Old Bridge 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.
The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.
 

This service scored 72 (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 told us they felt supported to raise concerns and felt staff treated them with compassion and understanding. The service undertook Friends and Family Tests (FFT) and the results of these were monitored for trends to improve care.
The service had processes for incident reporting including near misses and safety events and staff we spoke with demonstrated awareness of these. Learning from incidents was shared and monitored for trends.
There was a system to record and investigate complaints and learning was shared across the organisation. For example, an investigation took place following a complaint and the service changed practice in relation to a type of health screening as a result.
A member of the services Patient Participation Group (PPG) commented “We would like to receive more qualitative feedback especially regarding complaints which were upheld’’.
 

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 and care homes having a designated clinician to carry out visits.
There were systems for processing information relating to new patients and a dedicated person to carry out summarisation.
The service had identified that it needed to improve on following up of appointments that required a two week wait (urgent requests for a hospital specialist to see a patient with symptoms that may indicate cancer, ensuring they are seen within 14 days). Following our inspection, the service made changes to the process to ensure safe transitions for people requiring timely follow up.
The service used an external organisation to manage pathology (blood) results and had oversight of these, to monitor timeliness of results.
The service worked with other providers to deliver shared care and when people moved between services, referrals and test results were managed in a timely way.
 

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 had systems to protect vulnerable people from abuse and staff were clear on their roles and responsibility in relation to safeguarding. Staff were aware of who the safeguarding leads were for the service and how to raise concerns. A staff member we spoke with was able to give an example of where they had spoken to the Safeguarding Lead when they had concerns about a person.
Staff had received appropriate training in safeguarding adults and children and were able to access policies and procedures which contained up to date information and guidance, including a safeguarding handbook. The service continually refreshed safeguarding knowledge of staff by routinely discussing it at the services half day closures for protected learning time (PLT).
There were safeguarding registers held for both adults and children which were regularly reviewed at meetings with other relevant organisations. Updates were recorded in meeting minutes.
 

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. Staff could recognise a deteriorating patient and knew of action to take. People were advised on risks related to their condition and actions to take if their condition deteriorated.
Staff could recognise a deteriorating patient and know what action to take. There were clear processes and guidance for reception staff to follow, and they received training on emergency symptoms such as sepsis. GPs were available to support the receptionists with clinical advice where required.
Staff we spoke with provided examples of coordinated responses between clinical and non-clinical staff to manage medical emergencies. During our inspection we evidenced a clinician supporting a person in an emergency outside of the service.
 

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.
People could access the building and consultation rooms easily. The service was able to provide a space away from the waiting room to accommodate confidential needs of people using the service.
Health and safety risk assessments had been completed, and the service was supported by an external company to ensure compliance. The service had also carried out a security risk assessment. Fire safety policies and procedures to carry out equipment checks, and fire drills were in place. A fire audit and risk assessment had been carried out in September 2025, which identified the current fire alarm system was not adequate for the current use of the building and a new fire alarm system was required. The service has advised that they plan to replace this within the timescale recommended in the audit/risk assessment.
Clinicians had access to the equipment they needed. Equipment was calibrated within recommended timescales and was observed to be in good working order. Electrical items had been safety tested.
The service had a health and safety policy and undertook regular checks of clinical rooms. Clear signage throughout the building supported staff and patients during an emergency evacuation.
There was a business continuity plan 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.

We reviewed 5 recruitment files and evidenced that staff had appropriate recruitment checks, including references and a Disclosure and Barring Service (DBS) Checks. (DBS) is a check which enables employers to check the criminal records of current and potential employees to ascertain whether they are suitable to work).

Processes were in place to ensure that staff were appropriately trained and had received an induction and ongoing training relevant for their role. Where there were gaps in staff training there was a plan to address these.

External learning and development opportunities for staff were supported and staff could access ongoing training relevant to their role. Staff told us of how they were supported to achieve career progression.

The service implemented protected continuous professional development (CPD) time for all clinicians, allowing them to complete their mandatory training and develop in areas that benefit people’s care.

We evidenced that staff had received an annual appraisal and were supported by their manager or mentor. Staff told us that they received supervision. However, we did not see recorded evidence of this in the staff files we reviewed. The service was implementing a new framework to continually improve its supervision process overall.

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 service had appropriate arrangements for infection prevention and control (IPC). There were clear governance structures, including designated roles such as an IPC Lead, IPC Manager and IPC Support, to oversee and implement IPC measures. Staff understood their responsibilities in relation to IPC and were aware of the appropriate channels for seeking guidance and support. Training relevant to IPC was provided and completed by staff. The service completed the Annual IPC Audit Tool for General Practice, following the local guidance for IPC and had an IPC policy. Findings were presented at team meetings and an action list was created. For example, where additional waste bins were requested.
We evidenced sharps management processes followed with sharps bins used appropriately. However, we evidenced one instance of a sharps bin having not been dated in line with the IPC policy and relevant guidance. This was resolved during the inspection.
Personal protective equipment (PPE) was available to staff, and the service held stocks of PPE. Staff were able to describe to us the effective use of PPE and were able to tell us what they would do in the event of a spillage. The service had a designated lead for cleaning and decontamination.
There were handwashing facilities throughout all the buildings and there were appropriate warnings for hot water.
The service held records of staff immunisations. There were appropriate systems for waste and clinical specimen management. During the site visit, we evidenced the environment and equipment to be visually clean.
Cleaning of the buildings was carried out by an external contractor and internal cleaning staff; the quality of the cleaning was monitored by the service. Where the service was not satisfied with the level of hygiene achieved, action had been taken. Cleaning equipment was stored safely and contained appropriate data sheets for the products used.

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 and felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely.
Staff followed protocols to ensure they prescribed all medicines safely and medicines including controlled drugs were stored securely and at appropriate temperatures.
Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs.
Waste medicines were recorded and disposed of appropriately including medicines returned by patients. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.
There were processes to identify patients who do not need repeat prescriptions such as people who receive certain controlled drugs as part of their medication. The service monitored the prescribing of controlled drugs and could give an example of action taken as a result of this.
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.
Audits of prescribing took place, and we saw evidence of how these had been followed up where risks had been identified. For example, staff refresher training taking place. We evidenced that the service was in the process of introducing prescribing audits for non-medical staff.
Emergency medicines and resuscitation equipment were held in the service and staff knew how to access these. The service had processes to check stock of emergency medicines at each site and these were recorded.
As part of our assessment a number of set clinical record searches were undertaken by a CQC GP Specialist Advisor. These search criteria are freely available for practices to access at any time.

Our remote clinical searches evidenced that patients who were prescribed medicines that required additional monitoring had not always received the required monitoring.
Patients who were prescribed Amiodarone (a medicine used to treat irregular heart rhythms) did not received the required monitoring in our sample of 5 patients reviewed.
Patients who were prescribed a bisphosphonate (medicines used to treat or prevent bone loss) did not always receive the required reviews for long term use of the medicine.
However, the systems to monitor patients prescribed disease-modifying anti-rheumatic drugs (DMARDs) were effective and patients received the required monitoring.
Following our clinical searches, the service provided information to show that people affected had attended or had arranged appointments for reviews and required testing.
The service took further steps to improve their systems for medication monitoring, to ensure risks were negated and we received evidence of this following our inspections.
We reviewed all patient group directives (PGDs) used in the service and found that staff were appropriately authorised to administer these medicines safely.