Roundwood 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

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same. This meant safety was a priority, and people were protected from abuse and avoidable harm. We found safety was a top priority, and staff took all concerns seriously.

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. People were supported and encouraged to raise concerns when things went wrong, and staff treated them with compassion and understanding. Incidents were discussed and learning disseminated through staff meetings. Staff felt there was an open culture, and that safety was a top priority. 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. Staff informed us that they were aware of their duty of candour to inform people when things went wrong, and we saw evidence in letters to people to reinforce this. Learning from incidents and complaints resulted in changes that improved care for others.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. People felt supported and that clinicians acted in their best interest to keep them safe. The service shared concerns quickly and appropriately. Clinicians we spoke with were aware of safeguarding and the systems and processes to report concerns to keep people safe. Staff were appropriately trained in safeguarding procedures. The service maintained a list of vulnerable people and acted on concerns by working in partnership with other organisations. Multidisciplinary team meetings were used to raise awareness of potentially vulnerable groups of people. There were systems in place to follow up people who failed to attend important appointments in primary and secondary care or were frequent attenders to the emergency department, (for example, childhood immunisations or appointment to see a hospital consultant).

The service worked with people to understand and manage risks. The practice had engaged with people to obtain their views on access to a health care professional. Results showed that people were satisfied with access. National GP Patient Survey data and feedback received from people reflected that 66% of people responded positively to the overall experience of contact with their GP practice with the national average being 67%. Care was provided to meet people’s needs and there were systems and processes to identify and manage emerging risks of people and regular liaison with other health care professionals to highlight the risk, e.g. with the community nursing team, palliative care team and referral to hospital consultants. Systems were in place for checking and monitoring emergency equipment and medicines. The practice kept recommended emergency medicines and equipment, including oxygen, and defibrillator at both the main and branch site. All staff had been trained in basic life support. Staff could recognise a deteriorating person and knew the action to take. People were advised on risks related to their condition and the actions to take if their condition deteriorated.

The partners owned both the premises and were responsible for all risk assessments, cleaning arrangements and maintenance of their buildings. We saw that the practice had effective systems to monitor and comply with mandatory risk assessments, including fire safety and legionella testing to ensure that people and staff remained safe. Records showed fire alarms were routinely tested, and the practice had appointed their own fire marshals to direct patients and staff in the event of a fire. Staff completed fire training and attended regular fire drills which included the evacuation of the public. Electrical equipment had been calibrated and tested. Safety alerts relating to equipment were shared with the relevant staff and acted on. We observed that the practice was accessible for all people and included space for wheelchairs and prams.

The service made sure there were enough qualified, skilled, and experienced staff, who received effective support, supervision, and development. Staff received appropriate training and told us they were supported to progress within the team. The service had access to additional staff employed through their primary care network (PCN), which included, a physiotherapist, pharmacist, pharmacy technician, social prescriber, dietitian, mental health occupational therapist, mental health practitioner, health and wellbeing coach, housebound practice nurse, learning disability nurse and PSA nurse.They worked together well to provide safe care that met people’s individual needs. The service was building resilience in the staff team through training staff to be able to work in a range of roles. We saw evidence of staff team members being trained to scan and summarise incoming patient data in readiness for a colleague’s retirement. Safe recruitment processes were in line with regulations and were stored securely.

The service assessed and managed the risk of infection. They detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly. There were systems in place to assess and manage the risk of infection. Infection, Prevention and Control (IPC) audits had been completed. There was a designated (IPC) lead who had a good oversight of their IPC responsibilities. Staff were aware of who the IPC lead was. Staff had received relevant training in IPC. Risk assessments and audits were completed, and action plans were in place to mitigate potential risks. Clinical waste procedures were in place. Staff had a complete record of staff eligible for immunisations, in line with national guidance. People told us that they thought the practice was clean and tidy.

Clinicians 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 from their medicines. Systems were in place to manage and respond to Medicines and Healthcare Products Regulatory Agency (MHRA) alerts. Systems for managing the prescribing of medicines and treatment of other medicines were safe and met people’s needs. Protocols effectively supported the safe prescribing of medicines and staff involved people in reviews of their medicines. Medicines were prescribed appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. We reviewed the records of three people who were prescribed methotrexate (a medicine for treating conditions such as arthritis). We found one person did not have the prescribed day of the week the medication should be taken recorded on their prescription. This contravened a recent MHRA safety alert, and the practice agreed they would take immediate action to record this information in medical records. We also noted that one person had not had a recent methotrexate monitoring blood test. Further investigation evidenced that the practice had attempted to contact the person on several occasions by using different communication routes unsuccessfully. Also, we found that prescribing of pre-emptive steroid medication for people with asthma in case the condition worsened, was robust, however, it was not always recorded in the medical record that the patient was well at the point of prescribing the pre-emptive medication. The practice agreed they would take immediate action, to ensure that the information was recorded within the medical record as part of the routine asthma review as this was best practice. Systems were in place for checking the stock levels and expiry dates of all medicines, including emergency medicines and vaccines. Medical gases, such as oxygen, were stored securely and safely and they had completed required safety risk assessments. Prescription stationery was stored securely and tracked throughout the practice utilising a robust process which all staff were aware of. Prescriptions in printer drawers were locked during the day and emptied at the end of the working day and stored securely overnight.