Streatfield 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 service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture

At our last assessment, we rated this key question as Good. At this assessment, the rating has changed.

At this assessment we found the service in breach of legal regulation in relation to Regulation 12 – Safe care and treatment.

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. The practice had a standing agenda for significant events at their practice meetings which were held on a weekly basis. Lessons were learnt to continually identify and embed good practice. The practice listened to a sample of inbound calls each month to give constructive feedback to the team. The practice had a system to record and investigate complaints and these were discussed during practice meetings.

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 patients moved between different services. Referrals and test results were managed, and had oversight, in a timely way in line with practice policies.

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. Safeguarding policies were in place and known to staff. The service shared concerns quickly and appropriately.

We found that some non-clinical staff did not have the required learning of safeguarding for their job role. This was actioned after the on-site visit and all staff were shown to be up-to date with their training. The practice maintained a list of vulnerable people on registers, however some patients we reviewed did not have the appropriate codes on the practice database.

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 well maintained. Staff could recognise a deteriorating patient and knew of action to take. The practice held meetings every 8 weeks for all staff which included role play for emergencies and reminders of where emergency equipment was kept. All staff we spoke with during the assessment were aware of sepsis and the symptoms to look out for, could recognise a deteriorating patient, and knew of action to take.

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, fire risk assessments and legionella risk assessments 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. During our on-site visit, we found gaps in training files. There was a shortfall in the oversight of staff recruitment records. The service, after the on-site inspection, provided evidence staff were up to date with their required training. Some of these were completed after the assessment.

The service assessed and managed the risk 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. The practice had an Infection prevention and control policy that was tailored to the practice and included all information required for staff. The practice had carried out an infection prevention and control audit and taken appropriate action where required. All staff we spoke with during the assessment knew what to do in events of spillages and the procedures to follow.

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 regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines which were readily available. The practice had medical oxygen and a defibrillator for use in a medical emergency. During our site-visit we found that staff managed prescription stationery appropriately and securely. However, we found that an anaphylaxis kit was not found in all treatment rooms where vaccinations were being administered.

We also found some areas for improvement during our clinical searches. We found that, contrary to national guidelines, there was not a consistent follow up within a week of steroids being prescribed for 1 out of 4 patients we looked at with asthma who had been prescribed 2 or more courses of rescue steroids. We also found 3 of the 4 patients in this category did not have a steroid card. This is an important document for patients as it can provide essential information for emergency situations and ensuring safe management of steroid use. We found some patients prescribed an antiarrhythmic medication, used to treat and prevent a number of types of cardiac dysrhythmias, who had not had the required monitoring. Five of those we looked at were overdue monitoring. We found that 4 older patients on medicines used to treat depression were on a high dose without being informed of the risks. The practice demonstrated that they had followed up on all our findings during our clinical searches.