O'Flynn - Hampton Wick Also known as Hampton Wick 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

SAFE: We looked for evidence that people were protected from abuse and avoidable harm.

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

This service scored 75 (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. For example, the practice had identified an error in the system coding of a potential allergy response to a medicine on its patient records system. It reported the error, which resulted in a national change to the records system, benefitting all GP practices using the same records system.

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, and that safety was a top priority. 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. For example, when children moved to adult services, this was normally dealt with via direct liaison between the services. However, if that process did not take place, the practice facilitated the transfer to ensure continuity of care.

There were systems in place for processing information relating to new patients. Referrals and test results were managed in a timely way. The practice had systems in place to ensure that test results were sent to the correct clinicians.

The practice had taken the decision not to move to a process of digital triage for patients making contact. It had also developed an all-day GP triage system, with a GP speaking to patients who either phoned or attended the practice to determine the need for an appointment. Patients were also able to submit emails for triage of less urgent requests.

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.

At this assessment we found that staff were able to access safeguarding information via the internal computer system. However, there were no quick reference signs in reception, or other rooms to assist staff in making urgent reports and referrals. On raising this with the practice, it took immediate action and ensured reference posters were placed in all relevant areas, for the benefit of staff and patients.

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.

In addition to a range of regular safeguarding meetings involving relevant staff and stakeholder organisations, the children’s safeguarding lead was given protected time, monthly, dedicated to safeguarding updates, concerns and searches. This supported continuity of care and promoted strong working relationships between internal and external teams.

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. There were regular checks to ensure equipment remained functional and that supplies of emergency medicines remained available and in-date.

Staff could recognise a deteriorating patient and knew of action to take. This included staff being trained to identify patients who may have sepsis and how to access urgent help if needed. There were also posters around the practice explaining how to recognise signs of illness and deterioration.

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.

The practice was arranged over 3 floors, with all accessible for patients with disabilities via a lift. There were two waiting rooms, one on the ground floor and the other on the first floor. The ground floor waiting room was visible from the reception area. However, the upstairs waiting room had no similar arrangement. When we discussed this with the practice, it confirmed that clinical staff regularly passed through the upstairs waiting room so were able to identify any issues that might arise.

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 annually.

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.

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. Safe recruitment practices were followed. All staff participated in annual appraisals. There were also informal opportunities to discuss matters with senior staff. All staff we spoke to during this assessment felt confident to raise any concerns or issues with managers across the practice.

During staff interviews we discussed staffing levels. All staff members we spoke to confirmed there were enough staff to cover day-to-day running of the practice. In addition, the practice had provisions in place to ensure there was sufficient staff numbers to cover holidays and periods of sickness.

The practice told us it had not experienced difficulty in recruiting and retaining staff. For example, it was a GP training practice and had recruited GPs from those who had trained with the practice, while a number of others had been employed at other local practices.

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 practice had a designated infection, prevention and control lead and all staff had had relevant training. The infection prevention and control (IPC) lead had recently engaged staff in a practical exercise using ultraviolet (uv) fluorescent gel to reinforce the need for effective hand washing. Staff applied the gel to their hands before washing their hands. Under a uv light any missed cleaning was able to be seen.

Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

At our last inspection we found:

• Some patients being prescribed high risk medicines had not had sufficient monitoring to ensure their safety at the time of the inspection. The practice had acted, both before and after the inspection, to contact and work with non-compliant patients.
• The practice had a system to review safety alerts and was regularly completing searches of its patient list to review patients with relevant medicines to safety alerts. However, this system had failed to ensure patients at certain ages were prescribed safe doses of certain medicines.
• It had completed risk assessments. However, these did not demonstrate that there was a robust and effective system in place to ensure patient safety.

At this assessment:

• We looked at medical records for several patient groups, including those being prescribed medicines requiring regular monitoring. We found that the practice was able to evidence that all patients were receiving treatment and, where necessary, monitoring in line with national guidelines.
• Our review of prescribing in accord with medicine safety alerts found no concerns. The practice had a robust system for reviewing historic safety alerts to ensure prescribing remained in line with guidance.
• Immediately following the last inspection, the practice had implemented a improvements to its procedures for risk assessments. Since then, the practice had introduced a range of regular searches of the patient records system to ensure it complied with updates to medicines guidance.

People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff managed prescription stationery appropriately and securely. Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.