Rockliffe Court 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. People were protected and kept safe. 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.

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 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. This was reflected in the most recent National GP Patient Survey where 96% of respondents felt healthcare staff treated patients with care and concern. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. This included changes to prescription processes in the practice, appointment booking and changes to the waiting room.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. We saw changes made to procedures for GP’s and measures put in place for Type 1 Diabetic diagnosis following concerns raised. Staff felt there was an open culture and that safety was a top priority, with leaders at the practice seen as approachable and knowledgeable.

The provider had comprehensive policies and 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. We saw evidence of reflection and review by the senior leadership team following incidents/concerns included in an annual Significant Events review.

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 service worked with other providers to deliver shared care and when patients moved between services. 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 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 appropriately. There was an effective system in place using electronic records to map, monitor and respond to potential safeguarding concerns. The safeguarding lead at the practice was proactive in reviewing patient information and was knowledgeable and experienced on any actions that might need to be taken.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. All staff knew who the safeguarding lead was. Safeguarding was a standing agenda item on the practice meetings held monthly and there was a wider quarterly meeting that included external agencies.

The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations, including local authority safeguarding teams and charities.

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. This included having detailed notes on patient records setting out clear reasonable adjustments for patients when attending appointments.

Emergency equipment was available and maintained. We saw a paediatric defibrillator pad was not available to be used. When we raised this with the provider, this was addressed immediately. Equipment checks were carried out on a daily basis. The emergency medicines were located in the treatment room, organised into specific boxes. These boxes included simple but effective instructions (created by a GP in the practice) on the medications and equipment stored in each box. Whilst we acknowledge the practicalities of including the instructions in the boxes, we did raise with leaders at the practice the need for a central location for the emergency medicines to prevent any delays during an emergency. Leaders said this would be addressed straight away. Since our site visit leaders told us they have moved emergency equipment to reception.

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. 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 practice.We found training was up to date, learning needs and development of staff was encouraged by leaders and managed appropriately, and staff were working within their agreed areas of competence.

Safe recruitment practices were followed.

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 and all staff had had relevant training.The Induction of newly recruited staff included IPC training delivered by the IPC lead. Audits were completed on a quarterly basis but there were more regular informal discussions and reminders with staff in line with practice policy. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

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 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.

Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring.

There were suitable processes for staff to follow when dispensing medicines.

A pharmacy technician was employed by the practice who reviewed people’s medicines including discharge letters or clinic letters to ensure records were up to date and actions were completed. The practice used the Electronic Prescription Service to transfer prescriptions to the patient’s preferred pharmacy.
The practice had an in-house dispensary which dispensed prescribed medicines for patients who were eligible. There was a named GP responsible for the dispensary. The practice participated in the dispensing doctor's quality scheme and submitted their annual return in-line with standards. This is a scheme which is aimed at ensuring high quality care is delivered. Written procedures were in place however these required a review, to ensure version control and records of updates were clear. Leaders provided assurance that since our site visit this had been completed.
Medicines in the dispensary were stored securely. We saw NHS FP10 prescriptions were not always retained until the patients had collected the medicines. We raised this during the inspection, and the dispensary manager stated this would be rectified immediately.

Adjustments could be made for people with additional needs and if required dosette trays were dispensed by the practice. Staff who worked in the dispensary had the necessary qualifications, competence and experience. Each staff member had an annual appraisal.

The practice used NHS FP10 prescriptions which were printed and used within the onsite dispensary. There was an auditable process in place to record and track the use of controlled stationary. We were shown how dispensing incidents and near misses were recorded and learnt from.

There was a process in place for receiving drug alerts and medicines recalls and staff could describe how these were actioned.