Rectory Meadow 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 inspection, we rated this key question as Good. At this inspection, the rating remains the same and continues to be rated Good.

This service scored 78 (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 strong proactive and positive culture of safety, based on openness and honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify, embed and share good practice.

Patients felt supported to raise concerns and felt staff treated them with compassion and understanding. Leaders encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from any concerns, incidents and feedback. Staff felt there was an open culture, and that safety was a top priority. There were processes for staff to report incidents, near misses and safety events. Staff shared examples of reporting incidents regarding medicines and unexpected side effects externally via the Yellow Card scheme, a scheme ran by the Medicines and Healthcare products Regulatory Agency (MHRA) for reporting problems with medicines and medical devices. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave support where needed. Learning from incidents and complaints resulted in changes that improved care for others. This learning included collaboration with other services when a multi-disciplinary approach was required. For example, a significant event we reviewed showed the practice work closely with the local ambulance service. Strategies were developed and a change of policy instigated to improve patient safety, not only to practice patients but patients across the wider community. This demonstrated shared learning within the practice as well as nationally to improve patient safety.

The practice worked with patients, their families and healthcare partners to deliver, manage and monitor care. They made sure there was continuity of care, including when people moved between different services. Clinicians highlighted work with colleagues from secondary care including tissue viability nurses, heart failure nurses and further work with colleagues from community health to establish, sustain and improve safe systems and transitions of care.

There were systems in place for processing information relating to new patients. We reviewed the pathology and task lists on the clinical system which showed they were managed in a timely way. Patient referrals to specialist services including cancer services were documented in the referrals systems and patient record. These were managed promptly and appropriately followed up. Searches were in place to ensure all referrals were managed in a timely manner. The practice had fail-safe systems in place to ensure all cervical cytology results were received from samples sent.

The practice worked with patients 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. When required, the practice shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. Following a learning event, the practice implemented a ‘welfare check’ protocol to safeguard potential missing people and those in severe mental health distress, the practice told us this had improved the safety of patients, staff and the wider community.

Safeguarding registers for children and adults were reviewed and discussed during bi-monthly multi-disciplinary team (MDT) meetings, where any trends were monitored and updates made. To maximise attendance, meetings were scheduled on alternate days each month to allow for different working patterns. The practice acted on concerns and worked in partnership with other organisations. For example, they followed up children who attended Emergency Departments (formally referred to as Accident and Emergency) and those that failed to attend secondary care appointments.

The practice worked with patients 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, regularly checked and maintained. Staff could recognise a deteriorating patient and knew of action to take. Staff highlighted a recent educational session ran by the Advanced Nurse Practitioner which provided further awareness of medical emergencies, specifically sepsis (sepsis is a life-threatening reaction to an infection). Staff told us the session raised their confidence in spotting and managing a potential sepsis presentation. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

Staff detected and controlled potential risks within all areas in the practice. 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, reviewed and also tested to ensure staff understood their role and designated responsibilities within the plan.

We saw that the practice had effective systems to monitor and comply with 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 2 fire marshals to direct patients and staff in the event of a fire. Staff completed fire training and attended regular fire drills. Electrical equipment had been calibrated and tested. Furthermore, new light installations had been installed to promote energy efficiency and reduce eye strain for staff groups.

The practice 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, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Every clinician in the practice had a Clinical Mentor alongside a Team Lead where training and development ideas were discussed and brought to fruition. In addition, the senior GP provided monthly clinical supervision to the social prescribers employed through the local primary care network (PCN). This enabled staff to discuss individual cases, reflect on their practice and identify any changes to improve outcomes for patients. Safe recruitment practices were followed.

Appraisals were completed on a regular basis to support professional development. Staff felt supported with their professional development and we saw examples of staff developing in their role. As a training practice, we reviewed feedback the practice had received from trainees who had completed placements at the practice. This feedback was highly positive and praised the support, mentorship and development opportunities they had received.

The practice 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, and actions taken to mitigate risks. Waste, sharps, and clinical specimens were managed carefully to keep everyone safe. Staff vaccinations were kept up to date in line with the latest UK Health Security Agency (UKHSA) guidance. There was a clear system for reporting infection concerns to the relevant agencies, such as for notifiable diseases.

The practice made sure that medicines and treatments were safe and met patients’ 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. 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. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. 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 took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. This included a recent in-house educational meeting to raise antibiotic awareness, antibiotic prescribing habits and local guidelines including the South-Central Antimicrobial Network (SCAN) Guidelines for Antibiotic Prescribing in the Community.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. Recent 2 cycle clinical audits had reviewed medicines used to support patients with Attention Deficit Hyperactivity Disorder (ADHD), the second cycle of the audit demonstrated improvement.

As part of our assessment, a series of patient clinical record searches were undertaken by a CQC GP specialist advisor. This included a review of the management of patients on medicines that required monitoring. We found patients had received monitoring in line with guidance.

We also reviewed 6 additional national prescribing data sets and saw no variation when comparing the practice’s achievement to local and national averages for 5 of the 6 data sets. The remaining prescribing data set for a medicine used to control pain and seizures showed positive variation.