. Following our assessment the provider planned to purchase one, however they advised that other technological access solutions are now available to hearing-impaired people who have a smart phone.

A room was available to reception staff if they need to speak to people confidentially. There was an accessible patient toilet but no baby changing or breast-feeding facilities due to a lack of space. An alternative room was available on request and information was available to make people aware of this facility.

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. The provider had significantly expanded its non-medical clinical workforce since the last inspection, utilising a combination of its own and staff employed by the Primary Care Network (PCN). The provider had employed a practice nurse and clinical pharmacist both of whom were non-medical prescribers. The PCN-employed staff included a healthcare assistant, a pharmacist, and 2 physicians associates. The provider had also employed 3 long-term locum GPs in addition to the Lead GP. At the last inspection we found there was no documented evidence of clinical supervision and the lead GP was unable to demonstrate how they assured themselves of the competence of staff employed in extended roles. At this inspection 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. All staff could access clinical supervision and had protected time with a clinical supervisor. Formal clinical supervision comprised a review of 10 patient consultations every 4 months for each non-medical clinician by a GP, where feedback was provided in writing. Safe recruitment practices were followed. Staff files were organised so that relevant documents were readily and easily accessible, new staff had appropriate induction and records of staff immunisations were up to date. In the National GP Patient Survey 94% of people who responded had confidence and trust in their healthcare professional which is above the national average of 92.5%

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 provider had a designated infection, prevention and control (IPC) lead and all staff had relevant training. Cleaning schedules were in place and followed. The IPC lead had implemented an ongoing audit system which was reviewed and updated monthly. A hand hygiene audit was undertaken every 3 months and staff were given verbal feedback. Appropriate risk assessments and record keeping were completed, and actions taken to mitigate risks. All staff knew who the IPC lead was and where to access IPC policies. The IPC lead had a working relationship with the cleaning staff and information was shared regularly.

There were 4 clinic rooms which all met infection prevention and control standards. A separate room was carpeted and so was not used for clinical work except as an isolation room in an emergency situation. There was a risk assessment in place for the carpeting and the provider planned to replace the flooring when upgrading work started.

All clinical equipment was single use and no equipment required sterilisation. Appropriate personal protective equipment was available in all clinical rooms along with alcohol hand gel. Sharps bins were sited, used and disposed of appropriately. Staff understood how to manage a sharps injury although there had not been any such injuries in the last 12 months. The practice did not have a sluice or “dirty” utility room and so there was an appropriate standard procedure for disposing of urine specimens.

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.

During our last inspection of this provider, we identified concerns regarding medicines management. At this inspection we saw that the provider had redesigned the systems and processes for medicine reviews and people on medicines that require regular monitoring. They had aligned responsibility for these areas with specific staff roles embedding accountability and oversight. Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. Staff followed protocols to ensure they prescribed all medicines safely and to ensure people prescribed medicines with specific risks received recommended monitoring. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Records we reviewed as part of our clinical searches confirmed that these processes were working effectively to ensure people received regular monitoring and review and were kept safe.

Staff felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicine and vaccines. Waste medicines were recorded and disposed of appropriately. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Prescribing data reviewed as part of our assessment confirmed this. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes for example, the number of antimicrobials issued by the provider was lower than national averages demonstrating good stewardship. However, the prescribing of broad-spectrum antibiotics remained higher than the national average. The provider sought support from their Integrated care Board (ICB) to undertake a targeted campaign to improve their antibiotic prescribing in this area for example, patient education and delayed prescribing (this is where a watch and wait approach is taken and antibiotics are only prescribed if symptoms do not improve).

The addition of a pharmacist to the practice team had brought tangible benefits. For example, the pharmacist had oversight of all people requiring monitoring blood tests or a medicine review and ensured they were contacted and reviewed in a timely manner. During our previous inspection we identified concerns related to the management of people prescribed high quantities of medicines for severe pain. Following our inspection the pharmacist had reviewed all of these patients and implemented strategies to begin reducing or stopping this medication.

Medicines were stored securely and medicines which required refrigeration were stored at the correct temperature and monitored appropriately. However, other medicines were stored in a locked cupboard in a non-clinical room where the temperature was not monitored. In order to maintain their safety and effectiveness medicines should be stored below 25 degrees Celsius at all times. When we raised this with the provider, they installed a thermometer and created a standard operating procedure so that staff knew what action to take if the temperatures were outside the acceptable range.

Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments however, required warning notices informing people that oxygen was stored in the room were missing. When we raised this with the provider, they purchased the signage on the day of our assessment.