Hucclecote 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 69 (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.

Safety was a priority for everyone and was supported by those with clear roles and responsibilities for safety. The service had processes for staff to report incidents, near misses and safety events. Staff felt supported and encouraged to raise concerns and felt staff treated them with compassion and understanding. Staff told us there was open culture and leaders encouraged them to raise concerns when things went wrong.

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.

Representatives from the patient participation group (PPG) felt the service were open and honest. The PPG felt the service listened to them, took concerns seriously and made improvements to the service.

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 for processing information relating to new people joining the service. However, we found 81 new records required summarising. This was less than 1% of the service population. We discussed this with the service, who were aware of the issue, and took action and created a plan to clear this backlog within the next 5 months.

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 shared concerns quickly and appropriately through regular safeguarding meetings where vulnerable people were discussed. Minutes were taken and shared with staff to ensure everyone was aware of these vulnerable people. Important information was also shared, if required, during the daily informal GP meeting.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. Staff we spoke to were aware of who the safeguarding leads were and could demonstrate how they would raise a concern. The service 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 person and knew of action to take.

People were advised on risks related to their condition and actions to take if their condition deteriorated. GPS were available to support reception staff where clinical input was required.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety risk assessments and audits had been undertaken and risks identified had been addressed.

Contracts were in place to ensure the premises were maintained.

Staff were aware of the limitations of the premises, due to its age, and services were adjusted accordingly. For example, the service had ground floor rooms available to support those with mobility issues.

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. However, we identified some shortfalls in staff files and training completion rates. Staff worked together to provide safe care that met people’s individual needs.

There were a range of clinical and non-clinical roles within the service. Each role was allocated a list of mandatory training to complete at regular intervals. The service told us the mandatory training completion rate was 50-75%. We viewed the training records for 3 members of staff and found completion rates were 90%, 73% and 61%. We discussed this with the service who took action to gain better oversight of completion and planned to allocate additional time and resources to ensure training is up-to-date.

We found learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. However, during the onsite visit, we identified these records were not centrally held. For example, competencies, supervisions and appraisals had taken place for some staff but leaders did not have access to the documents for assurance they had taken place, issues had been identified and action taken where necessary. Following the inspection, the service told us they were going to review their processes to improve their record keeping.

Safe recruitment processes were followed however, during the onsite visit, we identified some information was missing from staff recruitment files. We viewed 3 staff files and found references missing for 1 member of staff and another member of staff was missing an annual self-declaration form (an annual confirmation by existing staff to confirm there has been no criminal activity since the original disclosure and barring service (DBS) certificate/or the previous self-declaration). Following the onsite visit, the service took action to review these staff files and completed risk assessments for them. The service also took steps to review all staff files to ensure all staff had been safely recruited and strengthen their processes for any future recruitment.

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. However, although cleaning schedules were available, we saw they were not always signed off in line with policy. This had already been identified by the service as an area for improvement in the recent infection prevention control (IPC) audit and was being addressed. The service’s IPC lead had already met with the cleaning contractor and was receiving regular cleaning audits by email. We observed the service and premises to be visibly clean during our onsite visit.

All staff had completed relevant training. The IPC lead had recently taken on the role and was reviewing and implementing new processes to ensure IPC risks were minimised and was in the process of sourcing additional training to support them in this lead role.

There was a process to record staff vaccinations in line with national guidance.

The service had systems and processes to ensure medicines and treatments were safe and met people’s needs, capacities and preferences. However, they were not always effective as we identified some shortfalls in how medicines were managed, and how oxygen cylinders and medicines requiring refrigeration were stored. The service 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 appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. However, during the onsite visit, we found oxygen cylinders were being stored unsafely. The cylinders were found lying on their side and were not appropriately labelled, which is not in line with guidance. Following the inspection, the service immediately addressed our concerns. We also found some confusion with staff and leaders over what emergency medicines were kept in stock. The service had recently reviewed systems and processes around emergency medicines and equipment following a significant event. Following our onsite visit, the service revisited their processes and risk assessment. We also found medicines stored in the fridge were touching the sides which could impact the air circulation and temperature. We raised this with staff who took immediate action to reposition the medicines.

The service had systems to manage and respond to safety alerts and medicine recalls and staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring and advice. However, our remote clinical searches of people’s records found these processes were not always effective. We identified 125 people aged over 65 and prescribed non-steroidal anti-inflammatory drugs (NSAIDs), antiplatelets or, over 75 years old who should have been prescribed or considered for a medicine to protect their stomach lining in line with national guidance. We reviewed 5 records and found the stomach protecting medicine had not been considered for people. The service took immediate action to review all 125 people within a month to consider if they required this medicine.

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. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

We reviewed a sample of Patient Group Directions (PGDs) (a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition by named registered health care professionals without them having to see a prescriber) and Patient Specific Directions (a written instruction from a doctor or other independent prescriber for a medicine to be supplied or administered to a named patient). Of those we reviewed, all had been completed appropriately in line with guidance.