Dr Azim Khan Also known as Unity 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 Requires improvement. At this assessment, the rating has changed to Good.

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 strong proactive and positive culture of safety, based on openness and complete honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice. Effective systems were in place to share learning. Staff felt supported to raise concerns and felt staff treated them with compassion and understanding. All staff we spoke with told us management were approachable and always listened to ideas and suggestions. Managers encouraged staff to raise concerns when things went wrong, and serious events were discussed at meetings for learning. For example, a complaint investigation found that a task had been missed within the practice, which resulted in practice wide learning on the management of tasks to ensure it did not happen again. Staff felt there was an open culture, and that patient safety was a top priority.

A representative from the Patient Participation Group (PPG) felt the service took concerns seriously and proactively made improvements to the service. The practice took their views onboard and consistently involved them in new initiatives and campaigns. The PPG had recently joined up with other PPGs within their practice network and shared numerous ideas which they are keen to adopt at Unity Surgery.

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. All staff were invited to significant events review meetings, and all significant events were discussed at regular protected learning time (PLT) meetings to allow all staff to contribute to learning. There were processes in place to share minutes from meetings with those who were unable to attend meetings.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The practice maintained a list of vulnerable people and acted on concerns, working in partnership with other organisations. The service had regular meetings with partners to share information and recorded this appropriately on patient records, demonstrating, where required appropriate actions were taken to safeguard people. The service shared concerns quickly and appropriately. We saw displays with safeguarding information and contacts on display where staff took calls from patients. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. Staff told us they had completed safeguarding training online. All staff were aware of the clear processes in place to identify and act on safeguarding concerns. Alerts on patient notes relating to vulnerable children and adults were in place. They knew who the safeguarding lead was and where they could get support on safeguarding issues.

The service always worked well with people to fully understand and manage risks by thinking holistically. They provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them. All patients that gave us feedback told us how easy it was to access the practice for advice and appointments. A range of appointment were available including evenings. The practice took pride in being the only local GP practice with late opening hours three days a week, opening until 8pm on Monday, and 7.30pm on Tuesday and Friday.

They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. They made notes on patient records if they had additional needs, such as requiring double appointments due to communication needs, which allowed reception staff to offer care in line with patient needs.

Individual risks were assessed, and people were appropriately involved in this. Our clinical searches found patients had regular comprehensive medication reviews and individuals with long term conditions had regular reviews.

Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take. All staff we spoke with knew how to access support in an emergency and were confident these systems worked effectively. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

Leaflets were available around common long-term conditions in the waiting area. We saw these were available in different languages to suit the local population.

The facilities and premises were appropriate for the services being delivered. There were planned refurbishments to increase clinic rooms and make improvements to the existing building, in line with infection, prevention and control guidelines.

A ramp was available for people to access the practice. Most clinic rooms were on the ground floor with patients occasionally seen on the first floor for specific clinics. We observed the practice was accessible for all people and included space for wheelchairs and prams. Hallways and corridors were clean and tidy and free from clutter. Staff offices were secure, and access was restricted from the public.

At our previous inspection, we found that risks associated with legionella had not been reviewed regularly by competent persons, and some equipment in use had passed its expiry dates. At this assessment, we found improvements in systems to monitor and comply with mandatory risk assessments, including fire safety and legionella testing to ensure that people and staff remained safe. The practice conducted weekly fire tests, staff completed fire training and attended regular fire drills which included the evacuation of people.

Electrical equipment had been calibrated and tested. Safety alerts relating to equipment were shared with the relevant staff and acted on.

Systems were in place for checking and monitoring emergency equipment and medicines. The practice kept recommended emergency medicines and equipment, including oxygen, and defibrillator.

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

The service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

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. Staff told us their development and support were a priority to management and were encouraged to access additional training they felt would support their development. For example, a nurse was booked on travel health and COPD training courses.

All staff had annual appraisals that focussed on development and staff wellbeing.

Safe recruitment practices were followed. The practice had a robust recruitment policy in place. Management told us they actively participated in the recruitment of additional roles funded by the primary care network. There were a range of clinical and non-clinical roles within the practice. The service had access to additional staff employed through their primary care network (PCN). Processes had been established to ensure staff working for but not directly employed by the service were recruited safely, had received appropriate and up to date training and were working within their agreed areas of competence. For example, a pharmacist, who was a prescriber had their consultations audited regularly to ensure they were working within the scope of their practice.

Staff told us they had protected learning time to complete mandatory training and the practice regularly closed for protected learning afternoons, which were used for team building, shared learning and discussion on significant events.

At our last inspection, we found failures in ensuring appropriate cleaning standards had been achieved in all areas of the premises. At this assessment, we found improvements had been made in this area. The practice was visibly clean. 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 detailed infection, prevention and control policy in place, which consisted of relevant partner contact details. Infection, Prevention and Control (IPC) audits had been completed, and actions identified were followed up. The practice manager and lead nurse shared the role of IPC lead, and staff were aware of who the IPC leads were. Staff had received relevant training. Risk assessments and audits were completed, and action plans were in place to mitigate potential risks. Actions from an external audit included diarising six monthly audits and some changes to flooring which were planned in line with premises refurbishments.

Staff had access to spill kits if required and were appropriately trained to use these.

Contracted cleaning staff were employed. Cleaning cupboards were visibly clean, appropriately stocked, and single use equipment was used. Whilst clinical rooms were clean, there were no cleaning logs kept for each room. However, they were suitably supplied with equipment including pedal bins, PPE and hand wash facilities.

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.

Clinicians 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 from their medicines. Staff followed protocols to ensure that all medicines were correctly prescribed and ensured people received recommended medicine reviews and regular monitoring. Protocols effectively supported the safe prescribing of medicines and staff involved people in reviews of their medicines.

Medicines were prescribed appropriately to optimise care outcomes, including antibiotics. Published prescribing data reviewed as part of our assessment confirmed this. For example, data on antibiotic prescribing for the treatment of uncomplicated urinary tract infections showed the practice performance was within national averages relating to safe prescribing, and they had consistently done so since 2014.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. For example, prescribing of pregabalin or gabapentin which are medicines used for the management of pain in long term conditions. Published prescribing rates of these medicines were in line with national averages since 2020. Regular medication reviews were completed to monitor compliance and check ongoing suitability of the prescribing.

Prescribing of hypnotic medicines used for treating severe insomnia and interferes with normal daily life were in line with national averages.

We did not identify any significant concerns as part of our review of medicines. We reviewed the medical records of people who had a confirmed diagnosis of asthma and had received treatment for an exacerbation of their asthma symptoms in the last twelve months. The review found that all people had received appropriate treatment and had received a follow up of their asthma condition within required timescales, as stated by National Institute of Clinical Excellence, (NICE). We also found that asthma consultations recorded within the medical records detailed relevant observations of the person’s breathing as per NICE guidelines.

We also reviewed a sample of records for people who were prescribed Angiotensin-converting enzyme inhibitors, also called ACE inhibitors, which aremedicines that lower blood pressure. We reviewed five medical records and found four of these were overdue for blood tests. The practice took appropriate action to invite them for blood tests and remind those who already had appointments booked.

Recall processes were robust and demonstrated that people’s safety was a priority. At the time of our assessment, the practice was moving to a birthday month recall system to improve patient engagement with reviews. The practice utilised varied methods of communication tools to contact people, including, text messaging, phone calls, letters and telephone calls. The service used interpreters when required.

Staff had the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions).

Systems were in place to manage and respond to Medicines and Healthcare Products Regulatory Agency (MHRA) alerts and medicine recalls. Systems for managing the prescribing of medicines and treatment of other medicines were safe and met people’s needs.

Additionally, the practice participated in PCN audits to promote quality and safety across the network. These included monitoring of people receiving methotrexate (a medicine to treat autoimmune conditions), opioid reviews and photo sensitivity. An audit into teratogenic medicines (which can cause birth defects) led to the development of flow charts sent to all practices, and when repeated, the audits showed improvement in monitoring of people receiving the medicines.

Systems were in place for checking the stock levels and expiry dates of all medicines, including emergency medicines and vaccines. Medical gases, such as oxygen, were stored securely and safely and they had completed required safety risk assessments. Prescription stationery was stored securely and tracked throughout the practice utilising a robust process which all staff were aware of. Prescriptions in printer drawers were stored securely overnight.

Waste medicines were disposed of appropriately including medicines returned by people.