Gnosall 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 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 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.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. The provider had processes 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. Learning from incidents and complaints resulted in changes that improved care for others. Documentation of the mitigation actions taken could be further strengthened. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the team discussed and learnt from clinical issues. There had been an introduction of a debrief meeting ‘5 at 5 to’ which took place daily at 7.55am with staff to discuss any changes or updates for the day. Staff felt there was an open culture, and that safety was a top priority. The practice was a training practice for medical students and GP trainees.

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.

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.

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. Electronic system codes were used to illustrate that any child on a child protection plan should be entered into the notes of all individuals living at the same address. As well as codes for those who did not attend for appointments or were not brought to appointments. The practice had made attempts to verify the safeguarding register with the local safeguarding team to ensure safeguarding information was accurate and up to date but had been unsuccessful to date. The practice had signed up to a recent Integrated Care Board (ICB) initiative to further improve inter agency communications.

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. There was a lack of a documented risk assessment for the emergency medicines not held by the practice which the practice clinical staff put in place during the assessment. 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 lack of a documented outcome in some of the maintenance records we reviewed whilst on site which the practice subsequently forwarded as evidence onto the CQC. 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, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were a range of clinical and non-clinical roles within the practice. Staff with extended or additional roles had completed additional training. The practice’s mandatory training was for the vast majority ofstaff up to date. Staff training reminder emails and meetings were held to encourage staff to complete their training. An induction policy was in place with role specific shadowing opportunities. Learning disability and autism Tier 1 or 2 training had been completed for all staff. Tier 2 training was being sourced for all remaining staff. We found staff’s learning and development needs were managed appropriately, and staff were working within their agreed areas of competence. These were reviewed during staff appraisals and at clinical supervision sessions.

Gaps were identified in the staff recruitment records. This had already been identified by the practice. The practice was in the process of putting person specific risk assessments in place for each staff member with identified gaps in their recruitment records and information requests had been made. All staff had been subject to appropriate level disclosure and barring service checks. The Disclosure and Barring Service helps employers make safer recruitment decisions.

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. Cleaning staff employed by the practice had completed relevant training including Control of Substances Hazardous to Health Regulations 2002, (COSHH) which is UK law requiring employers to control substances that can harm employees' health (e.g., chemicals, fumes, dust, biological agents). Risk assessments and audits were completed, and actions taken to mitigate risks.

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, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines.

Staff managed prescription stationery held in printers appropriately and securely. We fed back on our observations on site in respect of rarely used paper prescription stationery, where we found although securely held with access limited to named staff the serial number documentation was lacking. This was promptly actioned whilst on site by the practice.

Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. For example, our clinical searches identified no patients were overdue monitoring for high-risk medicines, however, one person appeared overdue a blood pressure check. During the inspection process the practice investigated and actioned this feedback promptly.

Our clinical searches identified 1211 patients prescribed one of two specific medicines used in the treatment and management of raised blood pressure. The number of patients identified by our search who had the potential not to have had required monitoring was, 12 out of the 1211. We sampled 5 of the 12 records and found that the practice had recalled patients who were overdue.

We completed clinical searches for patients prescribed medicines subject to a specific patient safety alert from the Medicines and Healthcare products Regulatory Agency, (MHRA). Records showed that 3 patients were prescribed a combination of these medicines. Following discussion with the Lead GP, we identified that 1 patient was under consultant specialist care and 2 patients had undergone medication reviews where discussion of the alert had not been documented. The practice acted on the feedback provided.

The practice used a software programme designed to reduce medication-related harm by identifying patients at risk from high-risk prescribing and inadequate monitoring. These reports were generated and reviewed monthly; this audit was conducted on an ongoing basis to ensure continuous compliance and patient safety. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was lower than local and national averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

All 5 medication reviews we sampled were comprehensive, good quality,reviews.