The Weobley and Staunton-On-Wye Surgeries

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 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Effective processes were in place to monitor and review incidents and significant events to ensure safe care and treatment. The practice had systems to ensure compliance with the requirements of duty of candour ensuring a positive learning culture about safety, based on openness and honesty. Staff were encouraged to raise concerns and report incidents which were later discussed at staff meetings. Learning and improvements were identified from individual concerns and complaints that led to embed good practice. The provider had a complaints policy in line with recognised guidance. During our assessment, we identified one complaint response that did not follow the policy as it did not include details about how to seek support if a patient was not satisfied with the complaint response. Therefore, we were not assured that all staff knew the complaints policy to ensure that all patients knew their options if they remained unsatisfied. The provider took action to ensure the complaints process was always adhered to in response to our findings. The practice had meetings with their Patient Participation Group to gain patient views about their experiences.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care when people moved between services. There were protocols in place for managing incoming correspondence into the patient’s medical records. Staff ensured pathology and blood test results were managed in a timely manner. Reminders were set to check whether results had been returned to ensure they were actioned accordingly. There was a high number of outstanding tasks for staff to complete. However, on further review they had been completed but not addressed correctly on the system. The provider was responsive and reduced this number during the onsite assessment and agreed to ensure all staff knew how to complete the task correctly on the system going forwards. Patient referrals to specialist services were documented in patient records and GPs followed up the appointment if required. Triage systems and protocols were in place for staff to follow. There were systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment, for example with out of hours providers.

Safeguarding systems and processes were developed and implemented within the practice. Safeguarding policies were in place and known to staff. Staff were trained to the appropriate levels for their role. Staff knew how to identify, report and take action regarding safeguarding concerns. Staff also knew the designated leads for safeguarding adults and children. Vulnerable people were coded and had alerts added to their records. The practice maintained a register of vulnerable people and acted on concerns quickly, working alongside other healthcare professionals, including safeguarding co-ordinators within the Primary Care Network (PCN). The out of hours service was informed of relevant safeguarding information. Safeguarding matters were discussed during weekly practice meetings and monthly multi-disciplinary team meetings. The practice had a chaperone policy in place to maintain patient privacy during intimate examinations. Posters were displayed in all consultation rooms and waiting areas.

The practice provided care to meet people’s needs that was safe and supportive. Staff worked proactively to support patients with the prevention of ill health. Staff could recognise a deteriorating patient. Patients were advised on risks related to their condition and knew what actions to take if their condition deteriorated. Patients were referred to services that could provide them with specialist advice to manage their condition. Patients who were prescribed high risk medicines were called for regular checks. The practice encouraged patients to attend health screenings such as heart rate and blood pressure monitoring.

Policies and procedures were in place to ensure facilities, equipment and technology were well-maintained to consistently support staff to deliver safe and effective care. Contracts were in place to ensure the premises were maintained. Portable appliance testing and calibrations were up to date. Health and safety risk assessments had been completed. Systems were in place to check the fire alarms and fire extinguishers, and fire evacuation procedures were displayed in reception. There was a business continuity plan in place which was monitored and updated when necessary. Both practices were accessible for those in wheelchairs as reception and consulting rooms were all on the ground floor. However, not all toilets had an emergency pull cord. Parking was limited at both practices however, disabled spaces were prioritised outside the buildings. The premises were clean and tidy.

Staff worked between the Weobley Surgery and Staunton on Wye Surgery to ensure there was always cover provided when required. The practice made sure there were enough qualified, skilled and experienced staff that worked well together to provide safe care and meet people’s individual needs. There were a range of clinical and non-clinical roles within the practice and dispensary. Safe, consistent recruitment practices were followed to ensure staff were suitably experienced, competent and able to carry out their role. For example, the personnel files that were reviewed during the onsite visit included all necessary documents such as proof of identity, references and interview notes. We found training was up to date and staff confirmed they received training appropriate and relevant to their role. As a GP training practice, learning and development for staff was encouraged and managed appropriately whilst receiving effective support and supervision. Appraisals were completed on a regular basis to support professional development. The practice manager had updated the appraisal form to allow free conversation and accommodate the needs of the staff. Staff felt supported with their professional development and were grateful for the opportunity to learn.

The practice assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns appropriately. The practice had a designated infection, prevention and control (IPC) lead and staff were aware who this was. All staff had the relevant IPC training. Cleaning schedules were in place and followed to ensure the premises and equipment remained clean and hygienic. Clinical rooms had adequate provision of personal protective equipment (PPE) and handwashing facilities. Annual hand washing audits were completed. Evidence of infection prevention and control audits were provided following our onsite visit, and actions were taken where necessary. The arrangements for managing waste, sharps and clinical specimens were appropriate and kept people safe.

The practice made sure that medicines and treatments were safe and met people’s needs and preferences. Staff followed established processes to ensure people using prescribed medicines with specific risks were reviewed and received recommended monitoring. As part of our assessment, a CQC GP specialist advisor reviewed a series of patient clinical records. This included a review of the management of medicines that required monitoring. We found most patients had received monitoring in line with guidance. Regular medicines reviews were carried out to ensure patient medicines were appropriate to their needs and safe. It was identified that some notes needed more detail to clarify what was discussed and advised. Staff involved people in their medicine reviews and helped them understand how to manage their medicines safely. The practice had effective systems to manage and respond to safety alerts and medicine recalls. Staff regularly checked medicine stock levels and expiry dates, including emergency medicines and controlled drugs. Although there was no record for checking stock levels and expiry dates for vaccines, an onsite observation showed the vaccines were appropriately stocked and in date. Fridge temperatures were monitored on a regular basis and staff knew what action to take if the temperature was out of range. There were suitable processes for staff to follow when dispensing medicines. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. The practice completed an antibiotic audit that showed good antimicrobial governance.