Highlands 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

There was a proactive, systematic approach to managing safety. Staff, patients and partnership workers were actively encouraged to raise concerns. Everyone we spoke with, without exception, who was employed by the practice or in partnership with them, reported that they felt part of a team who discussed and corroborated together to find solutions to problems that may arise. The practice demonstrated through consistent monthly time to learn (TLT), that the primary response was always to learn and continuously improve. Leaders embedded, maintained and sought to continuously have a culture of openness and collaboration, and safety was everyone’s top priority. Staff demonstrated a commitment to improve safety and there were clear roles, responsibilities and structures to meet safety goals. Risks were robustly assessed and managed through internal and external learning events and strong significant event analyses which were consistently reviewed, to avoid negative outcomes.

There was enough staff with the appropriate skills to deliver safe care, and leaders were able to demonstrate that they reviewed staff rotas to address demand and staff capacity. The complete staff team had completed the necessary training to the appropriate level for their roles. The practice demonstrated how services were proposed, planned and implemented with people and communities. This was done in partnership with the Patient Participation Group (PPG), which had in excess of 200 members and operated virtually and face to face. People were given information about their choices of care to enable them to balance risks of harm versus positive outcomes.

At our last inspection, we rated this key question as Good. At this assessment, the rating remains Good.

This service scored 81 (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 demonstrated a proactive, consistent, and positive safety culture based on openness and honesty. Clear processes were in place for reporting incidents, near misses, and safety events, and these were followed by all staff without exception. Leadership consistently listened to safety concerns, thoroughly investigated issues, and ensured transparent reporting over time.

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 that safety was a top priority. The practice 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.

Patient complaints were infrequent, and feedback was actively encouraged, systematically documented, and thoroughly investigated. All patient feedback was reviewed to identify trends and themes that could drive improvements. Evidence showed that incidents, complaints and any negative feedback were routinely discussed in Time to Learn (TTL) meetings, with the full team involved in reviewing outcomes to maximise learning and support change. Verbal complaints were also documented and responded to. We saw evidence of consistently documented clinical learning events over the previous 2 years.

The practice was a training practice and at the time of the assessment there were 3 GP registrars completing their training there. The registrars we made contact with were overwhelmingly complimentary about the training and support given to them. One of the registrars was about to take up a salaried GP role at the practice on completion of their training. At the time of assessment, due to the positive feedback from current and previous registrars, the practice had more requests for registrar placements than they were able to fulfil.

The provider worked extensively with a range of local and national healthcare services to establish and maintain safe, effective systems of care for patients. We received consistent and positive feedback from these partners, including the palliative care team, the local safeguarding team, the integrated nursing team, the Primary Care Network, the Integrated Care Board, and other allied health professionals such as the social prescribers, pharmacists and emergency care practitioners. Comments from partnership colleagues included remarks such as, a wonderful surgery, the best they had come across, and nothing was too much trouble with staff going over and beyond what was expected to give the best care possible to patients. Despite not being employed by the practice, associated workers reported feeling involved and part of the team and many had asked if they could be based at the practice.

The practice had robust systems and processes in place to ensure information was effectively shared across teams and agencies, enabling the delivery of safe, coordinated care. Collaborative work with other providers supported continuity of care, especially when patients transitioned between services.

The practice had a duty doctor in place each day who was based in the surgery. Part of their duties included reviewing referrals and test results. As a result of this system all pathology correspondence was processed on the day that it was received, meaning that patients faced no delays in receiving their results and onward care and treatment.

The service worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. They had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They always 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.

We saw that the practice had excellent working relationships with local safeguarding partners and that regular multi-disciplinary meetings were held to discuss vulnerable adults and children. The GP partner safeguarding lead was pro-active within the local system, sharing learning and best practice to continually improve patient safety, including a county wide safeguarding conference.

The safeguarding lead was responsible for the maintenance of the safeguarding register. Monthly audits ensured that the information was relevant and up to date. We saw that all family members were coded in the clinical system in any safeguarding concern, so that any concerns relating to the vulnerable person could be addressed. As well as the safeguarding register, there were ‘pop-up’ alerts on the patient record of all vulnerable adults and children, giving prompts to ensure the patient’s vulnerability was considered.

The safeguarding lead had developed digital templates which were accessible to clinical and non-clinical staff, and which prompted which specific actions to take depending on the responses given. Staff we spoke with told us that this system enabled them to feel confident with raising a safeguarding concern. Staff also told us that the safeguarding lead was on site every day and responded to requests for advice and guidance in a timely manner. In the absence of the safeguarding lead, there was a deputy who led in this area. All safeguarding concerns were addressed on the same day.

During the assessment we saw examples of where the practice had intervened in a timely manner and worked closely with partner organisations to keep vulnerable children and adults safe from harm.

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.

Individual risks to people were assessed, and people were involved in this process as much as possible. People understood the risks relating to them and what they could do to keep themselves safe.

Clinical staff, including GP trainees, were provided with an extensive range of tools and guidance to aid them to support people living with long-term health conditions such as diabetes, hypertension, and lung disease. People with long-term conditions were regularly invited for health checks to monitor and manage their wellbeing.

As a result of partnership working with local community healthcare providers, the provider actively encouraged participation in health screening and had met or exceeded the local and national cervical screening targets.

Childhood immunisation rates met or surpassed the World Health Organisation targets across all age groups.

Staff at the practice worked extremely well as a part of a multi-disciplinary team to identify people with frailty or requiring palliative care. They produced a joint plan for ongoing care which was regularly reviewed. Plans were also reviewed as risk changed or when someone involved in the person’s care requested it, including family members or carers as well as healthcare providers.

Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take. 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.

The service was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care.

The service operated from a purpose-built building that provided essential facilities, including safe access for individuals with physical disabilities. The premises were clean and equipped with appropriate resources to support effective infection prevention and control.

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.

A comprehensive business continuity plan was in place to support any major service disruptions, such as IT failures. The lift enabled access to the first floor and in the event that this was out of service, the practice ensured that anyone requiring lower-floor access would be accommodated accordingly. Plans were underway to re-purpose the branch surgery which was just across the road from the main surgery, to provide more clinical rooms and thus be able to offer additional services. There were no concerns from staff about the health and safety arrangements.

The service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

Robust systems were in place to manage sickness, absences, or staff turnover, meaning the practice rarely needed to rely on temporary or locum staff.

We reviewed a sample of recruitment records which demonstrated that robust recruitment processes were followed, and all required documentation was consistently maintained.

Feedback from people was very positive, particularly regarding satisfaction with staff and ease of access to clinicians. Patients told us directly how much they valued receiving care from a stable clinical team, allowing them to see the same clinicians regularly and benefit from consistent care.

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.

Evidence showed that recent recruitment campaigns for clinical and non-clinical staff, including salaried GPs and nurses, attracted a large number of high calibre applications. The practice had no long-standing vacancies which meant that staff were not under added pressure to cover vacant posts.

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 attended relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The practice used digital technology to improve their infection, prevention and control standards. Each clinical staff member was responsible for carrying out IPC checks in their clinical rooms at the end of every session and this was recorded using a QR (Quick Response) code. Each response was automatically received by administration staff in real time who were then able tell if a check on any room had not been completed, or if anything needed addressing. Managers audited the checks regularly to review and address any trends or issues.

Staff we spoke with told us that this method of carrying out and recording IPC checks was thorough, simple to do and less time-consuming than previous methods they had used.

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

There were appropriate arrangements for the safe management, use and oversight of controlled drugs in line with legislation and best practice.

Accurate, up-to-date information about people’s medicines was available, particularly when they moved between health and care settings, in line with current national guidance.

The provider had standard operating procedures for managing repeat prescribing for patients who failed to attend for related health checks. Staff followed protocols to ensure they prescribed all medicines safely, however the clinical searches which formed part of the assessment identified some patients who had not been recalled for the required monitoring. For example, not all people who were prescribed an aldosterone antagonist (often used in the treatment of heart failure) had received the appropriate monitoring within the timeframe required by national guidance and not all people who were affected by a Medicines and Healthcare Products Regulatory Authority (MHRA) alert had been reviewed or contacted. Leaders had followed up all missed monitoring before the onsite inspection and new protocols were in place to mitigate the risk of this happening in the future.

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. For example, the number of antimicrobials, (antibiotics and anti-fungal type medicines) issued by the provider was lower than local averages. There was a programme of regular audits of prescribing which focused on improving care and treatment.

Staff had access to emergency medicines and equipment including oxygen and a defibrillator. There were procedures in place to ensure that equipment was regularly checked to ensure that medicines were available and were in date. Vaccines were stored appropriately, and regular checks were carried out in line with the practice cold chain policy.