Fell Cottage 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 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. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong. For example, changes were made to appointment types at different times of the day to improve access. During staff meetings, the whole team discussed and learnt from issues.

Staff told us of an open and honest working environment, where leadership provided guidance and encouraged open communication. They felt confident raising concerns, knowing their feedback was valued and acted upon, with safety remaining a key priority. The records we looked at showed teams were reviewing and learning from incidents.

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. Learning from incidents and complaints resulted in changes that improved care for 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.

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 for example adult’s referrals to secondary care or community services. Referrals and test results were managed in a timely way.

The practice ensured effective management and oversight of triage by having a duty doctor available each day to handle urgent patient issues throughout surgery opening hours.

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. Staff were able to tell us who the safeguarding lead and deputy were in the practice and how to raise concerns. Who were appropriately trained in safeguarding procedures. They told us they received training in both safeguarding adults and children and had a clear understanding of their safeguarding responsibilities for reporting concerns.

The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

The practice had a chaperone policy in place, ensuring that chaperones were available to provide comfort and to help mitigate risk for both patients and staff. We saw staff who required a Disclosure and Barring Service (DBS) check had one recorded, including those acting as a chaperone.

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. However, the emergency bag did not have a tamperproof device to provide assurance it remained intact following checks.

Staff could recognise a deteriorating patient and knew of action to take. Staff received annual training in cardiopulmonary resuscitation (CPR), basic life support, and management of anaphylaxis. We saw examples of where appropriate action was taken by staff without delay.

Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Staff met with patients, their families and carers to discuss their care and treatment. Staff would use alternative methods of communication where needed and had access to interpreters.

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. Staff told us they had a regular team who they called upon to address any environmental issues or carry out necessary repairs.

Clinic rooms were all on the ground floor and were fitted with appropriate flooring and equipment. The premises was undergoing major renovations at the time of our visit. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed.

Appropriate emergency equipment and medicines were neatly stored and easily accessible to staff. However, there was no written risk assessment as to what medicines were required to be available on site in the event of a medical emergency. In speaking with staff, there was a clear rationale around the medication held which had been previously discussed. This risk assessment was put into place immediately following our visit.

There was a business continuity plan in place which was monitored and reviewed annually or sooner as changes occurred.

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.

There were a range of clinical and non-clinical roles within the practice. We found training was up to date, and staff were working within their agreed areas of competence. However, the electronic training management system had recently been changed, and we identified some inconsistencies in the type and frequency of training recorded for a small number of staff. The practice was made aware of this and advised that these would be incorporated into their current review, with checks undertaken to ensure no further anomalies exist.

Safe recruitment practices were adhered to. However, it was noted that oversight of administrative staff immunisations had not been in place. This was rectified immediately, with immunisation records requested and collated for all administrative staff

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 were completed, including hand hygiene, infection prevention control, cold chain and medical equipment audits. Staff took appropriate action to identify and mitigate risks and were aware of who the infection control lead was.

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 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.

We carried out clinical searches as part of the assessment and found that the practice had effective systems to identify and manage potential risks related to medicines. A small number of issues were identified.

There were 302 patients overall with hypothyroidism. Of these, 23 patients (7.6%) had not had thyroid function test monitoring for at least 18 months. Of the 5 patients we looked at, 4 were overdue monitoring and a medication review. Although patients had been contacted, no additional measures such as issuing shorter prescriptions had been implemented to promote compliance. Infrequent reviews increase the risk of patients being under or over treated for hypothyroidism. The practice has confirmed that since the assessment, all 4 patients had been reviewed. The practice was also in the process of implementing a new standard operating procedure for staff to support and encourage patient compliance with monitoring requirements.

National Institute for Health and Care Excellence guidance recommends that patients should be reviewed within 48 hours following an acute asthma exacerbation, that requires oral steroids, and their regular treatment should be adjusted if necessary to improve symptom control. There were 1,235 patients registered with asthma of which 40 had been prescribed 2 or more courses of rescue steroids in the last 12 months. Of these we reviewed 5 patients and found 2 patients had not been reviewed post steroid treatment. This poses a risk of deterioration due to asthma and delays in timely review. Following the assessment the practice reviewed these patients.

During the site visit we reviewed a sample of authorisations for staff to administer medicines under Patient Group Directions (PGD) and noted that some authorising signatures were dated before the 2nd member of staff was added to the document, meaning the authorisation was not valid. This issue was resolved promptly.

However, staff generally followed protocols to ensure they prescribed medicines safely, and ensured people received recommended medicines reviews and monitoring. 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.

Medicines were stored securely and at appropriate temperatures. There were no controlled drugs at the practice. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Waste medicines were recorded and disposed of appropriately including medicines returned by patients. 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 than local and national averages.

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