Lingfield 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

At our last assessment, we rated this key question as Requires Improvement. At this assessment, the rating has changed to Good.

We looked for evidence that people were protected from abuse and avoidable harm.

Emergency medicines and equipment were suitable and easy to access. The actioning of Medicines and Healthcare products Regulatory Agency (MHRA) Alerts had improved. The monitoring of high-risk medicines had improved. Patients with long term conditions had effective annual reviews. There were systems and processes to ensure the premises were safe for use. The monitoring of fridge temperatures and the tracking of blank prescription paper had improved. Recruitment checks were being carried out in accordance with the regulations and staff vaccinations were now maintained in line with current UK Health Security Agency (UKHSA) guidance. There was a culture of learning including from incidents, complaints, and significant events. Processes to safeguard vulnerable adults and children from the risk of abuse were clear and well understood by all staff.

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 incidents. 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. Managers encouraged staff to raise concerns when things went wrong. Staff felt there was an open culture, and that safety was a top priority. The provider had processes for staff to report incidents and safety events. Learning from incidents resulted in changes that improved care for others. There was a system to record and investigate complaints. The provider listened to people’s views and responded proactively to make improvements to the service. When things went wrong, they were investigated, and changes were made that ensured the care and the quality of the service improved. Information and learning from complaints, incidents and significant events was shared across the team to improve patient experience. Weekly meetings were held with standing agenda items on matters such as incidents and complaints. The learning from these were discussed and shared across the staff team. Representatives from the patient participation group (PPG) felt the provider took concerns seriously and made improvements to the service. The GP partners and practice manager attended PPG organised meetings with the public, to update the community on practice matters and challenges. The PPG told us these events were well attended and meant that the partners could hear, first hand, the issues affecting the patients and work to resolve them. For example, during a community event it was recognised that some patients did not know how to use the NHS App. The practice set up teaching sessions, meeting patients either face to face or in groups to ensure the knowledge was shared and patients felt empowered to use the NHS App.

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 incidents. 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. Managers encouraged staff to raise concerns when things went wrong. Staff felt there was an open culture, and that safety was a top priority. The provider had processes for staff to report incidents and safety events. Learning from incidents resulted in changes that improved care for others. There was a system to record and investigate complaints. The provider listened to people’s views and responded proactively to make improvements to the service. When things went wrong, they were investigated, and changes were made that ensured the care and the quality of the service improved. Information and learning from complaints, incidents and significant events was shared across the team to improve patient experience. Weekly meetings were held with standing agenda items on matters such as incidents and complaints. The learning from these were discussed and shared across the staff team. Representatives from the patient participation group (PPG) felt the provider took concerns seriously and made improvements to the service. The GP partners and practice manager attended PPG organised meetings with the public, to update the community on practice matters and challenges. The PPG told us these events were well attended and meant that the partners could hear, first hand, the issues affecting the patients and work to resolve them. For example, during a community event it was recognised that some patients did not know how to use the NHS App. The practice set up teaching sessions, meeting patients either face to face or in groups to ensure the knowledge was shared and patients felt empowered to use the NHS App.

Staff were trained to appropriate levels for their role and could identify vulnerable people easily. They were able to tell us about the systems and processes to keep people safe and safeguarded from abuse and felt confident in raising concerns. The service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. The service shared concerns quickly and appropriately. There were regular discussions between the service and other health and social care professionals such as social workers and health visitors.

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.

The practice held appropriate emergency equipment and medicines which was regularly reviewed and maintained. A system had been implemented to ensure all staff knew their role within a medical emergency to ensure it was managed effectively. Staff could recognise a deteriorating patient and knew of actions to take. The practice had a duty doctor each day to support with any patients who needed urgent action. Staff had been trained to recognise symptoms which may need urgent medical attention. The practice had designed a reception protocol which was designed to ensure staff could direct patients to the correct support. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. We saw safety netting information clearly documented within patient records.

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

Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed. The premises were clean and contained the appropriate facilities to support infection prevention and control. There was adequate signage and clear fire escape routes. There was evidence of up-to-date medical equipment calibration and portable appliance testing (PAT) certificates were in place.

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 that met people’s individual needs. The provider was actively recruiting for a practice nurse and an advanced nurse practitioner, as 2 members of staff had left. The provider informed us that due to not having successful candidates they were in the process of upskilling other roles in order to support the nursing team.

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. Clinical staff had easy access to informal and formal clinical supervision.

The provider had appropriate recruitment processes in place. Including disclosure and barring (DBS) checks, references, induction, and staff immunisation information.

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 and all staff had had relevant training. We saw posters around the practice including information about managing sharps injuries, handwashing, and clinical waste to support good practice. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The service made sure that medicines and treatments were safe and met people’s needs, including where people needed support due to their 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 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. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, and vaccines. 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. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.