Claremont Bank 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 provider had made improvements in the following areas: staff recruitment practices, responding to safety alerts and the management of significant events.

The service was no longer in breach of legal regulation in providing safe services.

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 practice had a proactive and positive culture of safety, based on openness and honesty. The provider had processes for staff to report incidents, near misses and safety events. Complaints, significant events and compliments were standing items discussed at staff meetings. Leaders encouraged staff to raise concerns when things went wrong, and these were investigated and reported. There were 10 significant events recorded in the previous 12 months. We sampled 3 and found these had been reviewed, analysed and shared in line with policy. Staff were aware of the process for raising a significant event. They were able to share a recent event, including the lessons learnt to identify and embed good practice to improve patient care. Staff felt leaders promoted an open culture, and that safety was a top priority.

There was a system to record and investigate complaints. We sampled 4 complaints and saw these were managed in line with policy 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 majority of patient feedback we received indicated that patients felt able to raise concerns and felt staff treated them with compassion and understanding. A representative from the Patient Participation Group (PPG) felt the provider took concerns and feedback seriously and proactively made improvements to the service.

The practice worked with patients and healthcare partners to establish and maintain safe systems of care. Staff worked to facilitate continuity of care, including when people moved between different services.

There were systems in place for processing information relating to new patients and incoming correspondence into the patient’s medical records. Referrals and test results were managed in a timely way. The practice had a shared care policy in place regarding the care responsibilities for prescribing and monitoring are shared between services ensuring continuity of care closer to home.

Safeguarding policies were in place and known to staff to keep people safe and safeguarded from harm or abuse. Staff had completed the relevant safeguarding training for their role and were able to tell us the action they would take if they suspected abuse.

The practice maintained a list of vulnerable people and acted on and shared concerns quickly and appropriately working in partnership with other organisations. At this assessment we saw clinical system alerts were used to identify people who were at risk of harm or abuse including household contacts. There were systems in place to respond to concerns and act on correspondence. For example, children who failed to attend their appointments or were frequent attenders to the accident and emergency department.

At the last inspection we advised the provider to take action to verify and reconcile the safeguarding register to ensure safeguarding information held was accurate and up to date. At this assessment we found safeguarding meetings were held on a regular basis to review the register. Safeguarding searches were carried out prior to the meeting to help identify and consolidate any safeguarding register discrepancies with the local authority. Meetings held were recorded.

The practice 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.

The suggested emergency equipment was available, or risk assessed. Systems were in place to check the emergency equipment and medicines regularly. Staff could recognise a deteriorating patient and knew what action to take and had received training in basic life support including scenarios to equip them in the event of a medical emergency. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. There were processes in place to ensure care was prioritised for their most clinically vulnerable patients.

The practice detected and controlled potential environmental risks. They made sure equipment, and facilities supported the delivery of safe care and met people’s needs. Improvements had been made to improve the safety of patients and staff. This included improved external lighting and handrails to improve visibility and help patients navigate the slope from the car park. Systems were in place for the checks of fire alarms, fire extinguishers and fire evacuation procedures. Portable appliance testing was completed annually to ensure equipment was safe to use. The practice had a range of risk assessments in place including, legionella, fire and premises that showed the risks were identified, assessed and addressed. However, access to the practice to assist wheelchairs users, pram users etc entering the practice had not been considered. There was a business continuity plan in place, which was monitored and reviewed.

Leaders 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. Leaders told us they continually reviewed the mix of skills across the multidisciplinary team and had introduced cross-functional team-working, with staff learning new skills to ensure staff were able to provide in-house cover for colleagues during both planned and unplanned absences. Training was discussed in staff meetings held.

There were a range of clinical and non-clinical roles within the practice. Staff told us they were encouraged and supported with their learning and development needs. Leaders told us they actively encouraged the team to continually enhance their personal development and provided opportunities for staff to undertake statutory, mandatory and recommended training, to equip them in their role. 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. At the last inspection we found staff induction processes were not always effective. At this assessment we found this had improved on the staff records we sampled.

We also found significant improvements had been made to staff recruitment practices. Since the last inspection 7 new staff had been employed. We reviewed 5 personnel files and found information was well presented and appropriate checks such as previous employment record, proof of identity and references had been completed. Staff immunisation status records were in place or obtained during our site visit.

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 appointed a new designated infection, prevention and control (IPC) lead. They were due to attend external training in September to fully equip them with the skills and knowledge in IPC to support them in their new role. Staff had access to an IPC policy and had received relevant training. Cleaning schedules were in place and followed, which identified rooms and frequency of cleaning. Internal environmental audits were completed, and actions taken to mitigate risks. We found the premises were clean and hygienic during our site visit. No concerns were expressed by patients and staff regarding infection, prevention and control.

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 and were confident managing the storage, administration and recording of medicines. The practice had processes in place for the management of prescription stationery. Patient group directions (PGDs), (written instructions to help qualified health professionals supply and administer medicines to patients), were correctly signed, authorised and dated. However records had not been crossed through to prevent unauthorised addition of signatures to a PGD after authorisation.

Staff followed protocols to ensure they prescribed medicines safely, and ensured most people received all recommended medicines reviews and monitoring. The minor shortfalls we identified during our remote clinical searches in relation to the monitoring of people with long-term conditions, were promptly actioned by the provider and information shared with us during the site visit. Leaders told us going forward they were looking to undertake medicine reviews during patients’ birth month to help simplify the process for patients and reduce the number of appointments they were required to attend the practice. Staff followed established processes to ensure people prescribed medicines with specific risks such as Methotrexate (an immune system suppressant drug) received the recommended monitoring.

Our remote clinical searches found 702 patients had received a medication review in the previous 3 months. We reviewed a random sample of 5 reviews and found 1 had been coded on the patient record but lacked information, such as details about what had been reviewed or changed as a result of the review or the monitoring arrangements. The practice agreed to action this.

Prescribing data reviewed as part of our assessment found the practice performance was mainly 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 with the exception of Broad-spectrum antibiotics (when the specific bacteria causing the infection is unknown), where prescribing was slighter higher than national averages.

Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Medical gases, such as oxygen were stored safely and levels checked regularly. There was a process in place for managing and responding to medicine safety alerts, which had improved since the last inspection.