Valley View Surgery

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• 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

There were processes in place to record, investigate, take action and learn from incidents and complaints. There were designated safeguarding leads and appropriate safeguarding processes in place. Staff understood the importance of keeping people safe, and how to escalate any safety concerns. The premises and equipment were clean and tidy. There were some clinical supervision processes in place, however this was not always documented and did not include the undertaking of prescribing audits for non-medical prescribers. There were some concerns around the monitoring of patients and with the actioning of safety alerts, however the practice took action to address these concerns.

This key question has been rated as Good.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were policies and processes in place to record, investigate and take action from incidents and complaints. These were discussed in clinical meetings, and minutes were made available to staff. Lessons were learnt to continually identify and embed good practice. For example, an incident whereby a faecal immunochemical test (FIT) had not been collected by a patient resulted in a change in process which included setting up a daily task for staff to check if FIT tests had been collected, and to contact the patient to ensure this was done. Most staff told us they were confident to raise concerns when things went wrong, and that they felt appropriate action was taken to protect patients.

There were policies in place to support the workflow and pathways for appointments, referrals, records summarising and correspondence. There were processes to monitor and manage care when patients moved between services, such as out of hours or after referral to secondary care. Measures were in place to monitor referrals, in particular those related to cancer 2-week waits, to track the progress of the patient following referral. Staff we spoke with understood the referrals and pathology results processes, as well as how to safely manage medical correspondence. A review of the practice clinical system, which formed part of this assessment, indicated that patient test results were being managed in a timely manner. There was however a backlog of 481 patient records to be summarised. We were told that this was largely due to issues with obtaining the records from Primary Care Support England, and that staff were requesting records on a weekly basis. After the assessment, the practice told us it had reduced the backlog to 139 records. In order to mitigate risk, the practice requested medical histories from patients at registration, and offered health checks for new patients.

There were designated safeguarding children and adult leads at the practice. Safeguarding policies contained relevant contact details and processes to follow. Staff were appropriately trained in safeguarding, and those carrying out chaperoning had received specific training for this process. Staff told us how they used the clinical system to record and alert others to safeguarding concerns, and explained how they escalated any concerns. There were monthly multidisciplinary meetings where safeguarding cases were discussed, and these were attended by practice staff and sometimes by external staff such as district nurses and members of the proactive care team.

There were processes in place for managing emergencies. Staff we spoke with knew where to locate emergency drugs and equipment. We saw that checks on emergency drugs and equipment were carried out and recorded regularly. We were told that a risk assessment had been carried out for recommended medicines that were not stored at the practice, however this had been verbal and not formally documented. The practice told us it would produce a written risk assessment for this. Staff received training in sepsis awareness and basic life support, and were able to explain how to act safely in an emergency, including alerting clinical staff and emergency services.

There were processes in place for health and safety risk management. For example, risk assessments had been undertaken, and fire alarm testing and evacuation drills were carried out on a regular basis. There was appropriate signage in place, such as for fire doors and escape routes. We saw that equipment was maintained, stored safely and was suitable for use. Fire extinguishers had been serviced, and clinical equipment had been calibrated to ensure correct operation. We were told that training for designated fire marshals was included in yearly mandatory fire safety training. Staff we spoke with told us that they had no concerns related to health and safety in the practice.

There were policies in place for recruitment and appraisal. Staff received regular appraisals, and induction packs were provided to new staff. We reviewed 3 staff personnel files as part of this assessment and found that documentation was generally in line with guidance. We saw Disclosure and Barring Service (DBS) checks, immunisation records and appraisal records were kept. However, some documentation, such as interview summaries, were not always available. Leaders told us about the ways in which they ensured staff were qualified and skilled to carry out their roles, and the support that they offered them. Physician associates were appropriately supervised, for example through daily debrief sessions with a GP, and documentation in records. We were told that GPs reviewed consultations for non-medical prescribers daily, however these checks were not documented. Non-medical prescribers told us that support was available to them as and when needed, however there were no regular planned sessions of supervision with them, and no audits of their prescribing were carried out. The practice told us it would immediately change its processes to ensure appropriate clinical supervision was in place for these staff.

Staff had access to appropriate training to meet their learning needs and to cover the scope of their work. We saw that the practice had a mandatory training and frequency schedule in place, and there were systems to monitor when mandatory training updates were due. Staff had not completed learning disability and autism training; we were told that this was in progress after recent discussions with stakeholders. After the assessment the practice told us that staff had completed the first part of this training, and were booked onto the second part. Furthermore, the completion of role-specific training for clinical staff, along with evidence of completion, was largely overseen and held by those staff members themselves. The practice told us it would make changes to ensure there was a clear record and oversight of role-specific training in future.

Staff told us they had enough support to carry out their role and could seek further guidance from senior staff when needed, however some staff highlighted that some members of staff were more approachable and supportive than others.

There was an infection prevention and control (IPC) policy in place. Staff received IPC training and those who handled clinical specimens explained how they did this safely. Staff knew who the IPC lead was and how to raise IPC concerns. Monthly IPC audits were carried out, and at the time of the assessment no IPC actions had been identified.

We found the practice premises and equipment to be clean and tidy. Appropriate personal protective equipment was available to staff. Clinical waste was appropriately managed by an external company.

Medicines were stored securely and at appropriate temperatures. Refrigerators used to store vaccines and medicines were regularly cleaned, temperatures were monitored and logged, and products were appropriately stored within them. Staff regularly checked stock levels and expiry dates for medicines.

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 as the practice performance was in line with or better than national averages for all indicators. For example, data from April 2024 to March 2025 showed that the percentage of Co-amoxiclav, Cephalosporins and Quinolones prescribed was at 3.5%, which was better than the national average of 7.8%. Clinical audits of prescribing were also carried out which focused on improving care and treatment. There were Patient Group Directions and Patient Specific Directions in place which relevant staff worked to.

As part of our assessment a Care Quality Commission GP specialist advisor undertook searches of patient records on the practice’s clinical system. Overall, our searches showed that medicines were not always effectively managed by the practice. However, where issues were identified, the practice was proactive in addressing these. We found the following:

Methotrexate (a disease-modifying anti-rheumatic drug): We identified 19 patients and found that 1 had not received the required monitoring in the last 6 months. We looked at 5 patient records in detail and found that all but 1 were minimally overdue monitoring. In addition, there was no documented link to the condition for which the patients were taking the medication (to clearly indicate what the medication was being prescribed for). After the assessment the practice told us it had linked conditions to the medication, and that they had arranged blood tests for the other patients as required.

Aldosterone antagonists (potassium sparing diuretic): We identified 14 patients with heart failure who were prescribed this medication. Of these, 5 had not had the required monitoring. We looked at 5 records in detail and found that there was often no documented link to the condition for which the patients were taking the medication. After the assessment the practice told us it had carried out medication reviews for all these patients, booked them in for a blood test, and linked conditions to the medication.

Potential missed diagnosis of diabetes: We identified 31 patients. We reviewed 5 patient records and found that 4 had not been appropriately followed up. After the assessment the practice told us it had reviewed records and contacted several patients within this category, for appropriate follow up.

Medication reviews: There had been 241 medication reviews carried out in the last 3 months. We reviewed a sample of these and found that they sometimes contained limited information.

There was a process in place for recording and sharing medicine safety alerts. We saw that safety alerts were routinely discussed in monthly multidisciplinary meetings. However, a review of clinical records on this assessment indicated that safety alerts were not always actioned in line with guidance. For example, we found the following:

Valproate and Topiramate (teratogenic drugs, which refers to drugs that can cause birth defects): 4 females of childbearing age taking either of these medicines were identified. We reviewed 3 records in detail and found that annual risk acknowledgement forms were not in place. After the assessment the practice told us it had arranged for risk acknowledgement forms to be completed. Furthermore, the practice told us it had reviewed the records of patients prescribed other teratogenic medications and contacted them with advice as appropriate.