The Randolph 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. We assessed all the quality statements from this key question. At our last inspection, we rated this key question as good. At this inspection, the rating remains the same.

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 practice had a proactive and positive culture of safety, they listened to concerns about safety and investigated and reported safety events. Leaders informed us they had internal processes and systems in place to report, investigate, and learn from significant events, complaints, or incidents that occurred.

Managers encouraged staff to raise concerns when things went wrong and staff told us they knew how to identify and report concerns, safety incidents, and near misses. During staff meetings, the whole team discussed and learnt from clinical issues and lessons were learnt to continually identify and embed good practice. Staff felt there was an open culture, and that safety was a top priority.

The practice worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. 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. The leaders explained they had oversight of the workflow tasks to ensure they were all responded to promptly. On the day of the inspection, we did not find any delays in the patient workflow tasks. Referrals and test results were managed in a timely way.

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. The practice had safeguarding children and vulnerable adults policies. While both policies were generalised company policies, universal for all Operose health, staff we spoke with knew the lead at the practice and how to report concerns. Both policies included key information to ensure there was a safe system to identify, review, and safeguard patients.

The practice had a system to highlight vulnerable adults and children on their medical records. The practice had a safeguarding register which was maintained by the safeguarding lead. There were regular meetings between the practice and other health and social care professionals, to support and protect adults and children at risk of significant harm. We reviewed safeguarding multidisciplinary team meeting minutes, staff explained they had a system to follow up with children who were not brought to appointments or who had attended A and E to identify any patterns. We reviewed 5 staff files and found safeguarding training was provided appropriately, and staff had completed the correct level of safeguarding training for their role.

The practice worked with people to understand and manage risks by thinking holistically. The practice had guidance for staff to identify people with immediate life-threatening conditions and people whose health was deteriorating. This included immediate advice to give people and how to escalate risk to an appropriate clinician. The practice had a triaging GP every day who was available for advice and support as necessary. All staff had completed basic life support, and anaphylaxis training relevant to their role.

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. There was a business continuity plan in place which was monitored and reviewed regularly. During the inspection, we reviewed the practice’s premises safety processes. 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 undertaken and risks identified had been addressed. We observed fire exits were clear and fire safety equipment was easily available and regularly checked. Staff were aware of what to do in an emergency and where emergency medicines and equipment were stored. Allocated staff also knew how to safely manage spillages of bodily fluids. We observed that the clinical rooms and offices used by the GP practice were fit for use and there were regular room checks. All equipment had been checked and calibrated as required.

The leaders 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.

There was a range of clinical and non clinical roles within the practice. Leaders informed us that they were at maximum capacity for staff with the new employment of 2 salaried GP’s, a prescribing pharmacist, and an additional administrator. All staff worked together well to provide safe care. We found that training was up to date, learning needs and development of staff were managed appropriately, and staff were working within their agreed areas of competence. Safe recruitment practices were followed. We checked 5 staff files, and found staff had completed role-specific training. All staff files we checked had up-to-date mandatory training that was at the appropriate level. We spoke to a new starter who confirmed that they were going through their induction and that they had received support from leaders. Staff responsible for specific clinical interventions, for example, reviews of people with learning disabilities, long-term conditions, cervical screening, and childhood immunisation, told us they received specific training and the practice showed us this during our site visit.

The practice assessed and managed the risk of infection. Leaders ensured that facilities and equipment were safe, and that equipment was maintained according to manufacturers’ instructions. Risk assessments and audits were completed, and actions taken to mitigate risks. The practice had a designated infection, prevention and control lead and all staff had had relevant training. A legionella risk assessment was in place. There were systems for safely managing healthcare waste. Cleaning schedules were in place and followed and the practice had an external company for this. The premises were visually clean, hygienic, and uncluttered. Patients told us the practice was always clean and well-maintained.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. The practice 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 followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our inspection confirmed this. There were regular clinical audits of prescribing that focused on improving care and treatment.

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 received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines.

Medicines including vaccines 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. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring.