Cornhill 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 people were protected from abuse and avoidable harm. At our last assessment, we rated this key question as good. At this assessment, the rating remains the same. This meant people were safe and protected from avoidable harm.

This service scored 63 (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 positive safety culture, underpinned by openness and honesty. Staff listened to concerns and investigated incidents appropriately. Although learning and actions arising from these events was discussed during monthly meetings,they were not recorded in detail, making it difficult to determine outcomes or whether improvements were implemented.

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 staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Staff felt there was an open culture, and 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

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.However, the practice had a backlog of notes waiting to be summarised and scanned into the electronic system. This had not affected patient care,but leaders acknowledged they needed to provide more hours for this task which has been actioned following our visit. Referrals and test results were managed in a timely way.

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.

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.

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

Staff could recognise a deteriorating patient and knew of action to take. This was further strengthened by the continuity provided by reception staff, many of whom knew patients by name and were able to promptly identify subtle changes in a person’s wellbeing. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

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. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. Leaders had secured funding to make alterations to the building to increase clinical space which would increase the services offered to people.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked well together to provide safe care which met people’s individual needs. However, in staff recruitment and human resources files it was difficult to find evidence of how people had been recruited and the process for collecting references and Disclosure and Barring Service (DBS) checks. This is a public body which helps employers make safer recruitment decisions by processing criminal record checks. Leaders provided evidence showing DBS checks had taken place. They had taken action to improve staff files going forward.

There were a range of clinical and non-clinical roles within the practice. We found some training had not been completed to the required level for a small number of staff, but role specific learning needs and development of staff was managed appropriately. Leaders were already looking for a new training provider which would ensure this issue was rectified and following the inspection they confirmed staff had been booked onto the required training. Staff were working within their agreed areas of competence.

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. Cleaning schedules were in place and followed.Waste storage was appropriate.The practice did not have an up to date full IPC audit which leaders assured us would be completed as soon as possible.There was a shorter audit available for handwashing. All areas of the practice were visibly clean and uncluttered.

The service made sure 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. 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 including controlled drugs were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. 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.However, the emergency medicines trolley was stored in a cupboard within a clinic room, making it difficult for staff to access quickly in an emergency. Leaders took immediate action to relocate the trolley to an area with easier access.The provider had effective systems to manage and respond to safety alerts and medicine recalls.

Staff followed established processes to ensure most people prescribed medicines with specific risks received recommended monitoring. However, clinical record searches carried out as part of our assessment by a Care Quality Commission GP Specialist Advisor identified 38 people who had been prescribed medicines to strengthen bones and reduce fracture risk by slowing down bone breakdown for more than five years had not been referred for a DEXA (Dual-Energy X-ray Absorptiometry) scan. A DEXA scan is a quick, painless, low-dose X-ray test which measures bone mineral density to diagnose osteoporosis, assess fracture risk and monitor bone health.

Of the five patients reviewed in more detail, three raised no concerns, as they had either taken a break from the medicine or were on a waiting list for a scan at the local hospital. Leaders advised they were auditing all 38 patients and would complete the appropriate follow-up and referrals.Leaders provided evidence to show some patients had already been referred to their local hospitals and were on the waiting list for the scan to be completed.

Clinical record searches over all demonstrated safe prescribing and monitoring. As part of our assessment, a Care Quality Commission GP Specialist Advisor reviewed patient records and identified very few issues in prescribing or the management of long-term conditions. For example, reviews for people with long-term conditions, such as diabetes and chronic kidney disease, had been completed in a timely manner.