Newhall 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. At this assessment, the rating has changed to good.

This service scored 66 (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. A representative from the Patient Participation Group (PPG) felt the provider took concerns seriously and made improvements to the service. Managers encouraged staff to raise concerns when things went wrong.

Systems were in place to discuss, learn from and disseminate information from clinical issues or learning events. 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. Incidents were discussed and learning disseminated through staff meetings and weekly updates. Learning from incidents and complaints resulted in changes that improved care for others. For example, introduction of the Medical Emergencies in Eating Disorders risk assessment tool for people who presented with an eating disorder.

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. Local health care providers used the same electronic patient record system and could easily access information about people using the service. Feedback from a local care home was very positive regarding the way the service worked with them.

There were systems in place for processing information relating to new patients. The service worked with other providers to deliver shared care and when patients moved between services. Referrals and test results were managed in a timely way.

The provider acknowledged there were challenges with summarising patient notes, although GP to GP documentation was reviewed when people joined the service. An external company was used for coding and matching information received by the service. The service was actively recruiting for a clinical coder and summariser.

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 service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

Systems and processes were in place to identify and raise awareness of potentially vulnerable groups of people. The service held internal safeguarding adults meetings and proactively engaged with care co-ordinators to identify any additional support that may be required. In additional monthly multidisciplinary team meetings were held to discuss vulnerable people in need of additional support. The service had systems in place to generate and corroborate the children’s register with health visiting services and relevant cases were discussed at the bi-monthly meetings. There were systems in place to follow up people who failed to attend appointments in primary and secondary care or, were frequent attenders to the emergency department.

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.

The majority of emergency equipment was available and maintained. However, a self-inflating bag with reservoir for a child was not available.

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 online triage system reviewed patient information for high risk symptoms and advised people to attend the emergency department when appropriate.

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.

The provider was in the process of making improvements to the premises, which included building work and upgrading the fire alarm system. Existing risk assessment for fire and legionella had been reviewed, updated and action taken to address identified risks. There were plans to repeat these risk assessments on completion of the improvement work. Staff completed online fire training and attended regular fire drills. Regular testing of water temperatures took place. Electrical and medical equipment had been tested and calibrated as required. There was a business continuity plan in place which was monitored and reviewed.

Cords to blinds were not secured to the wall in the 3 rooms we looked in, in line with a central alerting system (CAS) alert. Following our assessment the provider forwarded information indicating safety hooks for the blinds had been ordered.

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. Staff told us there were sufficient staff to meet the needs of people when all staff were at work, but there could be challenges when staff were on holiday or away from work due to sickness.

There were a range of clinical and non-clinical roles within the service. We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Staff were positive about the support, training and development they received.

The GP registrars and trainees, the clinical pharmacists and the advanced clinical practitioners were supported with regular debrief sessions and feedback on the quality of their consultations.

Safe recruitment practices were followed.

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. Improvements had been made to the systems in place to assess and manage the risk of infection. The service had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks where possible. Outstanding actions had been included on the risk register. Clinical waste procedures were in place.

Staff vaccination was maintained in line with current UK Health and Security Agency (UKHSA) guidance if relevant to their role.

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. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

Improvements had been made to the management of medicines. The service 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. Protocols supported the safe prescribing of medicines and staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. Medicine reviews were appropriate and well-structured. Processes were in place to provide assurance on the quality and safety of non-medical prescribing.

Our clinical searches identified a small number of people prescribed medicine that was potentially additive, who were overdue their annual medicine review to ensure correct compliance, avoid overuse and monitor for side effects. Our review of the records identified medicine reviews had taken place for some people but had not been coded on the records. Following our assessment the provider told us they had action to review those people identified in any of our clinical searches who required follow up.

The service did not stock all of the recommended emergency medicines. Although risk assessments were in place they were not robust as the service had not checked with the community pharmacist if they routinely kept these medicines in stock. Following our assessment the provider forwarded an updated risk assessment detailing the rationale and safety measures in place for the medicines which were not stocked.

Systems were in place for checking the stock levels and expiry dates of all medicines, including emergency medicines and vaccines. Medical gases, such as oxygen, were stored securely.

Prescription stationery was stored securely and although improvements had been made to the tracking of prescription stationery throughout the service, the process was not fully embedded. The number of printers in use for prescriptions had been limited. Care navigation staff maintained a log of prescriptions placed into the main printer at the start of the day and then at the end of the day and this was working well. The nursing team used the same system. However, on the day of our assessment the numbers of the prescriptions added to the printer used by the nursing team had not been recorded so 3 prescriptions were unaccounted for. We looked at the log for prescription boxes and pads. The log was inaccurate. There were 3 prescription pads, none of which were recorded on the prescription tracker. There were 2 boxes of prescription stationary, 1 open and in use and one unopened. Neither of these boxes were recorded on the tracker. It was not clear from the log when boxes had been received or which boxes were in use. Following our assessment the provider forwarded the updated prescription tracker, with details of the boxes and prescription pads available, where they were kept and which ones were in use.