Downton 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.

We assessed one quality statement in the safe key question. At our last assessment, we rated this key question as Good. At this assessment, the rating has stayed the same.

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.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The practice made sure medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened. Where shortfalls were identified through scheduled searches within the clinical IT system, the practice acted promptly to ensure patients received the necessary monitoring.

Our remote clinical searches identified patients were now receiving recommended medicine reviews and monitoring in accordance with national guidelines. Since our previous assessment, the practice had improved its systems to maintain prescribing oversight and clinical monitoring. This included appropriate blood test monitoring for patients prescribed disease-modifying antirheumatic drugs (DMARDs) such as leflunomide and azathioprine. Furthermore, patients on polypharmacy had received structured medication reviews. The practice had also implemented a dedicated medicines management team who provided effective oversight to ensure prescribing remained safe and aligned with best practice through regular audit, monitoring, and clinical review processes.

The practice had also commenced an improvement programme to ensure there were effective processes in place, including appropriate coding, changes to recall systems, and ensuring that clinical meetings took place to review protocols and training needs. The practice recognised there was an ongoing need for clinicians to engage in this improvement programme and had implemented a structured plan to facilitate this. This included scheduled engagement sessions, defined objectives, and protected time for participation in training and protocol review.

Staff worked with people to review their medications and ensure they understood how to manage them 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, were competency assessed on medicines optimisation, and felt confident in managing the storage, administration and recording of medicines.

Our clinical searches indicated the majority of patients prescribed medicines requiring routine monitoring had received appropriate monitoring in line with national guidance. In the small number of cases where blood test results were not coded within the practice system, the practice demonstrated monitoring had been completed in alternative settings such as secondary care or private clinics. These results were appropriately documented in the patients’ clinical records, either through correspondence or scanned documents, ensuring safe and continued prescribing.

Since the previous assessment, the practice had strengthened its medicines monitoring systems by implementing a structured and proactive audit process. A monthly audit was now conducted for patients prescribed medicines which require monitoring. This identified any outstanding blood test monitoring, with findings reviewed weekly by the pharmacy technician and pharmacist.

In addition, the practice had implemented an automated long-term condition review protocol. To ensure safe prescribing, the practice had also introduced a prescription block system. Where long-term condition reviews had not been completed by the due date, the pharmacist had assessed clinical need and either authorised a prescription or arranged a further invitation, in collaboration with the care coordinator team.

We found the practice had recognised a need to improve prescribing safety for patients aged over 65 prescribed non-steroidal anti-inflammatory drugs. The pharmacy technician and prescribing team had begun a targeted, structured review of this cohort, which included written correspondence and text messaging to affected patients to explain the clinical need and ensure informed decision-making. The practice had also held clinical discussions regarding the role of proton pump inhibitors in this patient group.