Linden Hall 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 Requires Improvement. At this assessment, the rating has changed to Good.

The service was no longer in breach of legal regulation in relation to providing safe services. We noted improvements in several areas including recruitment, staff training and safe storage and monitoring of medicines

This service scored 69 (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 process for reporting and recording significant events. Staff told us they felt able to raise concerns and that there was an open culture. There were opportunities to discuss any learning from these events and staff were able, when asked, to give an example of a recent event that had been discussed.

There was a system for recording and investigating complaints. However, complaint records we sampled were inconsistent. For example, one complaint, had been dealt with outside of the practice policy’s timescales. We also found that the patients had not been advised of the next steps or the escalation routes should they not be happy with the outcome of their complaint, for example the commissioner or the Parliamentary and Health Ombudsman. We also saw an example where there was limited detail in the response provided and that it did not address all elements within the complaint. Following the inspection, the provider advised us that they had reviewed the complaints discussed and had introduced a response letter template to incorporate the escalation details. There was evidence that complaints were discussed practice wide, and any learning and themes were shared.

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.

At the last inspection, we found that not all staff had received the appropriate level of safeguarding training required for their role. At this inspection, staff told us and records indicated that they had since received the appropriate level of training for their role.

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.

Safeguarding concerns were discussed at the practice meetings. There were processes in place to follow up people who failed to attend appointments in primary and secondary care or were frequent attenders to the emergency department.

The service worked with people to understand and manage risks. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

At the last inspection we found that no documented assessment was in place to mitigate any potential risks of not stocking all recommended emergency medicines. At this inspection, we found that all the recommended emergency medicines were available. Emergency equipment was available and maintained. The accessibility of the emergency equipment at the Muxton Branch was discussed. Following the inspection, the practice confirmed that they had reviewed the location and moved the equipment to a more accessible location within the practice.

Staff could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

Since our last inspection, the practice had introduced a total triage system. Data shared with us during the inspection showed that this process had significantly reduced the call volumes, resulting in patients waiting less than 90 seconds for their calls to be answered. A total of 92% of respondents to the National GP Patient Survey described their experience of contacting their GP practice as good, which was also significantly higher than the local and national averages.

At the last inspection, we found that not all health and safety risks had been assessed, and appropriate actions taken. At this inspection, improvements had been noted, and we found the service detected and controlled most potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

During the inspection, we discussed the location of the upstairs waiting area at the Muxton branch and the potential lack of direct oversight of patients in the event of an emergency. Following the inspection, the practice had obtained a quote for the possibility of installing CCTV for this area to mitigate risks to patients.

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.

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. A robust policy was in place for offering clinical supervision to staff. Staff told us they were very much supported to develop and learn.

There were a range of clinical and non-clinical roles within the practice. At the last inspection, we found that the recruitment checks were not carried out in accordance with the regulation and that not all staff were up to date with their training in safe working practices.

At this inspection, we noted improvements in the quality of staff records with some minor omissions noted, which were shared during the site visit. We also noted improvements in the completion of staff training, with most staff up to date with their training in safe working practices.

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 (IPC) lead and all staff had completed relevant training. Staff had access to personal protective equipment (PPE) and arrangements were in place for the disposal of clinical waste. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks. The areas we sampled during an environmental tour of both sites were visibly clean and hygienic. Staff we spoke with expressed no concerns relating to the cleanliness of the practice.

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.

At the last inspection, vaccines were appropriately stored but not monitored effectively to ensure they remained safe and effective, for example when the fridge temperatures went out of range. At this inspection we found refrigerators used to store vaccines and medicines were monitored to ensure temperatures were maintained and products were appropriately stored within them. Staff regularly checked medicines held in the event of a medical emergency,

Staff received training to support them in their role. Staff managed prescription stationery appropriately and securely. Staff stored medical gases, such as oxygen safely.

We reviewed a sample of the patient group directions (PGDs), (written instructions to help qualified health professionals supply and administer medicines to patients). We found all were valid.

Staff generally followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. We identified 123 patients who were either on antiplatelet or an anti-inflammatory medicine without being prescribed a medicine to protect against gastrointestinal bleeding. Following the inspection, the provider undertook a full audit of all patients that fit the criteria and sent us assurances that those identified patients had since been prioritised and reviewed. The provider planned a further audit in 4 months to help ensure patient safety and adherence to best practices.

At the last inspection, we found that not all medical safety alerts had been acted on. At this inspection, we found that a new process had been implemented, which included weekly checks on alerts to ensure timely action. All alerts were recorded using a spreadsheet and the information shared with relevant staff using task and email. Alerts were also discussed at clinical meetings.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment found practice performance was in line with national averages for Pregabalin and Gabapentin medicines (primarily anticonvulsant drugs, also prescribed for pain); psychotropic medicines (used to treat various mental health conditions); hypnotic drugs (used for the management of severe insomnia); and antibiotics.