Wargrave House 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 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice 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. The practice reviewed all significant events to identify trends and themes and ensured that relevant changes were made to reduce reoccurrence of these events. Managers encouraged staff to raise concerns when things went wrong. Patients felt supported to raise concerns and felt staff treated them with compassion and understanding. There was a system to record and investigate complaints. Learning from complaints resulted in changes that improved care for others.

The practice worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. The practice worked with other providers and services to ensure continuity of care, including when people moved between different services. There were systems in place for managing incoming correspondence for patient’s medical records, including processing information relating to new patients. Staff ensured pathology and blood test results were reviewed and actioned in a timely manner. Staff understood the referral system and were able to tell us about the process when dealing with referrals, ensuring they were followed up accordingly. Triage systems were in place for staff to follow. The practice had fail-safe systems in place to ensure all cervical cytology results were received from the samples sent.

The practice 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 practice had an effective system in place for the management, oversight and reviewing of safeguarding concerns. They shared concerns quickly and appropriately. Safeguarding policies were in place and known to staff. Most staff were up to date with their mandatory safeguarding training.To ensure all staff complete their mandatory training going forwards, management explained that dedicated time will be allocated in their diary to allow this. Staff knew how to identify, report and act when dealing with safeguarding concerns. They worked well with other healthcare professionals to ensure the concerns were addressed appropriately. Staff were aware who the safeguarding lead and care co-ordinators were. A list of vulnerable people was reviewed regularly and updated. Vulnerable people were coded on their system and had alerts added to their records. Safeguarding concerns were reviewed, and risk management was discussed during monthly multidisciplinary meetings. The practice followed up children who had not attended their appointments. The practice had a chaperone policy in place to maintain patient privacy during intimate examinations. Posters were displayed in consultation rooms and waiting areas.

The practice worked well with people to understand and manage risks. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. An effective system was in place to respond to patient safety alerts and patients were given advice on the risks related to their conditions with clear guidance on what actions to take if their health deteriorated. Staff showed awareness of recognising signs of a deteriorating patient and knew what action to take, such as escalating to the duty doctor. 87% of respondents to the National GP Patient Survey felt they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. This was lower than they local average of 93% and the national average of 91%.Emergency equipment such as a defibrillator and emergency medicines was available and well maintained.

The practice detected and controlled potential risks in the care environment. The practice had procedures to ensure equipment, facilities and technology supported the delivery of safe care. Audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place. Portable appliance testing and calibrations were completed. Systems were in place to check safety equipment including fire alarms and panic buttons. Fire evacuation drills were completed, and learning was logged and disseminated in the meeting minutes. During the onsite visit, the premises were visibly clean and tidy. Cleaning schedules were in place to maintain a clean, safe environment. Staff had received training in health and safety areas such as fire safety and infection control.

This training practice made sure there were enough qualified, skilled and experienced staff that worked well together to provide safe care and meet people’s individual needs. Leaders explained their recruitment processes to ensure appropriate numbers of suitably trained staff were employed to support the delivery of good quality care which met the needs of the patients.There were a range of clinical and non-clinical roles within the practice. Staff were working within their agreed areas of competence. We reviewed personnel files during the onsite visit and found that most necessary recruitment documents were accessible in the staff files. However, not all immunisations records were accessible, and not all staff had completed their mandatory training.The practice acknowledged this feedback and have updated their induction checklist to ensure immunisations are provided and assured us that staff will be given more regular protected learning time to ensure all mandatory training is completed. Staff were happy within their roles and were given opportunities to learn and develop whilst being supported to do so.For example, receptionists were upskilled and had enhanced care navigation training. An urgent care paramedic was supported to do their master’s degree in advanced care. The practice manager was in the process of completing a leadership course. Staff had annual appraisals and staff feedback showed they found them beneficial.

The practice assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns promptly. The practice had a designated infection, prevention and control (IPC) lead who had oversight and staff knew who this was. Staff had completed IPC training relevant to their role. Staff told us they knew their roles and responsibilities around IPC. Cleaning schedules were in place, including the use of different coloured cloths and mops to ensure the premises and equipment were kept clean. IPC policies were in place and IPC audits were completed bi-annually. It was identified that the clinical waste bins outside the building were not secured. The practice acknowledged this feedback and assured us the appropriate action was taken to mitigate this risk.

Staff regularly checked medicine stock levels and expiry dates, including emergency medicines. Some emergency medicines were stored in the drugs cupboard, however following our feedback the practice agreed to store these medicines on the resuscitation trolley alongside the other emergency medicines. Medical gases such as oxygen were stored safely. Fridge temperatures were monitored daily, and staff knew what action to take if the temperature was out of range. We saw evidence of clinical audits to improve patient care. As part of our assessment, our CQC GP specialist advisor carried out remote clinical searches of patient records to evaluate whether clinicians were prescribing a range of medicines safely. The practice made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes were made to their medicines.

Our clinical record searches reviewed the number of patients prescribed ACE inhibitor or Angiotensin II receptor blocker (a medication used primarily to treat high blood pressure and protect kidney function). We identified a total of 1,096 patients prescribed this medication and reviewed a random sample of 5 patient records. We found that 2 out of 5 patients had not had the appropriate blood test monitoring in line with guidance. The practice acknowledged this feedback and contacted both patients to book a blood test. We also reviewed other medicines that require monitoring such as methotrexate and Azathioprine (both immune system suppressant drugs) and found all patients were monitored in line with guidance and were appropriately coded on the system.

We reviewed whether the practice was actioning Medicines and Healthcare Products Regulatory Agency (MHRA) safety alerts. We randomly reviewed 5 patients that were prescribed Mirabegron (a medication used to treat an overactive bladder) and found that all 5 patients had been informed of the risks associated with this medication.

We identified 329 patients that had a medication review in the last 3 months. We reviewed a random sample of 5 patients and found that all 5 patients had their repeat medications reviewed in line with guidance. There was evidence that the prescriber had checked whether the patient was up to date with their monitoring before prescribing the medication.

We reviewed non-steroidal anti-inflammatory drugs (NSAID - used to reduce pain, fever, and inflammation) prescribed to patients over 65 years of age; and antiplatelet drugs (used to inhibit the formation of blood clots) prescribed for patients over 75. We identified 59 patients out of 283 who had not been prescribed Proton Pump Inhibitor (PPI) drugs. We reviewed a random sample of 5 patient records. PPIs are a group of medicines that decrease stomach acid production. National Institute for Care and Health Excellence (NICE) guidance recommends prescribing PPI drugs for elderly patients taking NSAID or antiplatelet drugs to reduce the risk of gastrointestinal bleeding. Of the 5 patient care records reviewed, we found 3 patients that had not been prescribed a PPI. Staff acknowledged our feedback in relation to this issue and have provided us with evidence that these patients have now started a PPI prescription.