Thorntree 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 the last inspection in December 2015 this key question was rated 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 provider had processes for staff to report incidents, near misses and safety events. The provider had a proactive and positive culture of safety, based on openness and honesty. Staff and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to identify and embed good practice. Staff felt that they were involved in learning that took place and reported feeling comfortable raising concerns and were able to describe incidents and the learning and changes that took place as a result. Incidents were discussed in monthly clinical or whole team meetings. We saw examples of where learning had taken place as a result.

The provider’s systems included a formal end of year analysis of incident themes and trends, which could help to identify small gradual changes.

The provider 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.

Regular multi-disciplinary team (MDT) meetings were held to review the care of patients with complex conditions or those nearing end-of-life, ensuring holistic, well-coordinated care. Referrals and test results were managed in a timely way. Clinicians followed established care pathways for diagnosis, treatment, and referral to specialist services. Referrals to secondary care, including urgent 2-week wait referrals for suspected cancer, were managed promptly on a risk basis, appropriately followed up, and frequently audited. Patients were given additional ‘safety netting’ advice, to call the practice within a certain timescale if they hadn’t heard, or their condition deteriorated. Communications from secondary care, such as discharge summaries, were processed efficiently to ensure continuity of care.

Reception staff were trained in care navigation, which supported them to direct patients effectively, based on their needs, and promote preventative healthcare through social prescribing.

Systems and processes were in place to respond promptly when concerns arose about abuse or neglect, and the practice aimed to work closely with partner agencies to ensure a coordinated approach. All staff had received safeguarding training appropriate to their roles and responsibilities and demonstrated a good understanding and awareness of safeguarding procedures. The practice, in conjunction with 10 others in the area, had secured additional project funding in recognition of significant safeguarding challenges in the local area. This would be used to employ additional staff across the area to work collaboratively across the practices and with outside agencies to improve care and support offered to patients with safeguarding risks and concerns.

Staff were aware of who the designated safeguarding leads were for both adults and children and felt confident in escalating any concerns. Safeguarding alerts were added to the clinical record system, although our clinical searches identified that not all household members were clearly linked, creating a risk that a clinician unfamiliar with the patient may not be able to find all relevant information easily, especially in cases where children moved between different addresses. The practice were aware that their safeguarding register was not as up-to-date or accurate as they would like it to be, and had already flagged a data cleansing exercise as the first priority once the safeguarding additional project started.

Patients were informed of their right to request a chaperone, with visible notices in waiting and clinical areas to support this. Staff had received appropriate chaperone training.

The service collaborated with individuals to understand and manage risks effectively. Care and treatment was delivered safely and appropriately. An effective system was in place to respond to patient safety alerts and patients were given advice on the risks related to their conditions with clear guidance on what actions to take if their health deteriorated.

Staff were provided with guidance and appropriate supervision to help them to support people living with long-term health conditions.

Emergency equipment was available and maintained, although more frequent checks needed to be initiated for the defibrillator and oxygen cylinder. The practice stated they would change their procedures with immediate effect.

Staff showed awareness of recognising signs of a deteriorating patient and knew what action to take, such as escalating to the duty GP. Staff described good communication between clinical and non-clinical teams and an open door policy enabling efficient sharing of information.

The provider detected and controlled potential risks in the care environment, with weekly monthly and annual checks. They made sure care 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 service operated from a building that provided appropriate 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.

Staff received training in all relevant health and safety areas, including fire safety, infection control, and environmental risks.

The provider had processes in place to make sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff received a comprehensive role specific induction, with reviews at 1, 3 and 6 months to identify any learning needs.

They worked together well to provide safe care that met people’s individual needs. Staff described a supportive environment where they were able and encouraged to access a variety of training and development opportunities, including daily clinical and prescribing supervision where necessary.

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.

Appropriate Disclosure and Barring Service (DBS) checks were carried out on recruitment. The immunisation status for clinical staff was recorded.

The provider 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 (IPC) lead, and staff knew how to escalate any IPC related concerns. All staff had received relevant training. IPC risk assessments had been conducted and audits were completed, with actions taken to mitigate risks.

The provider made sure that medicines and treatments were safe and met people’s needs.

Although the medication review process was adequate, our clinical searches highlighted that often the review process was administrative to check safety, rather than a comprehensive patient present review where staff involved people in reviews of their medicines and discussed side effects and how well the medicines were working for them.

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, and were regularly competency assessed on medicines optimisation and safe prescribing. Nursing teams and GPs worked together to flag and assess repeat requests for high risk medicines. Staff managed prescription stationery appropriately and securely.

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.

The practice had very high prescribing rates of Gabapentin and Pregabalin, 2.5 times the expected rate given the England average. These medicines can be associated with serious harm or lead to dependence; these medicines may also be misused or diverted to illegal use. The rates of these had remained higher than the average over a number of years. The practice was over twice the expected prescribing rate for the high risk prescribing area of multiple psychotropics (substances that affect brain function, such as anti-depressants). Whilst often clinically necessary, prescribing of multiple psychotropics carries a number of increased risks that warrant close monitoring. The practice was almost twice the expected rate of prescribing for a group of medicines known as ‘Z’ drugs, which guidance states should only be prescribed for the management of severe insomnia for short periods of time only.

We saw there was a programme of clinical audit in place to ensure these medicines were prescribed safely after appropriate review, and the practice stated they were dedicated to opioid review and reduction. The practice was about to begin an Opioid and Gabapentinoid deprescribing pilot, which would allow them to access specialist support, training and regular contact with an inpatient specialist nurse. The practice continued to try to engage with patients, and were supported by prescribing policies which aimed for opiate reduction such as a limit to the number of repeat prescriptions which could be issued before the patient had to attend a medication review.