Dr Bouch and Partners Also known as Bridge Road 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.

This key question has been rated as good.

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained, and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Medicines in the service were managed safely. Our clinical search findings for the management of medicines were mostly positive, although arrangements to ensure medicines were used effectively required strengthening. The provider had already recognised this and was taking steps to address this issue.

This service scored 72 (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. Leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice and improve care for others.

Care home representatives were able to raise queries and told us staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) told us leaders took concerns seriously and proactively made improvements to the service.

Managers encouraged staff to raise concerns when things went wrong. There were processes for staff to report incidents, near misses and safety events. Systems were in place to record and investigate these events, identify learning, and make any improvements required. Learning was shared with staff, as appropriate during meetings. Staff gave examples of improvements made following incidents and complaints, that improved care for others.For example, a pop‑up alert prompted prescribers to prescribe certain medicines alongside 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.

People gave positive feedback in relation to the registration process, and timely, appropriate referrals being made.

Protocols were in place to manage the flow of work. People’s correspondence which was deemed urgent, for example urgent blood results, were prioritised. Arrangements were in place to ensure required actions were reviewed and authorised by an appropriate clinician. We reviewed the tasks lists on the clinical system which showed they were managed in a timely way. Audits of the work of non-clinical staff were completed by leaders and issues identified were discussed and learning undertaken.

Referrals and test results were managed in a timely way. Staff who were involved in making referrals were clear about their role and checks were in place to ensure referral requests had been actioned. A range of audits were in place, for example to ensure people had been seen, results received, and follow up arrangements were in place.

The service worked with other services to deliver shared care and when people moved between services. Partner agencies who provided feedback for this assessment gave positive feedback for this area.

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. Staff who we received feedback from told us they were confident to identify and report any concerns.

The service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. Arrangements were in place to follow up vulnerable people who had not attended for their appointment, which included for example, attendance at the accident and emergency department. Monthly safeguarding multidisciplinary (MDT) team meetings were held where people were discussed and reviewed. We found people’s care records were updated as appropriate.

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.

Arrangements were in place for staff to identify, assess and manage people whose health was deteriorating, and for managing medical emergencies. Staff had completed training, relevant to their role and told us they could recognise a person who was deteriorating and knew of action to take. A duty GP was available every day for advice and support as necessary. Emergency medicines and equipment were available for use and checked regularly.

People who provided feedback for this assessment had no specific views or concerns in this area. People were advised on risks related to their condition and actions to take if their condition deteriorated.

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

Arrangements were in place to ensure the premises were maintained. For example, health and safety and fire risk assessments had been undertaken and risks identified had been addressed or were being actioned. There were ongoing checks for example, for legionella and equipment calibration. A range of risk assessments, which included for example disability access and manual handling, had been completed. Staff told us they had suitable and sufficient equipment to undertake their work and were satisfied with the health and safety arrangements in place.

During the site visit, we checked an action identified in the fire risk assessment and found it had been completed. People in the waiting room were visible to staff so they could identify and respond to any people whose health may be deteriorating.

Practice staff used technology securely and effectively and conformed to relevant digital and information security standards with arrangements in place for the confidentiality of data management.

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.

Feedback from people and care home representatives was positive in relation to the knowledge, skill, care and treatment provided by clinical staff.

Practice leaders followed safe recruitment processes in line with their recruitment policy. Appropriate recruitment checks were carried out which included Disclosure and Barring (DBS) checks. The professional registration of clinical staff was checked at recruitment and on an ongoing basis. New staff received an induction.

We found training was up to date and staff worked within their agreed areas of competence. This included for example, staff who were responsible for long term condition reviews, childhood immunisations and cervical screening. The learning needs and development of staff was managed appropriately. For example, the service had supported a practice nurse to become an advanced nurse practitioner. Staff told us they had regular appraisals and a sample of records we reviewed confirmed this.

Arrangements were in place for the clinical oversight of staff working in extended roles, which included those who prescribed medicines. A home visit GP was available to discuss pre and post visit support for clinicians undertaking these within their area of competency. A duty GP was also available for clinical advice and support. Staff who worked in extended roles advised they were easily able to obtain clinical advice from a senior clinician. Clinicians received regular supervision and review of their practise, and protected time for case discussions. The provider strengthened their oversight process and introduced a regular audit of a sample of clinical work undertaken by clinicians in extended roles. This had been completed retrospectively for 2 clinicians and areas for learning had been discussed with the clinicians involved, as appropriate.

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.

People we received feedback from gave positive feedback about the cleanliness of the service.

The service had a designated infection prevention and control (IPC) lead and staff had completed training relevant to their role. Audits were completed, and actions taken to mitigate risks. Staff told us about the systems in place for example, safely dealing with clinical specimens.

During our on-site visit, we found the service to be clean and tidy. We checked a sample of actions from the latest IPC audit and reasonable improvements had been made, considering the potential relocation of premises. Cleaning schedules were in place and followed. Effective arrangements were in place to communicate with the external cleaning company and resolve any issues. Appropriate arrangements were in place to manage clinical waste.

We reviewed a sample of staff immunisation records and found the service held the relevant information relating to the immunisation status of staff.

Our clinical search findings for the management of medicines were mostly positive, although arrangements to ensure medicines were used effectively required strengthening. Staff involved people in planning, including when changes happened.

We completed 1 remote clinical search which reviewed medicines usage, of a medicine for nerve pain, which can cause dependence. Our clinical search identified 162 people who may need to be reviewed. The provider had already recognised this and was taking steps to address this issue. Following the site visit, the service submitted an action plan, had secured additional clinical pharmacist resource, without impacting on existing clinics, and 46 people had a medication review booked. The service’s prescribing data for pregabalin or gabapentin was in line with the England average.

Our clinical searches showed that people received the correct monitoring when prescribed medicines which required additional monitoring. For 1 of the searches, the service had identified people who required review and continued work to encourage people to attend. We reviewed the quality of medicines reviews and sampled 5 people’s records from people who had a medication review in the last 3 months. We were satisfied with the quality of these medicine reviews.

The service had effective systems to manage and respond to safety alerts and medicine recalls. Our clinical searches showed safety alerts had been actioned appropriately. For example, informing people prescribed certain diabetes medicines about important signs and symptoms of side effects and when it would be necessary to seek medical advice. Following our clinical searches, the service reviewed people’s records and added a code to record that this advice had been given, so future searches would be more accurate.

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. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

We received feedback from care home representatives who told us the repeat ordering process generally worked well, and staff answered and dealt with any queries effectively. People’s medicines were reviewed and there was appropriate liaison with other services. Most people told us they were involved in regular reviews of their medicines and received good advice and quick responses to any medicine and prescription queries.

During our on-site visit we observed arrangements were in place to manage medicines safely.Staff regularly checked the stock levels and expiry dates of vaccines. Medicines that required cold storage were being appropriately kept within temperature monitored fridges. Controlled drugs were held on site; however, following the site visit, the provider submitted a risk assessment advising they were no longer going to hold controlled drugs and had arranged for their safe destruction. Prescription stationery was managed appropriately. Patient Group Directions (PGDs) were in place to allow nurses to give vaccinations without a prescription, and these had been appropriately authorised for use within the service.