Stanmore House Surgery Also known as Dr Cockrell and Partners

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 people were protected from abuse and avoidable harm. At our last assessment, we rated this key question as outstanding. At this assessment, the rating has changed to good. People were safe and protected from avoidable harm.

This service scored 78 (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. Staff followed their processes and listened to concerns, reported and investigated them. Managers encouraged staff to raise concerns, establishing a non-blame culture. Incidents and complaints were discussed in weekly meetings. Compliments were also shared amongst staff. Weekly team meetings gave staff an opportunity to discuss learning from incidents and complaints. This ensured lessons were learnt and became embedded in good practice. Patients felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the patient participation group (PPG) also felt the practice listened to their feedback and took appropriate action to make improvements to the service.

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. There were arrangements to ensure a safe and timely review of test results. Staff understood the referral system and were able to tell us about the process for dealing with referrals, ensuring they were followed up accordingly.

The practice worked well 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 very robust processes in place. Leaders felt that safeguarding their patients was instrumental in everything they did. The practice had both a clinical and non-clinical safeguarding lead in place. They acknowledged that every staff member had a responsibility to safeguard patients. Staff knew how to identify, report and act when dealing with safeguarding concerns. The practice encouraged the detection of low-level safeguarding concerns to try to mitigate the concern escalating. The safeguarding lead gave many examples that showcased their exceptional work in safeguarding patients. For example, a receptionist noticed the behaviour of a patient changed when in the company of their parent so flagged this with both safeguarding leads. The receptionist also noticed this patient had not submitted their online consultation form, so they followed up this conversation with the patient and assisted them with the form and booked an appointment. Without this attention to detail, this concern could have escalated. The practice also reviewed children who had attended or failed to attend AE or minor injuries. They worked well with other healthcare professionals to ensure the concerns were addressed appropriately. An effective system was in place for the management, oversight and reviewing of safeguarding concerns. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. Staff received annual safeguarding training alongside in-house updates. The practice held a vulnerable patient register that was regularly reviewed to ensure an accurate reflection. Systems were in place so staff were kept up to date with who may be vulnerable to harm. Monthly safeguarding meetings were held, and safeguarding was discussed on a weekly basis during the partner meetings with key information shared across both clinical and non-clinical teams. This has helped to strengthen awareness and increase reporting. Chaperones were available upon request. The practice contacted local schools to provide a two-way conversation to share appropriate information, and they engaged with child protection information systems to identify whether a child had ever had an interaction with anything safeguarding related within Worcestershire.

The practice worked well with people to understand and manage risks using a holistic approach. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. 91%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 in line with national average. Staff demonstrated a strong ability to recognise when a person’s health was deteriorating and were confident in the steps required to respond appropriately. This was reinforced by the GP partner led triage model. All patient requests were reviewed by a senior clinician at the first point of contact, allowing early, more timely decision-making and ensured patients received the appropriate care.Patients routinely received clear, timely information about the risks associated with their condition and were supported to understand what steps to take should their health deteriorate. Emergency equipment was readily available and well maintained.

The practice completed health and safety audits to identify and control potential risks in the environment. The practice had procedures in place to ensure equipment, facilities and technology supported the delivery of safe care. There was a business continuity plan in place that was regularly reviewed. Portable appliance testing and calibrations were completed. Systems were in place to check safety equipment including fire alarms and emergency lighting. Staff had completed face to face fire training. Fire evacuation drills had been completed. During the onsite visit, the premises were visibly clean and tidy. Cleaning schedules were in place to maintain a clean and safe environment. Patient feedback we received from our ‘Give Feedback on Care’ process showed that patients highly commended the practice for always being clean and welcoming.

The 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. Recruitment processes were in place to ensure appropriate numbers of suitably trained staff were employed.We reviewed personnel files and found the necessary recruitment documents were in place, except photograph identification and immunisation records for some staff files. This was swiftly rectified by the practice manager who provided assurance that processes were in place to prevent this from happening again. There were a range of clinical and non-clinical roles within the practice. Staff were working within their agreed areas of competence. We saw evidence of staff appraisals. Staff were given opportunities to learn and develop if this was of interest to them and were supported to do so. Staff feedback reflected they were happy within their roles and felt supported by their colleagues. The practice gave protected learning time to ensure staff were up to date with their mandatory training. Clinical supervision was evident and prescribing audits were completed regularly for non-medical prescribers to ensure safe prescribing.

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 appointed a designated infection prevention and control lead; staff knew who this was. Staff had completed appropriate IPC training relevant to their role. Staff knew their roles and responsibilities around IPC. IPC policies and cleaning schedules were in place and followed to ensure the premises and equipment were kept clean. Clinical waste was collected on a weekly basis. Clinical rooms had adequate provision of personal protective equipment (PPE) and handwashing facilities. IPC audits were completed, and actions were taken when necessary to mitigate any risks.

As part of our assessment, a series of patient clinical record searches were carried out by a CQC GP specialist advisor. This assessed whether clinicians were prescribing a range of medicines safely and whether they reviewed patients on medicines that required monitoring.

Our clinical record searches reviewed medicines that require monitoring. We reviewed patients prescribed Azathioprine (an immune system suppressant drug). All patients identified were monitored in line with guidance and were appropriately coded on the system. We also reviewed patients prescribed direct oral coagulant (DOAC) medicine used to prevent blood clots. We identified 365 patients prescribed DOAC. 1 of these patients had not received the appropriate blood test monitoring. We saw evidence of the practice contacting this patient, but the patient did not respond. In response to our feedback, the practice updated their policy to reduce the duration of the prescription for those that do not engage for their review. Following this change, the practice provided assurances that a blood test appointment had been booked.

There was a process in place for recording and sharing Medicines and Healthcare Products Regulatory Agency (MHRA) safety alerts. Safety alerts were discussed in weekly clinical meetings. Our clinical record review highlighted that safety alerts were actioned in line with guidance. We identified that all patients prescribed Mirabegron (a medication used to treat an overactive bladder) had been informed of the associated risks.

Our clinical record search identified 5 patients potentially at risk of having a missed diagnosis of diabetes. We reviewed these records and found that all 5 patients did not have diabetes.

We identified a total of 3,071 medication reviews that had been completed for patients in last 3 months. We reviewed a random sample of 5 medication reviews and found that all these reviews were completed appropriately with considerate detail in the patient record.

The practice adhered to an antibiotic stewardship policy that measures the appropriate use of antibiotics and optimises the use of antibiotics to improve patient outcomes.

The practice employed a medicines co-ordinator that monitored medicine usage, reduced medicine waste, liaised with local pharmacies and monitored the flow of prescriptions in and out of the surgery.

Staff regularly checked medicine stock levels and expiry dates, including emergency medicines and vaccines. 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. Staff managed prescription stationery appropriately and securely.