The Village 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.

We assessed all quality statements in the safe key question. At our last inspection, we rated this key question as Good. Following this inspection, the rating remains 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 demonstrated a proactive and positive culture of safety, underpinned by openness and honesty. Staff were encouraged to reflect, share learning and continually improve practice. Lessons were learnt to identify and embed good practice across the service.

A structured programme of regular meetings supported learning and improvement, including operational, managerial and clinical forums where significant events, complaints and audits were reviewed and discussed. There were clear processes in place to ensure learning was cascaded through newsletters, supervision sessions and learning bulletins.

Staff told us there was an open culture where safety was a top priority. Leaders modelled transparency and encouraged contributions from staff, who felt supported to raise concerns and share ideas. The impact of learning was monitored, and improvements were recognised and celebrated. When things went wrong, staff apologised and provided support to those affected.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. Staff made sure there was continuity of care, including when people moved between different services.

Systems were in place for registering new people and processing information to ensure care was delivered safely from the outset. The service worked with a range of external providers to deliver shared care, including community teams, secondary care and a local University. Staff told us referrals were made promptly, and evidence reviewed as part of our remote clinical searches demonstrated test results were acted upon in a timely way.

Multi-disciplinary team meetings supported safe transitions for people with complex needs, and the service worked with partners in health and social care to ensure information was shared appropriately. Audits were undertaken to monitor referral processes, and action was taken where delays were identified.

The service had effective systems in place to safeguard people from abuse. Policies complied with local and national safeguarding guidance and outlined clear responsibilities for staff in identifying, reporting and managing concerns. Staff we spoke with were confident in recognising safeguarding issues and knew how to escalate them appropriately.

There were designated GP leads for both adult and child safeguarding, supported by a non-clinical safeguarding lead. They worked as a team to ensure policies were current, information was cascaded to staff and training was delivered regularly. Staff told us the in-house training sessions, which included case studies and scenario-based learning, were relevant and helpful.

The service maintained secure lists of vulnerable people and worked with partner agencies through regular multi-agency meetings. Information from health, social care and the police was used to identify and monitor risks, including those for children and young people. Systems were in place to review missed appointments and accident and emergency attendances that might indicate safeguarding concerns.

Staff were supported by clear processes and felt confident seeking advice from the safeguarding leads. The service took safeguarding responsibilities for its staff seriously, with policies in place to support whistleblowing, wellbeing initiatives, and access to mental health first aiders.

The service worked with people to understand and manage risks. Care was tailored to meet individual needs in a way that was safe, supportive and enabled people to do the things that mattered to them.

Emergency equipment was available, regularly checked and maintained. Staff told us they were confident in recognising signs of a deteriorating person and knew what action to take. People were advised on risks related to their condition and were given clear information about what to do if their health deteriorated.

The service used clinical coding to identify people at higher risk and ensured they had a named GP, access to dedicated clinics and longer appointments where appropriate.

The service detected and controlled potential risks in the care environment. Premises were safe, clean and accessible, and regular checks were carried out to ensure standards were maintained.

Health and safety risk assessments, including fire safety and evacuation, were undertaken and reviewed. A premises log was used to track repairs and maintenance, and a dedicated premises lead oversaw this work. Staff told us they were trained to carry out dynamic risk assessments when needed, such as in response to adverse weather or lone working.

Clinical and non-clinical equipment was checked and maintained in line with guidance. This included annual calibration of clinical equipment, portable appliance testing of electrical items, and appropriate arrangements for sterilisation or single use of surgical instruments. Staff responsible for medicines storage demonstrated clear knowledge of temperature monitoring and equipment checks.

Access to the premises was controlled, with keypad entry systems and visitor sign-in processes in place. Panic alarms were available throughout consultation and public-facing areas. IT systems were supported by a commissioned provider, and staff said issues were resolved promptly.

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. Recruitment followed safer recruitment guidance, with appropriate checks undertaken before staff commenced employment. References were obtained, and Disclosure and Barring Service checks were completed in line with requirements.

New staff received a structured induction that introduced them to all areas of the service. Staff told us the induction process was supportive and enabled them to understand their roles clearly. Probationary periods were used effectively to assess suitability, with support plans in place if needed.

The service regularly reviewed its staffing levels to ensure the service was safely staffed and able to meet demand. Succession planning identified potential risks and helped to guide recruitment and training needs. A multidisciplinary team worked together to provide care, with locum staff used only when necessary.

Staff told us they felt supported in their roles. Appraisals were held annually and linked to a competency framework, with individual goals and training needs identified. Supervision was in place to provide regular opportunities for discussion and support. Staff told us they had access to mandatory training and development opportunities, and leaders had received training to ensure appraisals and supervision were effective.

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. Policies were in place in line with national guidance, and staff had received relevant training. Staff we spoke with were aware of the infection prevention and control (IPC) lead and knew how to raise concerns.

Audits were carried out regularly, covering areas such as hand hygiene, sharps disposal, cleaning standards and use of personal protective equipment. Actions from audits were documented and followed up.

Cleaning schedules were in place and recorded daily. Clinical and non-clinical areas were well maintained, and equipment was decontaminated appropriately between appointments. Staff told us they were confident in the infection control processes and knew who to approach for advice.

The service made sure medicines and treatments were safe and met people’s needs. People were involved in decisions about their medicines, and clinicians explained the risks and benefits before treatment was started. Staff worked with people and care teams, including the local University and residential settings, to ensure medicines were reviewed appropriately.

Medicines were prescribed, supplied and administered in line with legislation, national guidance and local prescribing policies. Records reviewed as part of our remote clinical searches showed information about medicines was accurate and up to date, including when people moved between services.

Staff supported people to manage their medicines safely. People knew what to do if their condition did not improve or if they experienced unexpected symptoms. Staff received regular training, were competency assessed on medicines optimisation, and felt confident in managing storage, administration and recording. Prescription stationery was managed securely and in line with national protocols.

Medicines, including controlled drugs, were stored securely and at appropriate temperatures. Stock levels and expiry dates were checked regularly, including for emergency medicines and vaccines. Waste medicines were recorded and disposed of appropriately, and medical gases were stored safely with the necessary risk assessments in place.

The provider had effective systems to manage safety alerts and medicine recalls, ensuring prompt action when required. Our remote clinical searches indicated people prescribed high-risk medicines received monitoring in line with national guidance, including those on disease-modifying antirheumatic drugs. People on polypharmacy had received structured medication reviews, and, where monitoring results were obtained in other settings, evidence was documented in patient records to support safe prescribing.

There was a strong focus on safe and effective prescribing, with antimicrobial use in line with both local and national averages. This reflected good prescribing practice and supported better outcomes for people. The service benefitted from having a primary care network (PCN) pharmacist on site, who undertook regular prescribing reviews to identify opportunities for improvement and ensure medicines were used safely and appropriately.