Oakwood 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 69 (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. People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from incidents. 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. The service promoted a culture of learning to improve patient safety.

All staff were committed to learning; they organised and implemented educational activities to share learning across the service. Staff shared positive experiences of learning and professional development, including opportunities for career progression.

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

Referrals were managed well in the service. Referrals were made quickly, and two-week urgent referrals were sent the same day. Administration staff processed them and the practice manager told us that they audited the process to ensure there was never a backlog.

Test results were managed in a timely way. There was a policy in place to ensure laboratory results were processed efficiently and our review from clinical searches confirmed that results were managed in a timely manner. The service had a duty rota for a named GP each day to cover triage and test results.

The service worked well with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They always shared concerns quickly and appropriately. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. There were separate policies for adult and children. The policies covered descriptions of the different types of abuse. Staff knew and understood the policies content. We reviewed the policies alongside safeguarding cases and saw examples of how staff followed the policy and procedures. The service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

There were systems in place to follow up people who failed to attend appointments in primary and secondary care or people who frequently attended out of hours or accident and emergency services. This was to minimise risk, ensure people had the appropriate levels of support they needed and reduces inappropriate use of services.

The service worked closely with local organisations in the community such as school nurses, health visitors, disability team, and domestic violence services. Quarterly meetings were held with these partners and regular in-house meetings.

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 at the service. However, improvements were needed in the storage and maintenance of these as we found not all equipment was readily available in the event of an emergency event, with some items stored in reception and others stored in a clinical room. Additionally, kits to treat anaphylaxis (severe allergic reaction) were not available and records relating to checks were not comprehensive. We raised these issues with the provider and management team during our site visit. Although action was taken in response to our findings, these concerns highlight a lack of effective oversight as they were not identified by the provider themselves. This limits our assurance at the time of the inspection that these improvements are embedded and will be sustained.

There was an emergency deteriorating patient policy in place which helped reception staff to recognise a deteriorating patient in the reception area and staff knew what action to take. People were advised on risks related to their condition and actions to take if their condition deteriorated.

The service operated from a leased premises within a large building with modern facilities. The service detected and controlled potential risks in the care environment. They raised any issues with the building with the landlord and made sure equipment, facilities and technology supported the delivery of safe care. Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed.

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 service. 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. The service had robust systems in place to ensure staff were employed in line with safe recruitment processes. They had a recruitment policy and separate Disclosure and Barring Services policy, both of which covered safe recruitment. The service had a large staff team, and we saw that all necessary documents in line with their policy and regulatory requirements were available for all staff.

Staff told us they could discuss clinical queries in relation to their medicine prescribing, or care and treatment planning, with leaders who they said had an ‘open door’ policy. This enabled staff to discuss individual cases, reflect on their practice, and identify any changes to improve outcomes for people.

Appraisals were completed on a regular basis to support professional development. Staff felt supported with their professional development, and we saw examples of staff developing in their role. The service had supported staff to gain additional qualifications resulting in career progression within the organisation.

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.

All staff at the service had completed relevant infection prevention and control (IPC) training. The provider ensured staff had necessary knowledge and understanding by ensuring all staff completed annual training and discussed infection control issues regularly during team meetings and inductions.

Staff vaccination status was confirmed at recruitment, and risk assessments were in place for staff who were unable to confirm childhood vaccination status. All staff were encouraged to have annual vaccinations such as influenza.

Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. As part of our assessment, we reviewed the processes in place for controlled drugs. Controlled drugs are medicines that are regulated by the government. This is usually because they are at a higher risk of causing harm (such as dependence or misuse). We found the service had accepted controlled drugs no longer needed from a person which was not following their own policy. The provider’s policy stated all controlled drugs must be destroyed via the pharmacy however a member of staff had accepted controlled drugs from a patient that were no longer required and intended to take them to the pharmacy to be destroyed. The drugs had been accepted and recorded correctly in the controlled drugs record book, but had not been taken to the pharmacy. Additionally, we found the service had ordered, dispensed, and stored medicines for named people in a cupboard, without a corresponding risk assessment or appropriate checks being in place. The lack of appropriate risk assessments and checks increased the risk of medicines being stored, dispensed, or administered unsafely. We raised our concerns with the provider and management team at the service, and they took immediate action to address the issues. However, effective medicines optimisation and governance processes should have enabled the service to identify and address these risks proactively.

As part of our assessment a Care Quality Commission (CQC) our GP Specialist Advisor undertook searches of patient records on the service’s clinical system. Our clinical records reviewed the care of people prescribed high risk medicines that require monitoring such as Methotrexate (an immune system suppressant drug) and Warfarin (a blood thinning drug), We found all people had received the required monitoring and were appropriately coded on the clinical system. Coding on NHS records refers to the way healthcare information is recorded using standardised clinical codes instead of (or alongside) plain text. It helps doctors, nurses, and systems communicate clearly and consistently.

We identified 39 people with Chronic Kidney Disease Stages 4 or 5 and selected 5 patient records at random to review. Out of those 5 records, we found 1 patient’s records had not been updated to reflect a change in their diagnosis. The provider took immediate action to rectify the coding immediately.

As part of our clinical searches, we reviewed the care of people with hypothyroidism (underactive thyroid). We identified 335 people who were diagnosed with hypothyroidism and most had received thyroid function test monitoring within the last 18 months, apart from 3 people. We looked in detail at the records of these people and discussed their care with clinicians. We found 2 people were already booked in for the relevant tests and the other person was in hospital.

We identified 218 people with diabetes whose last blood glucose reading was over 75. We reviewed a random sample of 5 patient records and found all people had their condition reviewed and managed in line with national guidelines.

There was a process in place for recording and sharing medicine safety alerts. Safety alerts were discussed in clinical meetings. We reviewed people who were prescribed an SLGT-2 inhibitor, which is prescribed to treat type 2 diabetes heart failure and chronic kidney disease and found they had been given the appropriate advice and support.

We reviewed a random sample of 5 medication reviews out of a total of 894 reviews that had been completed for people in the previous 3 months. We found 3 of these medication reviews had been appropriately undertaken, however, the review records for 2 people lacked sufficient detail. The management team took immediate action to rectify this issue.

The service 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 managed prescription stationery appropriately and securely.

Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Medicines including controlled drugs were stored securely. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.