The Village Green 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 and ensured those who needed to be kept informed were, in an appropriate time frame. 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 to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.At our last assessment, we rated this key question as Good. At this assessment, the rating has remained the same.

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 has remained 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 service had a strong proactive and positive culture of safety, based on openness and complete honesty. There were clear expectations in place whereby staff were expected to report incidents. 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. Feedback from this learning was shared with all staff. Where necessary training was provided promptly to any staff who required specific learning from an event.

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 clinical issues. 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. Learning from incidents and complaints resulted in changes that improved care for others, which was continuously monitored.

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. Registers were kept, and updated regularly for vulnerable patient groups, ensuring risk was minimised where required for these groups of patients.

There were systems in place for processing information relating to new patients. All new patients were allocated a named GP, and offered a health check at the time of registration. 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 with a clear system which could be audited by staff. Clinicians within the surgery operated a buddy system which ensured patient results were actioned on clinician days off and annual leave.

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 quickly and appropriately. The practice had regular safeguarding meetings where vulnerable patients were discussed. Documentation was clear. Leaders had a clear understanding of the types of abuse that were likely to be seen within the practice, this was due to a detailed amount of work being done to understand the patient population, as well as the wider population.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The provider told us they were in the process of training all administrative staff to a higher level at the time of our assessment, they told us this was due to administrative staff being a first point of contact for patients. We saw evidence during our site visit of this training being commenced by staff.

The service worked with people to understand and manage risks by thinking holistically. The practice utilised a range of professionals to ensure patients were able to gain the care required by the most appropriate person. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Where appropriate family members were involved in these discussions. Furthermore the practice ensured any patient who was ‘at risk’ was appropriately coded to ensure all staff were aware.

Emergency equipment was available and maintained, we saw evidence of daily and weekly checks being carried out on equipment. We discussed with leadership the possibility of relocation of the emergency equipment, this was due to the distance from reception to the new consultation rooms. Leaders told us they would consider an emergency box in Nurse reception in addition to main reception. Staff could recognise a deteriorating patient and knew of action to take and were up to date with training which would enable them to do so. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. We also reviewed documentation which indicated clinicians were accurately safety netting patients where required.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Regular checks were carried out by staff. 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. At the time of our site visit building work had recently been carried out, the practice ensured that signage was on display to keep patients safe during this time.

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.

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 managed appropriately, and staff were working within their agreed areas of competence. Safe recruitment practices were followed. The practice had a clear process in place for staff to develop, there was an induction process which supported new staff in a structured and supported way. The practice supported trainee doctors and offered a programme which benefited the doctors and the patient population.The care coordinator within the practice received nationally delivered training so that examples of her good practice could be shared with relevant professionals.

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. Cleaning schedules were in place and followed. During our site visit we observed cleaning equipment was stored safely. Risk assessments and audits were completed, and actions taken to mitigate risks. Staff were aware of where waste should be disposed.

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 we reviewed evidence of a log which accounted for prescription pads. 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 and at appropriate temperatures. Staff stored oxygen, safely and completed required safety risk assessments.

The provider had effective systems to manage and respond to safety alerts, we reviewed evidence on site which demonstrated that staff were aware of this process, and of alerts being shared with staff where required. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics, the practice had carried out audits on prescribing data and monitored and enhanced services where required.