Archived: Collington 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 requires improvement. At this assessment, the rating has changed.

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 now had a proactive and positive culture of safety. Staff now knew how to raise concerns and told us they were supported to do so. They believed leaders and colleagues were committed to investigating, resolving and learning from incidents. Where improvements were required, information, advice and guidance were shared verbally amongst staff to improve the safety and standards of care.

There were now established and effective formal and informal systems in place to capture concerns and complaints from people, staff, and partner services. Incidents and complaints were investigated in a timely and appropriate manner. Honest and transparent accounts were provided to people and where appropriate lessons learnt and shared to improve the service. An annual audit of significant events was carried out by the practice to identify themes and trends. These were discussed in the service. For example, improvements in the timely and accurate processing of two week wait cancer referrals.

Staff were able to provide us with examples of incidents learnt from. During clinical meetings, the GPs, clinicians and practice manager discussed and learnt from clinical issues. Minutes of these meetings were shared with all staff.

Shared care plans were not in place for all people who required them to assist and support them during transition between services. A shared care plan is a patient-centred health record designed to facilitate communication among members of the care team and assist in the coordination of care.

The service acknowledged this as an area for improvement. Following inspection, the service audited their care records and confirmed care plans were now in place for people.

The service had established systems to encourage and improve listening, engagement and work with people and their partners. For example, they were in the process of strengthening their systems to ensure the timely management and monitoring of referrals, admissions and discharges from services. Patient records correctly detailed prescriptions issued by secondary care.

Staff monitored people’s progress along care pathways, such as cancer referrals, to identify and address barriers to accessing and maintaining care, escalated risks to partnership forums for resolution where appropriate.

The views of people who used their services, partners and staff were listened to and considered.

The service had established and effective systems in place for safeguarding vulnerable adults and children. Records of vulnerable people were regularly revised to ensure information was current and relevant. We saw children had been appropriately followed up when they failed to attend appointments with primary and or secondary care services. This was overseen by an appointed safeguarding lead who contributed to multidisciplinary meetings.

Staff were trained in safeguarding. Staff told us they worked regularly and collaboratively with partner health and social care services to support and meet individual’s needs.

We checked a sample of records for people and found appropriate safeguards had been observed.

There were established and effective processes in place to support the early recognition and timely response to risks. Staff told us they invested in getting to know their patients so they could help understand and support them to manage their health.

People told us they were involved in decisions relating to their care. They were supported to identify and respond to changes in their health and signposted to support services appropriate to their needs.

Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take. People were advised on risks related to their condition and actions to take if their condition deteriorated.

The service assessed all their premises and ensured they were safe. There were now established and effective systems in place to identify, manage and mitigate risks to people. For example, the service had conducted environmental risk assessments (including legionella testing and portable appliance testing) for each site to ensure staff and people were safe. These were revised annually or more frequently in response to changes. Annual fire risk assessments were conducted at each site, and we saw fire safety wardens were on duty and all staff were aware of evacuation procedures and had rehearsed them. Maintenance contracts were in placed to maintain the accuracy of equipment (calibration), scheduled safety checks were conducted on the fire alarm system, emergency lighting and equipment.

Staff told us they had undertaken annual training in health and safety and practice procedures. Staff had been trained in basic and emergency first aid. Staff could alert colleagues to concerns such as verbal or physical abuse via their clinical system.

People had access to chairs with arms in the waiting areas to assist those with limited mobility. There were appropriate child changing facilities with appropriate restraint belt to mitigate the risk of the child falling whilst being changed. Clinical staff used single use items and had access to body fluid spillage kits to mitigate the risk of infection to people.

The service now made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. We found safe recruitment practices were employed when appointing clinical and non-clinical staff, including locum staff. The professional registration status of clinicians was actively monitored to ensure all staff were safe to practise. Staff had undergone Disclosure and Barring checks (a way for employers check your criminal record, to help decide whether you are a suitable person to work for them) or risk assessed. Staff had been appropriately immunised, or risk assessed to mitigate the risks to them and others of infection. Staff had been appropriately immunised, or risk assessed to mitigate the risks to them and others of infection.

Staff worked together well to provide safe care that met people’s individual needs. Staff and leaders understood the recruitment, disciplinary and capability processes and believed they were fair. The management team ensured they were applied appropriately to ensure there was no disadvantage based on any specific protected equality characteristic.

There were a range of clinical and non-clinical roles in 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.

The service had now assessed and managed the risk of infection. The service 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. 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. Our remote clinical searches identified there was now an effective process for reviewing peoples’ health in relation to the use of medicines that required monitoring. The clinical searches also showed that systems for recording and acting on safety alerts had improved. We found people on high-risk medicines were appropriately monitored. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics.

However, improvements were required in the documenting of medicine reviews to support clinical decisions. For example, we reviewed 5 clinical records and found 3 out of five medicine reviews had been coded as complete without a supporting narrative to who people were involved in reviews of their prescribed medicines and helped to understand how to manage their medicines safely.

Blank prescription forms and pads were kept securely, and their use monitored in line with national guidance.

Medicines including controlled drugs were stored securely behind locked shutters and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Waste medicines were recorded and disposed of appropriately including medicines returned by people. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

Staff had the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions).