Oak Tree 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 remained the same.

The service had a good learning culture and people felt able to raise concerns. Managers investigated incidents thoroughly and shared learning throughout the organisation. 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. The practice and dispensary staff managed medicines well and involved people in planning any changes. The service had procedures to monitor patients prescribed medicines that required additional oversight. However, during our clinical searches, we identified some gaps in this monitoring. The service responded promptly, addressing the issues and implementing further systems to reduce the risk of recurrence. Staff took appropriate action to protect people and safeguard them from abuse.

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.
Staff understood how to raise concerns and report incidents. The service had processes for incident reporting including near misses and safety events. There was a system to record and investigate complaints and learning was shared across the organisation. Findings from significant events were discussed in meetings and learning was shared to improve patient care. The service had an active Patient Participation Group (PPG) who met monthly in person with the practice. People felt supported to raise concerns and felt staff treated them with compassion and understanding. Staff felt there was an open culture and learning from incidents and complaints resulted in changes that improved care for others.

The service had systems to work with people and healthcare partners to establish and maintain safe systems of care.
Our remote clinical searches found that test results were not always processed in safe timescales. The service used an external organisation to manage pathology results and some had not been acted upon in a timely way. The service reviewed this arrangement and took immediate action to address this to ensure patient safety. The service planned to monitor this in the future to reduce the risk reoccurring. This will be monitored during our next regulatory activity with the practice.
The service understood the importance of continuity of care and treatment, especially when people moved between services. A daily huddle with practice staff and external teams supported this. The service promoted continuity of care and treatment, such as care homes having a designated GP to carry out visits.

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.
The service had systems to protect vulnerable people from abuse. Staff were aware of who the safeguarding leads were for the service and how to raise concerns.
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.
There were safeguarding registers which were regularly reviewed at meetings with other relevant organisations. Updates were recorded in meeting minutes, some improvement was needed to ensure that codes applied to patient records were removed when there were no longer any safeguarding concerns.

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.
Staff could recognise a deteriorating patient and know what action to take in a medical emergency. Receptionists received training on emergency symptoms and 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. People received information and advice on risks related to their condition and actions to take if their condition deteriorated. This could be provided in different ways to meet peoples’ individual needs.
Our clinical searches found that some patients had not been told about the risks of their prescribed medicines. The service acted immediately to identify, contact and review these patients. It included them in audits to improve safety and oversight.
 

The service identified and controlled risks in the care environment including equipment, facilities and technology to support safe care. The practice had a contract in place for cleaning of the premises and could monitor effectiveness of this service.
The service was well maintained and free from clutter. One building had been recently refurbished. Patients could access the building and consultation rooms easily. The reception area included a space for confidential conversations.
Health and safety risk assessments had been completed, and the service had taken appropriate action. Fire safety policies, procedures and risk assessments were in place. Staff took part in regular fire drills. Lone working policies supported staff who visited patients in their own homes.
Clinicians had access to the equipment they needed. Equipment was calibrated within recommended timescales and was in good working order. Electrical items had been safety tested.
The service had a health and safety policy in place and undertook regular checks of clinical rooms. Clear signage throughout the building supported staff and patients during an emergency evacuation.
 

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well across both sites to provide safe care which met people’s individual needs.
We reviewed 6 recruitment files during the site visit and found that the practice had not always followed their policy in relation to seeking references. In 2 of the staff files reviewed, appropriate references were not in place. Disclosure and Barring Service (DBS) Checks (Disclosure and Barring Service (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) had been made and risk assessments where required. The service provided additional assurances by implementing a process to audit staff files when recruiting new staff to ensure recruitment checks had taken place.
Processes were in place to ensure that staff were appropriately trained and had received an induction and ongoing training relevant for their role. This was monitored and time was allocated to complete training. External learning and development opportunities for staff were supported and staff could access ongoing training relevant to their role.

Staff received appropriate performance management through an annual appraisal and were supported by their manager or mentor. The service had a variety of roles, both clinical and non-clinical. The service was actively looking to recruit additional GP’s to be able to deliver more GP appointments. The service benefitted from a team of Advanced Clinical Practitioners to be able to meet the needs of the population and recognised that the population was growing, with demand increasing.

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 an infection prevention and control (IPC) lead and staff were aware of who this was. The practice had a range of policies to support infection prevention and control, including outbreak management and sharps management. Policies provided information regarding the management of outbreaks. An annual statement had been completed and actions were to be discussed at the next clinical meeting. Sharps management processes were followed with sharps bins used appropriately. Personal protective equipment (PPE) was available to staff and the service held stocks of PPE. There were handwashing facilities throughout the buildings and water was a safe temperature with handwashing posters displayed.
The service held records of staff immunisations. There were appropriate systems for waste and clinical specimen management. During the site visit we observed the environment and equipment to be visually clean. Cleaning of both buildings was carried out by an external contractor and the quality of the cleaning was monitored by the practice. Where the service was not satisfied with the level of hygiene achieved, action had been taken. Cleaning equipment was stored safely. Reception staff demonstrated awareness of prioritising patients who may have been experiencing a clinical emergency.

There were dispensaries at Oak Tree Surgery and at Pensilva. There was also a separate registered pharmacy business at Oak Tree Surgery, which was managed separately from the surgery, and regulated and inspected by the General Pharmaceutical Council
There were suitable arrangements for managing medicines safely within the two dispensaries, and these were overseen by a lead GP. There were Standard Operating Procedures (SOPs) in place. These were regularly reviewed, signed and followed by staff. There were suitable arrangements for ordering, storage and disposal of medicines including those needing cold storage and for controlled drugs. Safe systems were followed when dispensing medicines, and staff were suitably trained and had annual appraisals to make sure they were managing medicines safely.
The surgery offered a delivery service to housebound patients and there were safe systems in place for managing this. Systems were in place to report any incidents or errors. These were investigated and measures put in place to reduce the risk of recurrence. Dispensary audits took place as part of the Dispensing Services Quality Scheme, which the practice signed up to. There were suitable systems for managing medicines alerts and recalls and clinical staff could access a local microbiologist for advice.
At the last inspection, we recommended the provider reviews and standardises processes across the organisation to further improve prescription stationary security.
At this inspection, we found that prescription stationery was managed by dispensary staff, and there were suitable systems for allowing authorised access. Records were held to track the movement and location of these forms around the practice.
Our remote clinical searches found that patients who were prescribed clopidogrel and omeprazole/esomeprazole were not always advised of the interaction risk. The service took immediate action to identify, contact and review patients and planned to include this patient group in audits.
The systems to monitor patients prescribed disease-modifying anti-rheumatic drugs (DMARDs) were not effective. A clinical search identified 122 patients prescribed methotrexate. A search found that 5 patients had potentially not had required monitoring. A review of notes showed none had been monitored within the last 6 months, with one patient not monitored for over 6 years. National guidance recommends blood tests at least every 12 weeks for stable patients. In response, the service implemented process changes including pausing medicine for non-responders and downloading hospital blood results to ensure safe and effective monitoring.
The service prescribed ACE inhibitors or angiotensin II receptor blockers (medicines used to control blood pressure) to 2,340 patients. A clinical search identified 168 patients who had potentially not received the required blood monitoring. These patients had not been monitored in-house, which posed a risk to safe prescribing. In response, the service reallocated responsibility for monitoring to the Dispensary Admin Team and implemented monthly searches to ensure timely review. This process change aimed to improve oversight and reduce the risk of missed monitoring.
Following our clinical searches, patients were contacted and invited for blood monitoring.
We reviewed all patient group directives (PGDs) used in the practice and found 5 had been signed after they were authorised. This meant that staff were not appropriately authorised to administer these medicines safely.