The Wrythe Green 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 has changed.
 

This service scored 62 (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. 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 whole team discussed and learnt from clinical issues. Staff felt there was an open culture. 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.
 

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.
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 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.
 

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. 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 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.
However, safe recruitment practices were not always consistently followed and documented. For one member of staff there was no evidence that a Disclosure and Barring Service (DBS) check (a DBS check is a review of an individual’s criminal record, used to assess their suitability for certain jobs) was completed at the time of recruitment. There was evidence of a check completed by a previous organisation and staff told us that a check had been completed, but not documented, using the DBS update service.
There were a range of clinical and non-clinical roles within the practice. 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. Non-medical prescribers received informal and ad hoc supervision but did not have formal meetings with their supervisor. This was addressed shortly after the assessment.
 

The service assessed but had not fully managed all the risks of infection.
The practice 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 but actions were not always completed to mitigate risks. A legionella risk assessment had identified that water temperatures were not high enough to prevent the growth of Legionella bacteria. The practice had taken other recommended actions, and had other actions planned to address the water temperature.
 

The service had systems and processes to make sure that medicines and treatments were safe and met people’s needs, capacities and preferences, but these were not all consistently effective. The service did not have a system in line with legislation to allow healthcare assistants to administer medicines. People were involved in planning.
A patient specific direction (PSD) is a written or electronic instruction from an authorised prescriber (like a doctor) to supply or administer a medicine to a specifically named patient. It delegated the task of administering care to a suitably trained healthcare professional after the prescriber has individually assessed the patient. The PSDs in use in the practice were not legally valid. After we gave this feedback to the service, the leaders took action and sent us evidence of a new system of PSDs, compliant with the legal requirements.
The service had a protocol for prescribing medicines that require specific monitoring. We looked at some examples of people prescribed some of these medicines. We found that for one medicine prescribing followed the protocol, but for another medicine the prescribing was inconsistent. For this medicine, not all the people we looked at had the recommended monitoring and there was not consistent evidence of action to encourage people to attend to have the monitoring. After a period of temporary staffing, the service now had a stable and increased pharmacy team and had a plan in place to improve medicines monitoring.
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.
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. The provider had effective systems to manage and respond to safety alerts and medicine recalls.