Friargate 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 identified one breach of the legal regulations.

Although systems and processes were in place to maintain safety, some risk assessments not been either completed. Some staff expressed concerns about staffing levels, particularly in the nursing and reception teams, as well as there not being sufficient time to complete mandatory training during their protected learning time. Non-clinical staff expressed concerns about the level of decisions they were required to make when triaging appointment request forms. Following the inspection the provider shared evidence that staff were paid if they completed training in their own time, and had received training on triage, but also acknowledged the processes were still not fully embedded. The practice nurse had not been provided with clinical supervision or been made aware of auditing of their prescribing to support their development needs.

Although systems and processes were in place for medicines management, we heard from staff who supported people who used the service that requests by secondary care services to review people’s medicines on discharge were not always actioned and the process for repeat prescriptions was not always effective.

However, all reported incidents were investigated to reduce the likelihood of them happening again. Systems were in place to safeguard people, although there was no corroboration of the safeguarding list for children. Our remote clinical searches showed there was an effective process in place for monitoring people’s health in relation to the use of medicines.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Information for people on how to complain was on the practice website. People were only able to submit written complaints either directly through the practice website using electronic forms or by letter. People received a written response, the complaints leaflet, and details of how to escalate their complaint if they were dissatisfied with the response. The practice also collated compliments. One compliment supported staff had listened to and accommodated the specific needs of a person when attending the practice, to ensure the visit was as stress free as possible.

The provider did not accept verbal complaints from people, as they considered complaints were expressed more accurately in the person’s own words. People were informed to submit their complaint in writing or ask someone to help them if they were unable to do this.

Staff were aware of how to report incidents, near misses and safety events and were able to share examples of incidents raised and subsequent learning. Significant events were monitored for trends and patterns. Complaints and significant events were discussed at clinical meetings.

The provider had processes to report, investigate and learn from significant events, near misses and complaints. There was a system to record and investigate complaints and when things went wrong, staff apologised and gave people support. Duty of candour was considered as part of the complaints and significant events processes. Learning from incidents and complaints resulted in changes that improved care for others. Significant events and complaints were reviewed to identify any trends and action taken to address the findings.

The practice attended monthly multidisciplinary team meetings to discuss and improve outcomes for people with complex needs. The minutes from these meetings showed that people were involved in making decisions about their care and treatment. Where people did not wish to engage with these services for additional support, people’s decisions were respected.

Staff were aware of how to prioritise people who reported symptoms that may be clinical emergencies, for example sepsis. However, some non-clinical staff expressed concerns about the level of clinical decisions they were required to make when triaging appointment request forms from people. For example, if the forms should be sent to a GP, practice nurse, pharmacist or physiotherapist. Following the inspection the provider shared evidence that staff had received training, but also acknowledged that the processes were still not fully embedded.

Feedback from a representative of a care home where the practice provided care and treatment commented the practice often refused to carry out medicine reviews when people were discharged from hospital, even when the hospital had requested this. This meant patients may not be receiving the most appropriate medicines to meet their medical needs. Following the inspection the provider told us they had completed an audit of time taken to review medicines following discharge from hospital to the care home and the time was on average 5 working days. However, no evidence was submitted to support this.

Minutes from the multidisciplinary community support team meetings showed the practice worked with external health and social care providers.

There were systems in place to support adults and children to book blood tests and responding to request calls from health professionals. We saw instructions for staff to follow.

There were systems in place to support people to register with the practice.

Systems were in place allowing out of hours services to access people’s records as required.

We did not collect the evidence to score this category.

Staff were aware of their role in safeguarding people and the actions to take if they suspected abuse. They knew who the safeguarding lead was and had completed safeguarding training at a level appropriate to their role. Staff that chaperoned, were aware of their role and responsibility in keeping people safe.

Staff reviewed information received when new people registered was reviewed to identify any potential safeguarding issues. Reception staff were alert to identifying people who changed practices or locations frequently and shared an example of when they had raised concerns about a potential safeguarding issue.

The safeguarding lead who told us that one of the GP partners attended a multi-disciplinary meeting to corroborate their safeguarding lists for vulnerable adults. Systems were not in place to corroborate the safeguarding list for children with the local authority or health visitors. They said they would start to liaise with the health visitor via email prior to their internal safeguarding meetings to facilitate this.

The Integrated Care Board (ICB) shared their safeguarding assessment of the processes in place at the practice to safeguard children and vulnerable adults with the CQC. The assessment identified areas of good practice for example, clear lines of accountability for safeguarding.

There was a safeguarding policy in place to support staff to support children and vulnerable adults at risk of abuse. There was a safeguarding lead and deputy. Systems were in place to follow up vulnerable people that failed to attend appointments. GPs held regular children’s safeguarding meetings however there was no evidence from the minutes of these meetings that external partners attended these meetings to corroborate their safeguarding lists.

We reviewed feedback shared on the NHS website, with Healthwatch, local commissioners and provided directly via Give Feedback on Care forms. The feedback from people using the service indicated that not all people felt they were listened to or taken seriously and considered the attitude of some health care professional (GPs) was dismissive.

However, the results of the 2024 National GP Patient Survey showed that the percentage of respondents who stated that the last time they had a general practice appointment, the healthcare professional was good or very good at listening to them was 83%. This was similar to the local and national averages of 87%.

Our remote clinical searches of people’s records demonstrated that people were given information about risks relating to their medicines to support them to make an informed choice of any additional action or precautions they needed to take.

The GP partners explained they attended multidisciplinary team meetings monthly to discuss and improve outcomes for people with complex needs. Staff shared with us examples of when they had acted on potential risks to people.

Systems were in place to support people to be as involved as they could be to understand and manage risks to their own health, safety and well-being. This was demonstrated through our remote clinical searches which looked at medicine reviews, prescribing and adherence to medicine alerts. The practice held appropriate emergency medicines and equipment. Risk assessments were in place to determine the range of medicines held, and a system was in place to monitor stock levels and expiry dates.

Facilities and equipment were safe and equipment was maintained according to manufacturers’ instructions. There were systems for safely managing healthcare waste. A fire safety drill had recently taken place at the practice and learning from it had been shared with staff.

The facilities and premises were appropriate for the services being delivered. The practice was clean, tidy and well maintained. There was an ongoing programme of refurbishment of the building, taking into account the safety of people and staff.

Systems were in place to maintain the safety of the building, and risk assessments completed as required. The practice provided evidence of portable appliance testing, and calibration of equipment. Staff had completed their fire safety training and the principles of health and safety training. The provider told us the 5 year electrical installation condition report was completed in September 2020, although the certificate was not available to support this.

We did not collect the evidence to score this category.

Some staff expressed concerns regarding staffing levels especially if the practice nurse was not at work. They thought there needed to be increased numbers of reception and nursing staff. They thought resources could be better allocated which would assist with the workload. The GPs covered some of the appointments when the practice nurse was off and they had a temporary practice nurse to provide additional cover when required. The practice was in the process of recruiting for 2additional members of reception staff.

Not all staff had received an appraisal within the last year. They completed essential training in their own time as it was not feasible to complete it at work due to short staffing levels. They were not paid for completing the training in their own time. Following the inspection the provider provided evidence that staff could be paid overtime if they completed training in their own time.

The practice nurse confirmed the practice was supportive of them attending additional training to support them in their role. For example, additional training in infection prevention and control to support them in this lead role.

Policies and procedures were in place for the safe recruitment of staff. Staff vaccination was maintained in line with national guidelines. Training records demonstrated staff had completed the necessary mandatory training, such as safeguarding adults and children, infection prevention and control and fire safety. Systems were in place to identify any training due for completion.

People had access to a building that was clean, tidy and well maintained.

Non-clinical staff had not been made aware of risk assessments to mitigate potential risks to themselves or people or received hepatitis B immunisation. They had access to personal protective equipment (PPE) when handling specimens.

The GP partners told us they have implemented measures to reduce the risk of infection within the practice. People were seen in designated areas of the practice.

Staff completed infection prevention and control (IPC) training and were aware of the infection control lead within the practice.

IPC audits were carried out, however we found that lids were not available on the bins in 2 toilets within the practice. This had not been identified on their IPC audit. PPE was readily available and arrangements for managing waste and clinical specimens kept people safe. Control of Substances Hazardous to Health (COSHH) risk assessments were in place to protect staff from hazardous substances.

An IPC policy was in place to support staff which identified the lead for IPC. However, there was no mention of staff immunisations to potential health care acquired infections. An IPC audit had been completed in February 2024 and did not identify any concerns apart from not all staff had received full measles, mumps and rubella immunisation. COSHH risks assessments had been completed and processes for dealing with clinical waste were in place.

A hand hygiene audit had been completed in June 2024, which identified a small number of non-clinical staff failed to achieve the correct hand hygiene technique and required to revisit the IPC handbook and training materials.

Feedback from a representative from a care home where the practice provided care and treatment indicated that requests for repeat prescriptions were not dealt with in a timely manner resulting in people living in the home going without their medicines. In addition the practice often refused to carry out medicine reviews when people were discharged from hospital, even when the hospital had requested this.Feedback from people using the service indicated they felt that on occasion there was a reluctance to prescribe medicines with no clear explanation as to why.Following the assessment the provider told us they had reviewed time taken to review medicines following discharge from hospital, which was on average 5 working days; and repeat prescription requests from care homes were completed within 2 working days. However, no evidence was submitted to support this. Following the assessment the provider shared evidence of feedback to people explaining why requests for specific medicines had been rejected.

A nurse prescriber told us that they did not receive regular reviews of their prescribing practice or clinical supervision or peer review. They were not aware if their prescribing was audited.

The prescribing practice for all prescribing clinicians was overseen by the GP Partners. Reports to monitor prescribing were produced monthly and any outlying prescriptions were discussed with the relevant prescriber, and prescribing was discussed during the annual appraisal process.

Systems for recording and acting upon safety alerts were in place. A pharmacy technician had recently been appointed to assist with medicines management and protocols were being developed to support this role.

Staff had the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions). Vaccines were appropriately stored, monitored and transported in line with UKHSA guidance to ensure they remained safe and effective. Blank prescriptions were kept securely, however the systems for tracking prescription stationery throughout the practice were not always effective. The provider shredded the prescriptions, in line with national guidance, which were not accounted for on their prescription stationery log and added the prescription stationery that was missing from the log on the day of our onsite assessment.

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.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was lower than local and national averages.

Medicine optimisation information provided by the Integrated Care Board (ICB) supported the information held by us. The practice provided information returns to the ICB as required.