The Village 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. The rating remains good following this assessment.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Processes were in place for staff to report incidents and near misses. Leaders told us how they encouraged staff to raise concerns when things went wrong. We noted that only 4 significant events had been reported in the last 12 months which may indicate that the provider needs to review their reporting systems to ensure they are effectively capturing all incidents. We reviewed 1 significant event record and found that it did not clearly indicate the reason why learning had been identified. It did not indicate a clear action plan to make the improvements or provide assurance that action had been taken. The provider advised CQC of the actions taken but not all significant information for any temporary clinicians to be aware of had been recorded. The provider told us how they would address this following the assessment.

Staff feedback indicated that they knew how to report a safety incident, that they would be supported to do so and that the provider would take appropriate action.

There was a process for learning from complaints and sharing any actions needed across the staff team. Staff were knowledgeable about the complaint process and how to support patients to make a complaint.

The provider worked with people who used the service and healthcare partners to establish and maintain safe systems of care. There were processes to share information with staff and other agencies to enable them to deliver safe care and treatment. The clinicians told us there was regular information sharing with external health and social care professionals. Formal multi-disciplinary meetings had not taken place regularly over the last 12 months however, this had been identified and a plan put in place to address this. Feedback from people who used the service indicated they felt involved in decisions about their care and treatment. Members of the staff team were aware of local services and support networks that they could refer patients to in order to support them with their needs and to prevent ill health. Clinicians followed care and treatment pathways for treating and referring patients to other services. Referrals to secondary or specialist care were made promptly, and patients referred under the two-week wait rule for suspected cancer were followed up appropriately.

The service safeguarded people from the risk of abuse. There were systems and processes to respond when it was suspected that people may be subject to abuse or neglect. Staff had been provided with safeguarding training, and they had a clear understanding of safeguarding and how to take appropriate action to respond to concerns. Alerts were added to the patient record system when there were safeguarding concerns about a patient so that all relevant members of the staff team could easily identify this. The service worked with partner agencies to share information to safeguard people.

The service worked with people to understand and manage risks. A system was in place to respond to medical emergencies. Staff had received training in basic life support, and a training update was imminent. The reception team and 1 clinical member of staff had not received specific training on spotting the signs of sepsis. All staff had access to guidance on identifying sepsis.

Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Patients were directed to the most appropriate clinician or service to meet their needs and this included supporting people that may need urgent care and treatment. Staff were trained in the management of long-term health conditions such as diabetes and chronic obstructive pulmonary disease (COPD) in line with their role. A system was in place to recall people for regular checks on their health when they had a long-term condition. People who used the service were referred to services that could provide them with specialist advice to manage their condition and the risk of deterioration.

The provider had systems in place to identify and manage potential risks in the environment. They made sure equipment, facilities and technology supported the delivery of safe care. Regular checks were carried out on the premises, facilities and equipment provided. Contracts were in place to ensure the premises were well maintained. Health and safety related assessments and procedures to manage health and safety were in place. Staff had been provided with training in health and safety related topics such as fire safety and infection prevention and control (IPC). There was a business continuity plan in place to provide guidance for dealing with a major disruption to the service, for example an IT failure. Staff reported satisfaction with the work environment.

Staff received support and opportunities to develop. All new staff underwent an induction programme and were required to undertake mandatory training within an appropriate timescale. We noted that although new clinical staff had a role specific induction this was not recorded. There was a system to monitor staff training to ensure mandatory updates were completed. This did not record the date of the training. A new system had recently been introduced to address this. Staff were supported to develop their skills and learning. There were systems in place to ensure that staffing levels met the needs of the service. There were vacancies for reception staff following recent staff changes, which the provider was addressing. Staff told us that they felt there were enough staff to provide safe care, and they worked effectively as a team. The provider made sure that staff were suitable for employment. We looked at the recruitment records for a sample of staff. These showed recruitment practices were carried out in line with legal requirements. A record of staff immunisations was in the process of being collated for all relevant staff.

The facilities and premises were appropriate to support cleaning and IPC management. On the day of our visit the premises were clean and uncluttered. Procedures were in place to prevent the risk of infection. Staff had been provided with training in IPC and they were aware of their roles and responsibilities in this. Personal protective equipment was in sufficient supply and located appropriately around the premises. Cleaning schedules were in place and infection prevention control and cleaning audits were carried out. A recent hand hygiene audit had not been carried out but this was planned.

Cleaning equipment was stored securely. The arrangements for managing waste and clinical specimens kept people safe.

We reviewed clinical records for patients who had been prescribed medicines which required routine monitoring. Our review showed that overall, medicines were managed safely and the approach to medicines reflected current and relevant best practice. The provider followed up people who did not attend for the routine monitoring that was needed prior to prescribing medication. However, they should review their processes for continuing to prescribe medication when people are not consistently taking-up monitoring. We also identified that the day on which 1 medication should be taken was not clearly indicated. The provider told us how they were addressing this.

A higher number of medicines that were high risk were prescribed compared to the national average such as opioid and non-opioid analgesics (used for long-term disabling conditions and anxiety). The provider was aware of this and told us how they were working to reduce this prescribing through auditing and quality improvement projects.

Blank prescriptions were securely managed. Vaccines were appropriately authorised, and safety checks were carried out. Some improvements were needed to the management of emergency medicines that were addressed following the assessment.

The provider told us how they reviewed the prescribing practices of non-medical prescribers. A formal process to demonstrate their competence was not in place as this oversight was not recorded as part of the supervisory process.