Ixworth 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.

This key question has been rated as good.

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.

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. Leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice and improve care for others.

We did not receive feedback from people regarding their experiences for this quality statement. Representatives from The Patients Association - Ixworth Surgery told us leaders took time to consider and learn from concerns raised.

Leaders encouraged staff to raise concerns when things went wrong. There were processes for staff to report incidents, near misses and safety events. Systems were in place to record and investigate these events, identify learning, and make any improvements required. Learning was shared with staff, as appropriate during meetings, and minutes were available. Staff gave examples of improvements made following incidents and complaints, that improved care for others.For example, changes were made to an audit to ensure staff could check the progress of each referral for people referred for 2 different suspected cancers. An annual review was completed to identify trends, share learning and implement improvements where necessary.

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.

Feedback from people, which included from care home representatives was positive in relation to the registration process, the follow up from blood tests and investigations, and timely, appropriate referrals being made.

Protocols were in place to manage the flow of work. People’s correspondence which was deemed urgent, for example urgent blood results and urgent requests from NHS 111 were prioritised. Arrangements were in place to ensure required actions were reviewed and authorised by an appropriate clinician. Changes made to medicines following discharge from hospital, were actioned in a timely manner. We reviewed the pathology and tasks lists on the clinical system which showed they were managed in a timely way. Monthly audits of the work of non-clinical staff were undertaken by leaders and any issues identified were discussed and learning undertaken.

Referrals and test results were managed in a timely way. Staff who were involved in making referrals were clear about their role and checks were in place to ensure referral requests had been actioned. A range of audits were in place for example, to ensure results had been received for every cervical screening sample sent. The service had pop up alerts in people’s clinical record to support safe and effective care. These included for example, an alert for people with similar names.

The service worked with other providers to deliver shared care and when people moved between services. Some partners agencies gave positive feedback, such as reduced duplication of work and improved support for people, while others had no concerns about how the service worked with them.

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 service shared concerns quickly and appropriately.

The service had a designated GP lead for safeguarding. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding, to the appropriate level. Staff who we received feedback from told us they were confident to report any concerns.

The service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. Arrangements were in place to follow up vulnerable people who had not attended for their appointment, which included secondary care appointments. Regular safeguarding multidisciplinary team meetings were held to discuss and review people’s needs and actions were agreed and followed up.Minutes of meetings we reviewed confirmed this. Partner agencies who attended these meetings gave positive feedback, such as staff awareness of safeguarding, which included when concerns need to be raised.

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.

People were advised on risks related to their condition and actions to take if their condition deteriorated.

Arrangements were in place for staff to identify, assess and manage people whose health was deteriorating, and for managing medical emergencies. Staff had completed training, relevant to their role and told us they could recognise a person who was deteriorating and knew of action to take. GPs were available every day for advice and support as necessary. Emergency medicines were available for use, were stored appropriately and checked regularly.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Arrangements were in place to ensure the premises were maintained. For example, health and safety and fire risk assessments had been undertaken and risks identified had been addressed or were being actioned. There were ongoing checks for example, for fire safety, electrical safety, and equipment calibration. Staff told us they had suitable and sufficient equipment to undertake their work and were satisfied with the health and safety arrangements in place. The service had an up-to-date business continuity plan and this was monitored and reviewed.

During the site visit, we checked an action identified in the fire risk assessment and found it had been completed. People in the waiting room were easily visible to staff so they could identify and respond to any people whose health may be deteriorating.

Staff used technology securely and effectively and conformed to relevant digital and information security standards, with arrangements in place for the confidentiality of data management.

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.

Feedback from people, which included care home representatives was positive in relation to the knowledge, skill, care and treatment provided by clinical staff. Non-clinical staff were described as proactive and understanding.

Leaders followed safe recruitment process in line with their recruitment policy. Appropriate recruitment checks were carried out which included Disclosure and Barring (DBS) checks. The professional registration of clinical staff was checked at recruitment and on an ongoing basis. New staff received an induction and training plan, adapted to their role. Competency was assessed during the probationary period to ensure capability and safe practice. Staff told us they worked within their agreed areas of competence.

There was oversight of the completion of training deemed mandatory by the service and training completion was up to date. This included for example, staff who were responsible for long term condition reviews, childhood immunisations and cervical screening. The learning needs and development of staff was managed appropriately. For example, they had supported an administrator to enrol on the nurse associate programme. Staff gave examples of learning events they were supported to attend and shared their learning with colleagues. Staff told us they had regular appraisals and a sample of records we reviewed confirmed this.

GPs were available every day for clinical advice and support. A multidisciplinary team meeting was held daily in the morning to review and plan care for people presenting complexities or requiring collaborative input. Arrangements were in place for the clinical oversight of staff working in extended roles, which included those who prescribed medicines. Clinicians received regular supervision and review of their practise, and protected time for case discussions. The provider strengthened their documentation by introducing a quarterly audit, reviewing a 2.5% sample of clinical cases handled by clinicians in extended roles. The first audit has been completed retrospectively and areas for learning had been discussed with the clinicians involved.

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. People gave positive feedback about the cleanliness of the service. Care home representatives were satisfied with the infection protection and control arrangements when clinicians visited.

The service had a designated infection, prevention and control (IPC) lead GP and nurse and all staff had completed training relevant to their role. Staff told us about the systems in place for safely dealing with clinical specimens and spilt bodily fluids. The IPC lead had completed an annual audit, and a range of monthly and weekly IPC audits. Most of the actions had been completed and a risk assessment was in place where work was planned but not yet completed. Arrangements were being made to upgrade the flooring at the time of this assessment.

During our on-site visit, we observed the service to be clean and tidy. Cleaning schedules were in place and followed. Effective arrangements were in place to communicate with the external cleaning company and resolve any issues. Appropriate arrangements were in place to manage clinical waste.

We reviewed a sample of staff immunisation records and found the service held the relevant information relating to the immunisation status for staff.

The service had safe and secure systems to manage medicines within the surgery premises, their associated risks and related stationery. However, there was limited oversight of the risks associated with the delivery service.

Care home representatives said people’s medicines were reviewed regularly.

The service included both a dispensary and a registered pharmacy (not included in our assessment) owned by the GPs. The dispensary was open from 8.30am to 6.30pm Monday to Friday and 9am to 1pm on a Saturday.

The dispensary was clean, tidy and well organised with only authorised people having access. All medicines were kept within the recommended temperature ranges. There was a separate designated area used to prepare blister packs for people who had been identified as needing them.

All staff working within the dispensary were appropriately trained and had annual appraisals. Staff told us leaders were very supportive in providing access to any additional training.

The dispensary was part of the Dispensing Services Quality Scheme (DSQS) and completed annual audits as part of this; we were told about recent changes that had been made to minimise errors due to distractions from phone calls.

Standard operating procedures (SOPs) were in place for all the dispensary activities. The service had a medicines delivery service which was highly valued by those who used it. However, the SOP covering the delivery service did not reflect the service provided. The delivery service vehicle was not compliant with guidance on the transport of Controlled Drugs and didn’t provide the required assurance when delivering items that required cold storage. Both were actioned immediately by the provider. There was no risk assessment for the prescription collection points. Following our assessment the provider immediately completed a risk assessment and put in additional security measures.

Medicines reviews were undertaken by a multi-disciplinary approach within the service. Sometimes completed by a self-review questionnaire where appropriate. The team worked closely together to enable people to get the necessary monitoring required at peoples’ convenience, such as having their own phlebotomist to take blood samples. Our clinical searches showed that people received the correct monitoring when prescribed medicines by the service.

Incidents were reviewed as part of regular meetings and we heard about actions taken to minimise any reoccurrence; for example, we heard about a change in dispensing procedure following an incident where a person had been given an incorrect medicine.

There was a comprehensive system to action new safety alerts or recalls although we found evidence in 2 historical cases where the provider was not compliant. In the first case we found that people had been prescribed 2 medicines that should not be prescribed together, the provider took immediate action to review these people. In the second case people were not being given additional information in line with national guidance about fire risks associated with their medicine. The provider advised they would order the relevant leaflets.

Patient Group Directions (PGDs) were in place to allow the nurse to give vaccinations without a prescription, and these had been appropriately authorised for use. Prescription stationary was managed appropriately.

The service met quarterly with the Integrated Care Board medicines optimisation team. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes. Most of the prescribing data reviewed as part of our assessment confirmed this.