Gravel Hill 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 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.

Service users said that feedback was encouraged and they felt supported if they needed to raise concerns. There was clear information available on how to raise a concern displayed within the premises and on the website. Staff had good knowledge of the complaints process, which was open and transparent. The complaints policy was detailed and contained all the relevant information which included timescales, the investigation process and how to escalate the complaint.

Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service, with relevant feedback such as the Friends and Family Test (FFT) results shared at the group meetings.

The leaders encouraged feedback from staff and we saw evidence of a clear, open and proactive approach when a concern was raised. An example was shared which demonstrated a clear open culture to concerns and feedback from staff. The leaders had acted appropriately and promptly, staff felt listened to and safe. There had been clear open conversations with all relevant staff members, who expressed they were able to speak freely, given honest explanations if things couldn’t be changed and actions were prompt and reflected on within the team.

Examples of learning from complaints demonstrated a clear, consistent, non– discriminative approach. Each event was reviewed and clearly demonstrated an active learning approach.

Learning from events, complaints and feedback was proactively shared routinely through various methods such as staff bulletins and meetings. There was evidence that learning and acting on feedback was embedded into the service with significant events part of meeting agendas, with staff expressing there was no fear of repercussions. The results from the Friends and Family Test (FFT) were reviewed and shared weekly amongst the whole team and trends identified, reviewed and actioned promptly.

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.

There were systems in place for processing information relating to new people registering with the service, which included welcome text with the service leaflet and questionnaire. There were options and support available for service users who were unable to complete the forms online. Information gathered was used to make an initial assessment of the persons needs and ensure details were recorded correctly.

The process for recalling service users for routine reviews was clear and well managed. Alternative methods of contact were used as required such as phone contact or letter depending on the service users’ needs. Additional measures had been added for those with long term medical conditions, such as service users who were recorded as asthmatic received a questionnaire with the scoring outcomes identifying those who were most at risk and required additional actions.

Test results were managed well, colour coding was used to identify results and tasks within the system. Test results reviews were completed in a timely and methodical manner, ensuring those requiring urgent action were dealt with promptly.

The service made use of technology to improve pathways, including software for medical reports and online self-booking for influenza vaccination clinics.

Evidence showed good referral levels to other services such as the pharmacy first scheme within community pharmacies and minor eye clinics hosted by community opticians.

There was a system in place to ensure those with a new diagnosis of cancer received contact from a doctor within 6 weeks and supported by the primary care network (PCN) cancer care coordinator, ensuring they had information they required and could ask any questions they may have.

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.

Safeguarding policies were in place and fit for purpose. Staff were knowledgeable and could confidently explain their understanding of safeguarding, processes and their responsibilities. The service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. Information and guidance relating to safeguarding was visible to staff in an appropriate and easy to access way, such as signage with more details held within the digital system.

Additional measures were in place within the premises for service users to alert staff if they required help in a subtle confidential way and staff were able to give good examples of behaviours and situations that may alert them to a safeguarding concern.

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.

Staff showed a good understanding of how to recognise a patient who may need urgent attention and the processes around emergencies, there was clear flow charts to support staff in relation to potential serious symptoms which could indicate a heart attack or sepsis. All staff were trained in basic life support (BLS).

Emergency situations and access to required equipment and medicines had been risk assessed and shared with the staff. The equipment and medicines that may be required in an emergency were securely stored with a system to identify if there had been access to stock, expiry dates and they were clearly labelled for easy identification.

Patients told us that they were given clear advice on what to do if their condition didn’t improve and were able to ask questions about their condition.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety risk assessments and audits were undertaken and any risks identified had been addressed. The risk assessments were well documented with a clear risk level and further actions added if required. The risk assessments were shared amongst the team and health and safety was an agenda item in practice meetings with updates on any concerns, actions or repairs. The risk assessments covered a full range of areas, which also included lone working, and personal safety

There was a well thought out business continuity plan in place, which was easy to follow, considered various scenarios and contained relevant details, guidance and key contact information. The sharing of the plan was also well thought out, with consideration given to various methods of secure access to allow the right people access at the right time. This plan was monitored and reviewed regularly.

The premises were clean and well maintained with knowledgeable staff who ensured this was part of daily routines.

Fire safety was well managed; staff were up to date with training including allocated fire marshal roles. There was evidence of routine checks including carbon monoxide and fire extinguishers, which were observed to comply with test date.

Fire drills were completed with a proactive risk based approach. The drills were completed regularly with clear relevant observations, details of events and actions to be completed such as reminders of checks to be completed.

Relevant safety certificates were seen, such as electrical wiring and fire systems, which were routinely completed, logged, recorded and monitored. All health and safety risks and controls were recorded and monitored within an overarching health and safety assessment for additional reassurance measures and management.

A sample of electrical appliances were reviewed and complied with Portable Appliance Testing (PAT) to ensure they were safe to use and prevent electrical accidents.

Rooms and computers were kept securely to maintain equipment and patient information, as well as secure storage of hazardous items kept under Control of Substances Hazardous to Health Regulations (COSHH), such as cleaning products, which all had clear easy to access safety data sheets.

Oxygen cylinders were stored securely with a risk assessment completed, appropriate warning signage for identifying the location of flammable hazardous materials were not in place. This was brought to the attention of the service providers during the onsite assessment and rectified immediately.

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.

We saw evidence of a knowledgeable team, with structured schedules and time to use for development and knowledge based improvement. The service demonstrated a clear line of responsibility that enabled staff to work confidently within their role supported by others.

Recruitment files were well organised and a sample check identified all relevant processes and checks had been completed to ensure the staff were safe and qualified to do their role.

Supervision occurred in a structured and open way, with set times for one to one sessions as well as access to support as required, in addition to this there were clinical catch ups where patient care could be discussed while arranging the urgent requests for the day.

The service had good relationships with roles provided through the Primary Care Network (PCN) such as Mental Health Practitioners and Health and Wellbeing coaches. These roles were invited to practice meetings, as well as Midlands Partnership Foundation Trust (MPFT) supporting roles, this ensured all roles involved in patient care were informed of information and updates. One of the service leaders was the PCN lead completing appraisals for the additional roles and ensured the roles were integrated into the team.

Training and development were organised, well thought out and discussed openly. Appraisals included individual development plans and wishes that linked into the practice succession planning process. This showed staff were included and developed, as well as safe planning for the future qualifications and recruitment.

Various handbooks had been developed with clear guidance on processes to ensure consistency

The service offered a robust program of clinical supervision to non-GP clinicians, such as advanced nurse practitioners, and completed clinical support for other roles within the primary care network (PCN) such as clinical pharmacist and paramedics. Protected time was allocated daily for debriefing and discussion with an allocated GP supervisor. This allowed for an open-door and real time approach to supervision and clinical guidance.

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 service had a designated infection, prevention and control (IPC) lead, who was supported by another clinical role. All staff had received relevant training and we saw evidence of regular updates, including a hand hygiene audit.

The service had completed their IPC annual statement to review and demonstrate measures in place to reduce infection risk. There was evidence that significant events relating to IPC were reviewed, actioned and learning shared.

Audits relating to IPC were completed monthly and actions were identified, discussed and completed in a timely manner. The audits included a review of cleaning schedules ensuring they were in place and followed, with a visual check of the building observing a clean and well maintained environment. There were risk assessments, and actions taken to mitigate risks.

Clinical waste including sharps were well managed with staff aware of risk and what to do in the event of an injury.

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.
Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.
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, and controlled drugs. These checks were documented and reviewed. Waste medicines were disposed of appropriately.
Staff stored medical gases, such as oxygen, safely. We found that the signage to identify the oxygen cylinders as a potential hazard were not adequate, the service immediately acted upon this and ensure the correct information was in place and visible.
The service used Patient Group Directives (PGDs) for authorising immunisations, staff using them were knowledgeable in the use of them, however we found that some PGDs had been authorised before staff sign off, this didn’t show a clear line of authority to use them. The service acknowledged this and provided reassurance that the authority process would be reviewed and amended so all PGDs were correctly in place.
The service had effective systems to manage and respond to safety alerts and medicine recalls. A clinical search reviewed a sample of records which showed all were up to date, correctly actioned and recorded.