Catterick 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.

At our last assessment, we rated this key question as good. At this assessment, the rating has changed to requires improvement.

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.

The practice had a proactive and positive culture of safety. This was based on openness, honesty, and focusing on improvement rather than blame.

Staff told us they knew how to report a safety incident.

Leaders had an ‘open door’ policy which encouraged staff to approach them with any safety (or other) concerns. The practice listened to concerns and investigated safety events, reflecting on how to do things better in the future.

All staff were invited to relevant meetings. Learning from safety events was shared with staff to drive improvements. Staff gave us examples of learning which had led to improvements.

Clinical staff held regular discussions about patient care. Leaders also discussed safety events during full practice meetings.

However, the provider did not maintain a formal log of significant events to help with any analysis of trends and themes.

Catterick Village Surgery 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.

Leaders ensured patients who also received care from other parties (such as patients receiving private treatment elsewhere and those who required shared care agreements) were reviewed to ensure continuity of safe care and treatment.

Clinical staff attended safeguarding and multi-disciplinary team meetings to discuss more vulnerable patients. They also held daily ‘debrief’ discussions on how to better support their patients.

Staff and leaders told us they knew the patients and their individual needs well. They used patient feedback to try and improve pathways for people.

The practice ensured patient referrals and test results were managed in a timely way.

Clinical pharmacists were involved in the review of safety alerts received from the Medicines and Healthcare products Regulatory Agency to ensure appropriate action was taken to protect patients when required.

The practice did not always work well with patients to understand what being safe meant to them and to protect patients from potential bullying, harassment, abuse, discrimination, avoidable harm and neglect. Staff did not always share concerns quickly and appropriately.

Staff added relevant safeguarding flags and codes to patient records, but the provider did not always take appropriate action when vulnerable patients did not attend the practice. For example, if a patient with a learning disability did not attend their pre-booked appointment or if a child was not brought to the practice when expected. This included children subject to ongoing safeguarding concerns.

We reviewed (undated) audits regarding vulnerable patients who did not attend their appointments. The provider was unable to demonstrate sufficient assurance that effective safeguarding action had been taken.

We found safeguarding policies were not always clear in terms of which staff members should do what, when and how in various scenarios.

Although children subject to ongoing child protection concerns had an appropriate flag on their record, adults living at the same address did not have anything on their patient record to alert staff to be aware of safeguarding issues. The provider resolved this quickly.

All staff had received some safeguarding training. However, we found the level of training was not always what was expected for their role. Additionally, staff training was not always completed in line with the practice’s own safeguarding policy.

The practice had a safeguarding lead (clinician) who ensured any flagged safeguarding concerns were monitored and reviewed monthly.

Leaders worked with healthcare and local authority partners. They escalated concerns and shared information when appropriate.

The practice worked with patients to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The GP Patient Survey showed that 91% of patients (who responded) knew what the next step would be after contacting Catterick Village Surgery. This was higher than the national result of 83%.

The practice had daily ‘sit and wait’ clinics available (with days alternating across their 2 branch sites), meaning patients who arrived by 10:30am were guaranteed an appointment with a member of clinical staff on the same day.

Patients waiting for their appointment were visible to reception and other staff. Staff were alert to signs of patient discomfort. Both clinical and administrative staff gave examples of appropriate action they had taken when patients showed signs of distress or their health deteriorating rapidly.

The practice ensured emergency equipment (such as a defibrillator to give a jolt of energy to the heart) was available and maintained. All staff had completed training in resuscitation.

Catterick Village Surgery did not always detect and control potential risks in the care environment.

The provider leased the Catterick Village site building from a third party. There were long-standing issues with the landlord regarding the maintenance of the building. However, the provider remains responsible for ensuring the premises from which they deliver services are safe and appropriate.

The practice had not completed its own health and safety risk assessments or audits. Leaders had not fully considered or assessed how environmental concerns may affect both staff and patients. As such, they had not put measures in place to mitigate any risks present.

Fire safety was not managed effectively. The practice was not adhering to its own policy. There was no evidence of all staff having taken part in a comprehensive drill to test their knowledge and preparedness in the event of a fire. No staff member had been formally designated as a fire warden. There was no evidence of any evaluation of fire drills to ensure staff, patients and visitors had acted appropriately and exited the premises within safe timescales.

The provider had not documented any business continuity measures for staff to refer to in the event of an emergency.

However, the provider ensured equipment was checked regularly to ensure it was safe. Staff told us they had access to the right equipment to safely perform their role.

Although Catterick Village Surgery ensured there were enough qualified, skilled and experienced staff to provide care and support to patients, we found the practice did not maintain recruitment documentation in line with the requirements of Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff recruitment files were not comprehensive and lacked the verification details and checks we expect to see. Additionally, the information held was not in line with the practice’s own recruitment policy and procedure.

The practice employed non-medical prescribers (NMPs). These are qualified healthcare professionals (in this case, clinical pharmacists) trained to prescribe medicines. However, NMPs must have their competence checked, assured and supervised by their GP practice. Although GPs had regular discussions with NMPs about their prescribing for patients, Catterick Village Surgery did not ensure NMPs were subject to regular, scheduled audits to ensure safe prescribing practices.

However, we were provided with (undated) audits of the recent prescribing by NMPs which evidenced prescribing competency in line with guidance set by the National Institute for Health and Care Excellence. The audits showed patients were followed up appropriately and that safety netting was completed when required. Catterick Village Surgery now intends to complete annual audits of prescribing by NMPs.

Leaders told us the practice had an open, supportive and learning-centred approach to working together. Feedback we received from staff confirmed they had enough training for their role, had an annual appraisal, and felt supported by their managers and leaders. Staff had completed their mandatory training.

The practice had staff in a range of clinical and non-clinical roles. Staff worked within their agreed areas of competence. Clinical staff had access to regular informal supervision through daily and weekly ‘debrief’ discussions, as well as in more formal, structured reviews.

The provider did not appropriately assess or manage the risk of infection.

We found waste (including clinical waste) at the Catterick Village site was not stored securely and was in an area which could be accessed by patients or visitors.

The practice leased the (Catterick Village site) building from a third party which also completed the cleaning. We found the provider did not have appropriate oversight of the cleaning of the premises. Leaders did not have access to appropriate records to evidence regular, safe and effective cleaning of this service location. There was no evidence of the provider carrying out audits or regular checks to ensure the cleanliness of the premises.

The Colburn branch site had carpets in some consultation rooms. The provider had not completed a risk assessment of this. There was no policy relating to the cleaning of these carpets and what action must be taken in the event of them being contaminated with a spillage (such as bodily fluids) between any cleaning cycles.

A recent infection prevention and control (IPC) audit of the Catterick Village site had not identified the IPC concerns we found. For example, a ripped patient chair in a consultation room (which could not have been cleaned effectively due to visible damage), as well as the unsafe storage of clinical waste.

However, staff had completed IPC training relevant to their role. The practice had a designated IPC lead who had recently undertaken more in-depth IPC training. They intended to complete regular IPC audits going forward.

The practice made sure medicines and treatments were safe for patients and met their needs and preferences. Staff involved patients in planning, including when changes happened.

Clinical staff discussed prescribing practices during regular ‘debrief’ discussions, as well as in formal practice meetings. Staff used a trusted website (containing analysis of NHS primary care prescribing data) as a tool and resource to discuss, reflect and brainstorm clinical practice and individual approaches to prescribing.

The practice had appropriate Patient Group Directions (PGDs) in place. PGDs are written instructions that allow specified, registered healthcare professionals to administer specific medicines to a pre-defined group of patients without a prescription from a doctor. However, we discussed with the provider the need to improve the administration of this process.

As part of our assessment, a CQC GP Specialist Advisor completed a series of patient clinical record searches. This included reviewing the management of patients on a sample of medicines that require monitoring.

Catterick Village Surgery ensured safe monitoring of patients prescribed disease-modifying anti-rheumatic drugs (DMARDs). These medicines treat autoimmune conditions (such as rheumatoid arthritis). Regular monitoring should be completed to ensure the medicine is working safely without harming the patient’s body. We checked the records of 36 patients prescribed DMARDs. We found 100% of these patients had been fully monitored to ensure their medicines were safe for them.

High-risk medicines are those which have a high potential for causing significant harm to a patient. People taking them must be closely monitored. We found Catterick Village Surgery mostly ensured safe monitoring of high-risk medicines. However, there were some patients who had not been monitored within appropriate timescales.

Our searches showed 17 patients were prescribed an aldosterone antagonist. This medicine is used to treat conditions such as heart failure and high blood pressure. We found 6 patients were overdue appropriate 6-monthly monitoring. We checked 5 patient records in detail which showed these people had been tested in the past 9 months.

Our searches showed 208 patients were prescribed direct oral anticoagulants (DOACs). These are blood-thinning medicines used to treat and prevent blood clots. We found 29% of these patients had not their creatine clearance calculated in the past 12 months. This is required to ensure patients are receiving a safe dose and their kidneys are clearing the medicine properly. We also found around 11% of patients taking DOACs were overdue appropriate blood monitoring.

Our clinical searches also reviewed action taken by Catterick Village Surgery in response to the Medicines and Healthcare products Regulatory Agency (MHRA) drug safety alerts. The MHRA regulates medicines in the UK. It sends alerts to GP practices to make them aware of the hazards of some medicines so they can take steps to protect patients when required.

We found Catterick Village Surgery was mostly compliant with responding to MHRA alerts. For example, our searches showed 36 patients were prescribed a combination of angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers (to help lower blood pressure) with an aldosterone antagonist. Of these, we found 11 patients were overdue their 6-monthly renal blood monitoring (to check their kidneys were working properly).