Drs Jones & Blaylock Also known as Throckley Primary Care

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 good. At this assessment, the rating remains the same.

This service scored 69 (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.

Staff told us of an open and honest working environment, where they were supported by leadership, felt they were able to raise concerns and that their views were listened to and acted upon, with safety a top priority. During staff meetings, the clinical team discussed and learnt from clinical issues. There was also a daily clinical meeting to share learning. Staff felt there was an open culture, and management encouraged a culture of learning from incidents. 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. Learning from incidents and complaints resulted in changes that improved care for others. The provider acknowledged that the administrative team meetings were difficult to arrange as a whole group and had recently tried holding duplicate meetings, to ensure all staff were included. Further discussions were underway at the time of inspection to arrange a regular time slot whereby all staff could hold meetings altogether. Managers also used emails to share learning with staff.

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 effective systems in place for processing information relating to new patients and summarising their records. The service worked with other providers to deliver shared care and when patients moved between services, for example, adult referrals to secondary care or community services. Referrals and test results were managed in a timely way. The practice had created dedicated appointment slots each day for GP sessions to ensure follow ups to referrals and tests could be made without delay with the relevant GP for patient continuity.

The practice ensured effective management and oversight of triage by having a duty doctor available each day to handle urgent patient issues throughout surgery opening hours. For home visit requests these were discussed in the clinicians’ daily meeting to allocate tasks and patients appropriately to ensure patient continuity whenever possible.

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.

Staff were able to tell us who the safeguarding lead was in the practice and how to raise concerns. They told us they received training in both safeguarding adults and children and had a clear understanding of their safeguarding responsibilities for reporting concerns.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. Administrative staff had recently completed Safeguarding level 2 training to adhere to both intercollegiate and Royal College of General Practitioners guidance. The practice maintained a list of vulnerable people and acted on concerns, working in partnership with other organisations.

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.

We saw Disclosure and Barring Service (DBS) checks were undertaken, however, there was an issue with 3 staffs’ DBS checks. The risks had been mitigated with risk assessments until the DBS checks were completed.

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. However, we found an undated pocket mask and undated infant manual resuscitation device. Staff removed both items immediately when this was highlighted and replacements supplied. The emergency bag did not have a tamperproof device to provide assurance it remained intact following the nurse check. We found guidance was conflicting with its requirements, however, for best practise the provider stated they would use the devices in future.

Staff could recognise a deteriorating patient and knew of action to take. A recent example was provided whereby reception staff had identified a patient at the front desk having a stroke and alerted the practice duty GP immediately. 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 met with patients, their families and carers to discuss their care and treatment. 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.

Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. Clinic rooms were all on the ground floor and had appropriate flooring and equipment. Appropriate emergency equipment and medicines were accessible to staff.

There was a business continuity plan in place which was monitored and regularly reviewed.

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 training was up to date, 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 as there was a clear open-door policy in place, staff felt well supported by others.

Safe recruitment practices were followed. 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, and relevant vaccinations were in place for staff. Some information we asked for was not immediately available but was provided to us after a short time.

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 lead who was the practice nurse, and all staff had had relevant training. Cleaning schedules were in place and quarterly audits of each room were completed and reviewed.

Risk assessments and audits were completed, including hand hygiene, and aseptic non touch techniques for wound dressings with actions taken to mitigate risks.

There were small elbow operated taps in clinic rooms. However, they were located on the sink close to the wall, which made it was very difficult for staff to get an elbow behind the lever to turn the tap on. This created a risk that staff might use a contaminated hand instead. The practice had previously identified this issue, and since the assessment it was being further investigated by the practice.

The service made sure that medicines and treatments were generally safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

In our clinical searches we found 96 patients over the age of 65 years were prescribed antiplatelet medication without gastroprotection. Whilst the individual risk was low, there are a large number involved. The practice also did not appear to have an effective system in place to identify patients’ overuse of salbutamol inhalers. These issues were investigated immediately by the practice.

However, 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 medicines safely, and ensured people received recommended medicines reviews and monitoring.

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. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

The provider had systems to manage and respond to safety alerts and medicine recalls, however for Medicines and Healthcare products Regulatory Agency (MHRA) alerts, we found there were shortfalls over time for alerts to continue to be flagged and responded to.

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.

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