Stillington 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, but staff told us that learning was not always shared with them unless it was specific to their role, and if they had not raised the concern themselves. Systems we looked at supported this finding and as a result of our inspection, the practice team considered a way to introduce a more simplified approach to sharing learning from events more widely. 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, with monitoring of non-medical prescribers working within their competencies. Managers made sure staff received training. Staff managed medicines well and involved people in planning any changes. Protocols and standard operating procedures for the dispensary kept the dispensing service safe.

This service scored 81 (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. For example, the team made changes to the protocol for arranging ambulances for patients who needed admission to hospital, following a non-harmful near miss.

Staff we spoke with, told us they were confident in a raising significant event and could describe the process for doing this. Staff felt there was an open culture, however some staff told us that communication could be improved.

The provider had a process 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. However, staff told us that learning was not always shared with them unless it was specific to their role, and if they had not raised the concern themselves. Systems we looked at supported this finding and as a result of our assessment, the practice team considered the introduction of a more simplified approach to sharing learning from events more widely.

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.

Staff understood their roles and had systems in place to manage tasks and test results. Through searches on the practice’s clinical system, we saw that referrals and test results were managed in a timely way.

All test results and received documents were actioned the same day (Monday-Friday) Blood results were also reviewed out of hours at weekends by GP partners and when necessary, they contacted patients at weekends about those abnormal results needing immediate action. This enabled the practice to contact the labs at weekends to add on tests when necessary, reducing the need for patients needing to come back for a new blood test.
 

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.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. There was a safeguarding lead and deputy for safeguarding concerns regarding adults and children. These concerns were discussed at multiagency meetings, where appropriate.

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 and maintained. 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. A review of records on the practice’s clinical system showed that non-medical prescribers were working safely within their competencies. There was a robust structure in place for auditing and reviewing the competencies of these members of staff.

There was a partnership made up of 2 GPs (a male and a female) who were responsible for running the practice. The practice also employed salaried GPs. There was a diverse mix of clinical roles which included advanced nurse practitioners, practice nurses and health care assistants. There was also a range of non-clinical roles at the practice.

Safe recruitment practices were followed. As part of this assessment, we looked at recruitment files of 4 members of staff. All files had appropriate checks carried out. The practice provided assurances that mandatory training was up to date, except for a few individuals who had experienced delays due to personal circumstances. This was in hand to be completed at the earliest opportunity following our assessment.

Some staff in non-clinical roles had not had a DBS check carried out. The reason for this was that the practice had been refused the higher standard of safety checking (enhanced disclosure) by their check provider. Some of the staff without those completed checks had been trained as chaperones, but were not actively undertaking chaperone activity, to date. The practice undertook risk assessments for those staff, as a result of our assessment, while the issue could be resolved.

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. Risk assessments and audits were completed, and actions taken to mitigate risks. As part of our visit, we reviewed treatment rooms, consultation rooms and stockrooms.

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, 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.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. Appropriate action had been taken in respect of a combination medicine alert around a statin (medicine that lowers cholesterol levels), with certain calcium channel blockers. We looked in detail at 2 patients’ clinical records and saw that both patients had been advised of risks and had dissented from a change in their medication.

Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines which were stored on site.

DISPENSARY:

Prescription pads were stored securely within the dispensary and were accounted for each day. A log of serial numbers was documented on a spreadsheet to ensure only one box was in use at any one time.

When prescriptions were dispensed, a barcode system was in use to ensure the correct drug and formulation was picked by the dispenser. If an incorrect drug or formulation was picked by a staff member, the system wouldn’t allow this to be dispensed, and no label would be produced. However, for none barcoded items this system could not be used. Staff stated only nonbarcoded items and controlled drugs would be second checked by another member of staff.

Controlled drugs, which require extra storage and recording requirements due to their potential for misuse, were kept in an appropriate locked cupboard within the dispensary. An electronic register was in use and stock levels were checked weekly to ensure balances were correct. Balances checked on the day of assessment were all correct.

Systems were in place if items were out of stock, and staff knew what processes to follow to ensure patients would not be without their medicines for significant periods of time. Prescriptions were dispensed in a timely manner in date order. Acute prescriptions, which had been prescribed by a GP on the day, would be dispensed immediately whilst the patient waited for them.

Medicine incidents and near misses were recorded on a spreadsheet and appropriate actions were taken to follow up on these. Dispensary staff would look for any trends and themes and if necessary, discuss them with the relevant senior staff to ensure future learning.

Temperature monitoring was completed daily where medicines were stored, including medicinal fridges. While air conditioning was in place, it was only turned on manually if temperatures exceeded 25 degrees.

Prescriptions awaiting collection were regularly reviewed and followed up on if patients had not come to collect them. If appropriate, items which had not been collected would be returned and a note on the patient’s records would be uploaded.