Grayshott 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 Requires Improvement. We have seen improvement and at this assessment the rating has changed to Good.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. The service had processes for staff to report incidents, near misses and safety events. Staff we spoke with were able to clearly describe incidents that they considered to be significant events and how they had been handled appropriately and discussed within their immediate team. However, reporting processes were not always implemented effectively or working as intended, to ensure all incidents were captured centrally. This meant there was a lack of management oversight of some incidents and a failure to identify themes and learning from some incidents.

There were systems to record and investigate complaints, and when things went wrong, staff apologised and gave people support. However, we found that there may be missed opportunities for identifying themes from concerns raised informally.

The service worked with people and healthcare partners to establish and maintain safe systems of care, within which safety was managed and monitored.

We spoke with a range of staff during our assessment, including clinical and non-clinical staff, who told us they worked with each other and patients to ensure safe systems, pathways and transitions. Staff told us they had the clinical information they needed to deliver safe care and treatment. There were systems in place for processing information relating to new patients, including the summarising of patient notes. The service worked with other providers to deliver shared care and to promote continuity of care when patients moved between services. Information was reviewed and actioned by practice staff in a timely manner. Test results and referrals to specialist services were managed in a timely way and outcomes monitored. For example, staff ran frequent searches to ensure patients had been seen following their fast-track referral. There were appropriate systems in place to identify and manage activity to reduce the risk of backlogs developing.

There were systems and processes in place to flag records for vulnerable children and adults. The service shared concerns quickly and appropriately. A review of children safeguarding records showed that alerts were appropriately placed on clinical records and their household family members. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The service maintained a list of vulnerable people and acted on concerns, working in partnership with other organisations.

Staff could recognise a deteriorating patient and knew the actions to take if a patient became unwell. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Staff were able to explain the appointment booking system and how they triaged patients to the right appointment or identified those in need of urgent assistance. Emergency equipment was available and appropriately maintained.

The provider had policies in place to ensure patient data was handled safely. Staff told us they had completed information governance training. We found individual care records were written and managed securely, in line with current guidance and relevant legislation.

Staff told us there were fire procedures in place and they had completed relevant health and safety training. They also described recent fire drills and knew what to do in the event of an emergency or major incident. Safety equipment was subject to regular checks and maintenance.

However, we found there was a lack of management oversight of some health and safety monitoring processes. Health and safety risk assessments had been undertaken to ensure risks within the premises were identified but the service had not always ensured that identified risks were actioned in a timely manner or sufficiently reviewed. For example, in relation to risks associated with Legionella bacteria.

The service had failed to ensure timely review of some health and safety risk assessments. For example, no review of the fire risk assessment for the premises had been carried out following changes made to the fabric of the building. An area of the premises where large quantities of paper were stored had not been included as part of the fire risk assessment, that omission had not been identified by the service.

Where the service undertook regular health and safety monitoring checks, there was a lack of oversight by leaders and a failure to identify when they were not operating as intended.

The service made sure there were enough qualified, skilled and experienced staff, to provide safe care that met people’s individual needs. However, the service did not always ensure recruitment checks were undertaken in a timely manner or in line with their own recruitment policies. For example, some Disclosure and Barring Services checks (DBS) and reference requests were not completed by the time staff commenced their employment or started clinical work within the service. Where this occurred, there was a failure to fully assess the risks or record the rationale associated with allowing staff members to work without a DBS check.

There were a range of non-clinical and clinical roles within the service, including a physician’s associate and nurse associate. We found training was up to date and learning needs and development of staff was managed appropriately. Staff were mainly working within their agreed areas of competence and received appropriate levels of clinical supervision and support. However, the service had failed to ensure clinical staff employed on a sessional basis had the required recruitment checks in place and had the appropriate monitoring. This included setting out agreed areas of competence.

There was a lack of processes in place to seek assurances or to confirm whether appropriate recruitment checks, or training had been undertaken by clinical staff employed by the Primary Care Network (PCN) but who were working under the direction of the service.

The service had implemented improvements since our last assessment, to assess and manage the risk of infection. There was a designated infection, prevention and control lead and all staff had received relevant training. Cleaning schedules were in place for staff and external cleaning contractors to follow. Risk assessments and audits were completed, and actions taken in the main, to mitigate risks.

The service had worked closely with cleaning contractors to improve standards of cleanliness within the premises. However, there were some areas, such as the cleaning of high-level surfaces, which continued to be identified in the service’s cleaning audits as requiring further attention. We found cleaning to be generally of a good standard, with some isolated areas needing additional focus, such as dust on privacy curtain poles and high-level door closers.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in reviews of their medicines and any decisions made 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 we spoke with during our assessment had knowledge of current and relevant best practice and professional guidance.

As part of the assessment, we conducted remote searches on the services’ clinical system and reviewed a selection of patients’ clinical records. Our review of patient clinical records showed that patients were being effectively and safely managed. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. We saw that the service had embedded a proactive approach which included regular searches of the patient clinical records system, to ensure patient care and monitoring was completed in line with current guidelines. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring and the service had designated staff members to support and co-ordinate this approach.

Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely. Medicines, including controlled drugs, were stored securely and at appropriate temperatures. Vaccines requiring refrigeration were stored, monitored and transported in line with national guidance. We found that fridge temperatures were monitored, and appropriate actions taken to respond to potential cold chain breaches. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. The service had effective systems to manage and respond to safety alerts and medicine recalls. Staff had the appropriate authorisations to administer medicines using Patient Specific Directions and Patient Group Directions.