Grey Gable 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.

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. Lessons were learnt to continually identify and embed good practice.The practice had processes for staff to report incidents, near misses and safety events.Managers encouraged staff to raise concerns when things went wrong.People felt supported to raise concerns and felt staff treated them with compassion and understanding. During staff meetings, the whole team discussed and learnt from clinical issues.

The practice 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 such as the summarising of new patient notes. Referrals and test results were managed in a timely manner. The practice had recently started upskilling a staff member to support the medical secretary with tasks such as managing referrals. Leaders of an aligned care home told us that the practice completed relevant referrals to other professionals in a timely manner to support the residents’ ongoing care.

The practice 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 practice shared concerns quickly and appropriately. The practice had appropriate management and oversight and review of safeguarding. Safeguarding policies were in place, up to date and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained and regularly updated a list of vulnerable people that was regularly reviewed and updated. Vulnerable people were coded on the system and had alerts added to their records including household contacts. The practice responded to and acted upon correspondence such as children not brought in for appointments. The practice had regular clinical and multidisciplinary meetings to discuss safeguarding concerns.

The practice 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. Staff could recognise a deteriorating patient and knew of action to take. The practice ensured that staff had the knowledge and experience to respond to emergencies. For example, they held a training session to ensure all staff were aware of the contents of the emergency medicines and equipment trolley. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The practice detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Health and safety were regularly discussed at team meetings. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. Portable appliance testing and calibrations were up to date. Systems were in place to check safety equipment including fire alarms, emergency lighting and panic buttons. Fire evacuation drills were completed regularly.

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. Leaders supported staff to be upskilled after they identified gaps in some roles. For example, they upskilled a member of staff to support and reduce the workload of the medical secretary. Learning and development for staff was encouraged and managed appropriately. There were a range of clinical and non-clinical roles within the practice. Staff received regular appraisals and received allocated time for learning and development.

The practice 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 (IPC) lead and all staff had completed relevant training. Cleaning schedules were in place and followed. The practice had a cleanliness working group to ensure cleaning standards were maintained. IPC audits were completed regularly, and the appropriate actions were taken when necessary.

The practice 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. As part of our assessment, a series of remote patient clinical record searches were undertaken by a CQC GP specialist advisor. This included a review of the management of patients on medicines that required monitoring. We found patients had received monitoring in line with guidance. For example, we reviewed a random sample of 5 patients identified as having a potential missed diagnosis of diabetes and found no issues with the monitoring of these patients. We reviewed a random sample of 5 medication reviews that had been completed for patients in the previous 3 months. We found 4 of these reviews were completed appropriately but 1 was just a code and lacked information, such as monitoring arrangements or details about what had been reviewed or changed as a result of the review. The practice had effective systems to manage and respond to safety alerts and medicine recalls. Our review of clinical records indicated that safety alerts were actioned in line with guidance. For example, we reviewed 3 patients prescribed Mirabegron (a medicine that eases the symptoms of an overactive bladder) and found all patients had been informed of the risks and had been chased up for a blood pressure check. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. We found the dispensary had appropriate protocols in place for staff to follow to ensure they dispensed medicines safely. Patients told us they received their medicines in a timely manner.