The Old Court House 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 inspection in October 2016 using the old methodology, we rated this key question as good. At this assessment the rating has stayed 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. The staff and leadership listened to concerns about safety, investigated and reported safety events and lessons were learnt to consistently identify and embed good practice. Learning outcomes were discussed at both clinical and administrative meetings with actions for improvement made. Staff informed us that they were encouraged to raise concerns. Lessons learned from complaints and significant events were shared with staff during meetings and minutes were held electronically for staff to have access.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services. Systems were in place for processing information relating to new patients. The service worked with other care providers, including health visitors, community nurses and secondary services to deliver shared care when patients moved between services. Referrals and test results were managed in a timely way.

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, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns, working in partnership with other organisations. Safeguarding concerns were discussed in weekly meetings to ensure all concerns were being managed appropriately.

The service worked with people to understand and manage risks by thinking holistically. They provided care that fully met people’s needs and was safe, supportive and enabled people to do things that mattered to them. Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of actions to take. Patients were advised on risks related to their conditions and actions to take if their condition deteriorated.

The service detected and controlled patient risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Cleaning was undertaken by an external company and appropriate systems of communication were in place. The practice had carried out a health and safety risk assessment and audits. Risks identified had been addressed by the practice and an action plan established, which included the potential need for an upgrade to the fire warning system. There was a business continuity plan which was monitored and reviewed.

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 and met people’s individual needs.

There was a range of clinical and non-clinical roles within 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. Staff recruitment practices were followed.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with the appropriate agencies promptly. The practice had a designated infection, prevention and control lead and all staff had received relevant training. Cleaning was carried out by an external company. Schedules were in place and there were communication channels to discuss areas of concern. 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. They involved people in planning including when changes happen. Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training. Staff managed prescription stationery appropriately and securely. Protocols were followed to ensure staff prescribed all medicines safely and recommended reviews and monitoring was done with patients. Staff regularly checked the stock levels and expiry dates for vaccines and controlled drugs. Emergency medicines were placed in an area accessible to all staff at the practice. Systems were in place to ensure that these were appropriately monitored. At the time of the visit, all emergency medicines were present and in-date.

Staff stored medical gases, such as oxygen, safely and completed the required risk assessments. Systems were in place to manage safety alerts. Staff followed processes to ensure people prescribed medicines with higher risks received recommended monitoring. Steps were taken to ensure staff prescribed medicines appropriately to optimise care outcomes, including antibiotics.

The prescribing data reviewed as part of our assessment showed that the practice prescribed antimicrobials at a level lower than local and national averages, and the prescribing of pregabalin and gabapentin (used for treating long-term conditions such as epilepsy and neuropathic pain) was significantly lower than the local and national averages. However, the prescribing of antibiotics such as Co-amoxiclav, Cephalosporins and Quinolones was above the national average.

Clinical audits of prescribing were conducted which showed the drive to improve care and treatment for the patients.