Nunwell 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 69 (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. They listened to concerns, reported and investigated them. The practice had processes for staff to report incidents. Themes were identified and lessons were learnt to continually recognise and embed good practice. Managers encouraged staff to raise concerns that were later discussed in meetings. People felt supported to raise concerns and felt staff treated them with compassion and understanding. Learning from complaints resulted in changes that improved patient care. Representatives from the Patient Participation Group (PPG) felt the practice took concerns seriously and improvements were made to the service following feedback from the PPG.

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. Staff understood the referral system and were able to tell us about the process for dealing with referrals, ensuring they were followed up accordingly. Triage systems were in place for staff to follow. The practice had fail-safe systems in place to ensure all cervical cytology results were received from the samples sent.

The practice 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. Staff knew how to identify, report and act when dealing with safeguarding concerns. 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. The practice shared examples of how they identified safeguarding concerns and acted accordingly. Safeguarding policies were in place and known to staff, who were trained in safeguarding procedures. Staff were aware who the safeguarding leads were. The practice had oversight of a list of vulnerable people that was reviewed regularly. Vulnerable people were coded on their system and had alerts added to their records. Safeguarding meetings were held regularly. Staff were chaperone trained to maintain patient privacy during intimate examinations.

The practice worked well with people to understand and manage risks. 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 well maintained. 95%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 is higher than the local average of 93% and national average of 91%.For example, the practice identified newly diagnosed cancer patients and sent a letter acknowledging their diagnosis to offer support and provide links to relevant cancer charities and resources to help manage their diagnosis.

The practice detected and controlled potential risks in the care environment. The practice had procedures to ensure equipment, facilities and technology supported the delivery of safe care. Audits had been undertaken and risks identified had been addressed. The practice shared with us plans to renovate the building to create more clinical rooms. They also intend to resurface the car park after the completion of the building renovation. There was a business continuity plan in place. Portable appliance testing and calibrations were completed. Systems were in place to check safety equipment including fire alarms and fire evacuation drills were completed. During the onsite visit, the premises were visibly clean and tidy. Cleaning schedules were in place to maintain a clean and safe environment.

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. Leaders explained their recruitment processes to ensure appropriate numbers of suitably trained staff were employed to support the delivery of good quality care which met the needs of the patients.There were a range of clinical and non-clinical roles within the practice. Staff were working within their agreed areas of competence. Staff were happy within their roles and were given opportunities to learn and develop whilst being supported to do so. We reviewed personnel files during the onsite visit and found that most of the necessary recruitment documents were accessible in the staff files, except for some interview notes that were provided following the onsite visit. Not all staff had completed their mandatory training, and regular appraisals were not evident. Although the practice informed us of informal clinical supervision where staff could approach their mentors at any time, formal clinical supervision was not evident.

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 a designated infection, prevention and control (IPC) lead and staff were aware of this. Staff had completed appropriate IPC training relevant to their role. Staff told us they 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 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 such as Azathioprine and Leflunomide (both immune system suppressant drugs) and found all patients were monitored in line with guidance and were appropriately coded on the system. However, the shared care agreement could not be found in some of the patient’s files. This document should be in place and readily available.

We identified a total of 8 patients prescribed Lithium (a medication used to treat mood disorders) and found that 2 patients were not monitored appropriately. The practice did not have an effective recall system in place but when this feedback was given to the practice, the practice was already aware and in progress of making the process more robust.

The practice did not always adhere to Medicines and Healthcare Products Regulatory Agency (MHRA) safety alert guidance. Not all patients were aware of the risks when taking certain medications such as Teratogenic medication. The patient notes did not provide enough detail to evidence an appropriate discussion had taken place. The practice acknowledged this feedback and provided us with assurance that the identified patient had been contacted, and an appointment had been made to formally discuss the risks.

A clinical record search identified some patients had a missed diagnosis of diabetes. We reviewed a random sample of 5 patient records and found that 2 patients had not been correctly coded on the system. These 2 patients therefore experienced an unnecessary delay in their treatment choices. The practice acknowledged this feedback and have assured us that these patients have been contacted and now have a treatment plan in place.

We reviewed non-steroidal anti-inflammatory drugs (NSAID - used to reduce pain, fever, and inflammation) prescribed to patients over 65 years of age; and antiplatelet drugs (used to inhibit the formation of blood clots) prescribed for patients over 75 with no Proton Pump Inhibitor (PPI). PPIs are a group of medicines that decrease stomach acid production. National Institute for Care and Health Excellence (NICE) guidance recommends prescribing PPI drugs for elderly patients taking NSAID or antiplatelet drugs to reduce the risk of gastrointestinal bleeding. We reviewed a random sample of 5 patient records and identified 3 patients that were not prescribed Proton Pump Inhibitor (PPI) drugs. Staff acknowledged our feedback and contacted these patients. 2 of these patients were no longer taking NSAID and the remaining patient has now started a PPI prescription.

Staff regularly checked medicine stock levels and expiry dates, including emergency medicines, vaccines and controlled drugs. 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.