Dr Nederlof and Partners Also known as Riverside 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 78 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice 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. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. People felt supported to raise concerns and felt staff treated them with compassion and understanding. There were clear processes in place for reporting incidents, near misses and safety events. These were reviewed at 12 weeks and again at 52 weeks to ensure actions and learning was embedded. We saw evidence of reflective practice within the dispensary team when they discussed near misses in team meetings. The practice engaged with their Patient Participation Group (PPG). Representatives from the PPG felt the practice took concerns seriously and proactively made improvements to the service.

The practice 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. There were processes in place for managing incoming correspondence to patient’s medical records and reviewing and actioning pathology and blood test results. There was a system for patient referrals, and we saw these were managed and monitored appropriately.

The practice worked well with people and healthcare partners to fully 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. The practice held a register for vulnerable adults and children that was regularly reviewed and updated. Vulnerable patients including household contacts had codes and alerts on their records. The practice responded to concerns and correspondence including children not attending appointments. The practice held regular multi-disciplinary team meetings to discuss safeguarding concerns. They also held training sessions at the quarterly whole practice team meeting which included safeguarding topics such as Female genital mutilation (FGM) and coercive control. This improved staff knowledge and the reporting of safeguarding concerns within the practice. Leaders described how this knowledge helped a member of staff to report a safeguarding concern. Staff told us they found this training very informative and beneficial. The practice recognised the importance of having regular contact with safeguarding leads of the local schools.The safeguarding lead contacted them to help improve communication between the practice and the school to further support vulnerable children. We saw feedback from educational professionals who appreciated this.

The practice 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 and maintained. Staff were knowledgeable about recognising a deteriorating patient and knew of action to take. Staff including receptionists received training on emergency symptoms including sepsis (a life-threatening reaction to an infection).

The practice detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Portable appliance testing and calibrations were up to date. 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. Systems were in place to check the fire alarms, fire extinguishers and emergency lighting. The practice was accessible for wheelchair users as there were designated disabled parking spaces, and all consulting rooms were on the ground floor.

The practice made sure there were enough qualified, skilled and experienced staff, who received effective support and supervision. 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 and safe recruitment practices were followed. The practice ensured staff employed through the Primary Care Network (PCN) were suitably experienced, competent and able to carry out their roles. Most staff felt supported with their professional development but there were some missed opportunities for staff to be upskilled. Staff were positive about the appraisal process, and the practice had recently implemented a mid-year appraisal to further support this.

The practice 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 (IPC) lead and all staff had relevant training. Cleaning schedules were in place and followed. Clinical rooms had adequate provision of personal protective equipment (PPE) and handwashing facilities. Risk assessments and audits were completed, and actions were taken to mitigate risks. The IPC lead regularly performed random IPC spot checks on clinical rooms and gave staff feedback to ensure IPC policies and procedures were followed.

The practice 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. As part of our assessment, a series of patient clinical record searches were undertaken by a CQC GP specialist advisor. This included a review of the management of patients on medicines that required monitoring. We found patients had mostly received monitoring in line with guidance. Staff regularly checked the expiry dates for all medicines, including emergency medicines, vaccines and controlled drugs. However, we did find that there were large quantities of the emergency medicines which may have made it difficult to locate a medicine during an emergency. We fed this back to the practice who were responsive. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The practice had a dispensary which had suitable processes for staff to follow when dispensing medicines. We found the dispensary to be well organised. Patients told us they received medicines in a timely manner. We found Patient Group Directions (PGDs) (written instructions to supply or administer medicines to patients without a prescription or an instruction from a prescriber) were in good order. The practice had effective systems to manage and respond to safety alerts and medicine recalls. The practice provided evidence of audits being completed after a safety alert to ensure all patients impacted were managed appropriately.