The Brooke 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 strong proactive and positive culture of safety, based on openness and complete honesty. There was joint ownership and leaders actively listened to concerns about safety and thoroughly investigated and reported safety events. Leaders had a clear understanding of the duty of candour and its importance within a transparent safety culture. Lessons were always learnt to continually identify and embed good practice. Learning outcomes were shared wider with the Primary Care Network (PCN) ensuring anonymity of individual people.

People and staff felt supported and told us they are actively encouraged to always raise concerns and to bring new ideas and new ways of working to the attention of managers. People told us that they felt staff treated them with compassion and understanding.

During staff meetings, the whole team discussed and learnt from clinical and non-clinical issues. Learning outcomes were shared with all relevant staff following discussion to ensure those that could not attend due to other commitments did not miss out on important learning. The managers individually tagged staff in the meetings notes so that staff that were unable to attend meetings could go straight to the part of the meeting notes that was relevant for them to read.

Staff told us 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 had a duty of candour lead and held a robust policy in this which was followed. From the sample of investigations and complaints we saw they were well documented and included detailed learning and where changes were required, how these would be implemented and monitored. For example, a potential misdiagnosis; this was fully investigated, audits were undertaken to review potential risks to other patients, learning recorded with learning and outcomes shared in clinical meetings, including reference to ‘Jess’s Rule’. Jess’s Rule is a primary care initiative to encourage GPs to rethink an initial diagnosis if a patient presents with the same symptoms or concerns. In another example, we noted outcomes included additional safety netting was implemented and on-going audits carried out to ensure changes were effective.

The provider used an IT system that allowed communication channels that could be monitored by all clinicians including GP’s, paramedics and pharmacists. This allowed for peer support for all clinicians and for any other members of the team to ask questions or to highlight their concerns which allowed for quick responses and to allow patients to get the correct level of care immediately. This worked effectively when patients were being triaged and the non-clinical staff had concerns. This reduced errors and allowed for an open culture to be developed.

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.

All appointment requests were processed via an electronic triage tool. This reduced the risk of different service users receiving different outcomes when presenting with the same issue or concern.

During community events, like the Point of Care Testing and Diagnosis bus, the provider ensured that all staff had access to laptops that required smartcard access. This ensured that patient details and health records remained confidential and secure and were able to update immediately on to the patient record. The point of care bus was an initiative run and fully funded by the practice and gave patients easy access to have bloods taken, blood pressure checks performed and started on any treatments as needed.

The service worked closely with people and healthcare partners to fully understand what safety meant to them and how best to achieve it. They maintained a clear focus on improving people’s lives while protecting their right to live safely, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. Staff shared concerns quickly and through appropriate channels.

The practice had implemented robust safeguarding policies and standard operating procedures that staff understood well, which included a domestic abuse policy. It ensured all staff received appropriate safeguarding training. For high-risk and vulnerable groups, including Looked-After Children (LAC) and families on child protection registers, the practice appointed a dedicated Safeguarding Administrative Lead. This individual carried out manual cross-referencing searches to ensure no vulnerable individuals were missed. The Lead Nurse coordinated directly with Health Visitors and Social Workers to maintain oversight and ensure vulnerable children did not fall through gaps in care.

The practice strengthened its safeguarding approach through innovative risk identification processes. It automatically classified patients with active safeguarding flags as clinical red flags. Staff bypassed standard administrative processes and immediately escalated these cases verbally to the On-Call Clinical Team to ensure a prompt clinical response. This way of working is shared wider with the Primary Care Network (PCN) so that other practices can work in the same way to ensure that they are also keeping people safe.

There was a proactive commitment by all staff to take immediate action to keep people safe from abuse and neglect. The service had built strong relationships with partners and developed clear processes to work together across services. All staff understood these processes and told us they felt confident in raising concerns should they need to.

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. There was a wall partially blocking the view from the reception area to the waiting room. Staff were witnessed to be walking through this area at regular times during busy periods to ensure they could see all patients and identify quickly any deteriorating patients.

Patients were advised on risks related to their condition and actions to take if their condition deteriorated or did not improve. If patients attended the surgery or made a request to see a GP was made on the telephone patients were advised what to do should their condition deteriorate whilst waiting for their appointment.

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.

There was a business continuity plan in place which was monitored and reviewed.

Equipment checks and calibrations had been completed and there were records to show that these had been completed periodically.

All non-clinical areas were clean, tidy and free from clutter. The waiting room was warm, appropriately furnished and seating was in good repair with wipeable surfaces.

The clinical rooms were clean. Handwashing facilities were appropriate with Personal Protective Equipment (PPE), hand towels and liquid soaps available for use. The privacy curtains were routinely checked by the provider and in good repair.

Fire extinguishers had undergone sufficient checks. There was signage around the building telling people where to go and what to do in the event of a fire. There were fire doors in the building which had the correct signage on.

The service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and development opportunities. 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 up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. The provider regularly audited roles to ensure people were working within their competencies and these audits were used to support 1:1 and appraisals. Safe recruitment practices were comprehensive and rigorous to ensure that all staff are suitably qualified, experienced and competent to deliver high-quality care and the provider followed their own recruitment policy. Staff had requested additional capacity within the reception team to meet demand. The Management Team were in the process of recruiting a Receptionist Manager in response.

The rotas were well managed and staffing levels and skill mix were consistently reviewed to ensure they were safe and enabled proactive, personalised care. There were additional roles in the form of Clinical Assistants and GP Assistants that were able to support the clinical teams. There was at least 1 clinical lead available during practice opening hours to support staff both clinical and non-clinical where clinical decisions needed escalating or where patient queries required clinical input.

Senior clinicians held 2 debrief slots each day for clinical assistants and reviewed a range of patient examinations. They took themes into clinical meeting, to share learning. 

The provider employed Patient Care Specialists (PCS) that had specific roles within the surgery. This included Digital Lead, Complaints Lead, Prescriptions Lead, Quality and Outcomes Frameworks (QOF) Leads, Safeguarding Lead and Phlebotomy Lead. This allowed staff to focus on specific areas which improved outcomes for patients.

The service also employed paramedics and pharmacists which helped to boost the clinical capacity and allow for more clinic availability where it deemed not appropriate for a GP at triage. Employing pharmacists and paramedics was central to the staffing model of the provider and allowed more appointments to be available for patients where it might not always be necessary for them to see a GP. This allowed GPs to be available to see the more complex cases. The pharmacists were able to focus on patients with long term conditions that also required regular monitoring due to the medication they were taking to have reviews completed within appropriate timeframes.

The pharmacist also took responsibility for clinical audits and innovation, and improvements work alongside the lead GP. The pharmacist undertook rigorous checks of patient records and ensured people that required monitoring due to medications were recalled appropriately.

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 practice had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits, including handwashing audits were completed, and actions taken to mitigate risks.

Liquid soap and hand towels were available in the public and staff toilets and in all the clinical rooms that were checked. The curtains in rooms were all clean and in a good state of repair. The sharps bins were managed in line with guidance. Clinical waste was stored appropriately.

All equipment we saw being used was clean and appropriate for use. We witnessed clinical staff were bare below the elbow whilst on duty which promoted effective hand hygiene.

The service always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences and there were comprehensive processes in place to promote safe optimisation of medicines. They always 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 and there was a cold chain protocol in place for when vaccines were to be given outside of the practice and staff used a portable fridge. Staff regularly checked the stock levels and expiry dates for all medicines, and vaccines. 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 or very similar than local and national averages. There was a robust programme of clinical audits of prescribing that focused on improving care and treatment.

The practice contributed to innovative research on medicines and treatments and had been shortlisted for a national award and had successfully reduced the number of patients being prescribed ‘Z’ drugs from 116 to 25 patients which is approximately 78%. The practice continued to prescribe ‘Z’ drugs to patients within secondary care, and those receiving end of life care. ‘Z’ drugs are medications which have a high rate of dependency and are a class of sedative-hypnotic medications primarily prescribed for insomnia. The service promoted long term non-drug sleep advice in the form of online videos published to the practice online channel. This was designed to help improve patients' wellbeing without the need for long term dependency on drugs.

The provider had contacted all patients that had been identified as being on drugs that had the potential to cause harm when used long term. Discussions had been recorded in patients notes to say these conversations had taken place with decisions being made in partnership with people as to whether to remain on these drugs or not.