Front Street Surgery Also known as Drs Orr, Green, Pal & Nellist

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 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 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.

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 clinical meetings and daily huddles, the team discussed and learnt from clinical issues. Staff felt there was an open culture, and that safety was a top priority. All staff we spoke to knew how to raise concerns. 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.

There were systems in place for processing information relating to new patients. The service worked with other providers to deliver shared care and when patients moved between services. Referrals and test results were managed in a timely way. Staff were knowledgeable about their roles and the systems in place to manage tasks relating to patient care. Systems were in place to monitor task lists and to manage and redistribute tasks in the case of staff absence.

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 known to staff. These included the relevant agency contact details. Staff were appropriately trained in safeguarding procedures. The practice had lead clinicians in safeguarding for adults and children which were known to staff. There was also a secretary who worked part of the week as a non-clinical safeguarding coordinator, to support the clinical team. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. Chaperones were available and clinical and non-clinical staff had received training in this area.

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. Staff could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Emergency protocols and flow charts were displayed throughout the practice which supported clinical and non-clinical staff to recognise signs of sepsis, for example.

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

Contracts were in place to ensure the premises were maintained. 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. Equipment had been calibrated and tested for electrical safety. Staff had been trained in fire safety and there were nominated fire wardens.

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 mostly 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. We found that the clinical oversight and competence assurance of the nurse practitioners, by the GP partners was robust and effectively supported them to deliver high standards of care and treatment. Delivery of some roles was supported by the primary care network.

The service thoroughly assessed and managed the risk of infection. They always quickly detected and controlled the risk of it spreading and always shared concerns with appropriate agencies promptly.

The practice had a designated infection, prevention and control (IPC) lead and all staff had had relevant training. The IPC lead held people to account where the standards were not being met. They were proactive in their role and had successfully improved standards across the practice. For example, QR codes were in situ around the clinical rooms so that all staff could access the uploading of checks. Once a QR code had been scanned, the information pertaining to IPC was immediately uploaded to the practice’s workflow platform. This ensured that was effective oversight of the checks. The IPC lead had shifted the culture through their approach to ensure that IPC was everyone’s business within the team. We saw staff in all departments wiping down high traffic areas and taking ownership of the cleanliness. There was a dedicated isolation room which was fit for purpose. Cleaning schedules were in place and followed, and the IPC lead had collaborated effectively with the cleaning team to raise standards. Risk assessments and audits were completed, and actions taken to mitigate risks. The practice had invested in new fixtures and fittings to optimise the standards set out by the IPC lead. There was a positive and proactive culture towards infection prevention control from the whole team.

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 including controlled drugs were stored securely 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 patients. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was lower than local and national averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. The arrangements for managing Patient Group Directions and Patient Specific Directions (a process for safely prescribing vaccinations) were safe and robust.