Heaton Road 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.

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 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 all staff to raise concerns when things went wrong. During staff meetings, the team discussed and learnt from issues raised. Staff felt there was an open culture, and that safety was a top priority. 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. From the sample of complaint records we reviewed, we found the practice responded to people’s complaints in a timely manner. Themes and trends from incidents and complaints were reviewed at regular intervals to identify further learning and we saw this resulted in changes that improved care for others. For example, work completed on overall telephone access identified peak patient usage times which has determined staff working hours and days.

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 including the registration of looked after children, and from the age of 13 as children start to transition from children to adult services. 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. There was also a system in place for children registered at the Practice from the age of 16 as they start to transition from children to adult services.

Referrals and test results were managed in a timely way. As a result of patient feedback, the Practice had created dedicated appointment slots for GP sessions to ensure follow ups to referrals and tests could be made in a timely way with the relevant GP for continuity for the patient.

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 GP safeguarding lead and deputy within the practice worked closely together and with staff to share concerns quickly both internally and externally as appropriate. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. Links included with the local safeguarding team, social workers, the health visitor team and the Police.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. Staff demonstrated a good awareness and knowledge of identifying safeguarding concerns and the necessary action to take. Administrative staff had recently completed Safeguarding level 2 training to adhere to both intercollegiate and Royal College of General Practitioners guidance.

The practice had a dedicated Safeguarding Coordinator who monitored safeguarding and highlighted concerns and trends both internally and externally working in partnership with other organisations. Part of the work included keeping child and adult risk registers, monitoring mother and baby checks, improving baby immunisation uptake and monitoring hospital visits to accident and emergency departments and walk in centers.

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.

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. 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. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. 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 the maintenance team attended upon request to resolve any issues or necessary repairs. The property team also attended weekly to check fire alarms and monthly to check the lighting.

Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. Clinic rooms had appropriate flooring and equipment. Appropriate emergency equipment and medicines were in place and accessible to staff. However, we found several children’s emergency face masks were out of date. We highlighted this to staff, and they removed these immediately. There were replacement facemasks in stock which were in date to replenish these.

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

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 learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Staff told us they had received relevant training for their role, and they had access to clinical supervision where appropriate. They told us they received regular appraisals and that their development and training was discussed in the appraisal. However, we were not assured management had clear oversight of mandatory training completion for staff. We requested further information, and this showed the data included additional training courses which were not mandatory. In both sets of data received it was clear some staff were not up to date with mandatory training.

We saw the practice had a recruitment policy and recruitment checks were carried out. We sampled recruitment checks for staff and saw that checks had been undertaken prior to employment. For example, proof of identification, references, qualifications, registration with the appropriate professional body, staff had a contract of employment and relevant vaccinations were in place for staff.

The service assessed and managed the risk of infection.

The Practice had an infection prevention and control policy in place and had completed an annual infection control statement.

The practice had a designated infection, prevention and control lead who was the practice nurse, and all staff had had relevant training. Cleaning schedules were in place and followed.

Risk assessments and audits were completed including hand hygiene, and actions taken to mitigate risks.

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. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. We saw staff had the appropriate authorisations to administer medicines under Patient Group Directions (PGD). 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. 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.

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