The Mill Hill 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 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 practice 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. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Managers encouraged staff to raise concerns when things went wrong. 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 practice 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. The practice worked with other providers to deliver shared care and when patients moved between services. Referrals and test results were managed in a timely way. We saw that 97.9% of triage requests were dealt with within 24 hours of being received.

The practice 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.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The service maintained a register for vulnerable groups that included a safeguarding register. However, we did not see alerts placed on household members for these vulnerable patients on the safeguarding register. The leaders took immediate action to rectify this. There were regular meetings between the practice and other health and social care professionals and the service shared concerns quickly and appropriately.

The practice 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. 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 practice 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 recently undertaken and majority of the risks identified had been addressed and or the practice applied short term measures. Leaders informed us that redecoration and modernisation plans for the building were being carried out in a phased manner to minimise any disruptions to daily operations. There was a business continuity plan in place which was monitored and reviewed. However, we found that some of the practice policies were not specific to the practice such as the health and safety and fire safety policies, and leaders informed us they would review and update these.

The practice 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. Safe recruitment practices were followed.

The practice 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. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The practice 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. 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 usually followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. They took steps to ensure they prescribed medicines appropriately to optimise care outcomes. However, our clinical searches identified that some patients prescribed medicines primarily used to treat neuropathic pain, epilepsy and certain anxiety disorders had not been followed up in line with recognised guidance to avoid dependence and misuse (4 out of the 5 patient records checked). The leaders provided an update immediately following the site visit with a phased action plan to reach out to all patients on these prescribed medicines. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. No issues were identified in the patient records we reviewed, including patients with asthma, cases involving a potential missed diabetes diagnosis, patients with Chronic Kidney Disease (CKD) or those with hypothyroidism.

Medicines including vaccinations were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. 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. The provider had effective systems to manage and respond to safety alerts and medicine recalls.