Knoll Medical Practice

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 patients were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as Requires Improvement. At this assessment, the rating has changed to Good.

This service scored 78 (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 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.

Patients felt supported to raise concerns and felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong. Learning events and significant events were discussed during clinical meetings. There were processes to ensure staff had reviewed significant events and any associated learning. Staff felt there was an open culture, and that safety was a top priority. The provider 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 patients support.

Learning from incidents and complaints resulted in changes that improved care for others. For example, an incident with out-of-range refrigerator temperature resulted in improved systems and processes for monitoring the refrigerators which held vaccines and medicines. This meant the practice could be assured that vaccines and medicines were safe and effective to administer.

The service always worked with patients and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when patients moved between different services.

There were systems in place for processing information relating to new patients. The practice had implemented an automated system for the registration of new patients. This system had reduced the amount of time taken to register a new patient from approximately 4 to 5 days to less than 24 hours. We saw examples of where this system had been used to improve outcomes for patients. For example, one patient noted an urgent concern they would like to discuss with a GP. This patient was able to be contacted, seen and receive appropriate treatment within a few hours rather than after a number of days, which would have been the case without the automated system.

Referrals and test results were managed in a timely way. An automated system was used for normal results, the parameters of which were defined by clinicians. There was appropriate clinical oversight of this process. This meant that normal results could be automatically filed and freed up clinician time to review abnormal results.

The service had carried out an audit on hospital discharge summaries. This found a high percentage of discharge summaries did not always include all the relevant information and many were either not coded or coded inaccurately. This placed patients at risk of missed diagnoses, delayed monitoring, and unclear follow-up arrangements. The practice implemented system improvements including template standardisation, improved training, and audit processes. Initial findings were that the follow-up arrangements were clearer and therefore safer, and coding errors were more easily identified. The practice had plans to repeat this audit to fully assess whether this had resulted in improvements in patient care.

The service worked with patients and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving patients’ lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service 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 patients and acted on concerns working in partnership with other organisations.

The practice had taken part in a pilot study where the clinical and administrative safeguarding leads at the practice had access to a system which immediately gave relevant safeguarding information regarding children registered in the practice. This included whether there were any safeguarding alerts coded on the record, which local authority this was relevant to, and any named individuals involved in the child’s care, such as social workers. Information about attendance at accident and emergency or instances of the child not being brought to appointments was available. The pilot was ongoing at the time of our inspection; however, staff spoke positively about the impact on patients so far. This was particularly noted in the reduced time taken to collate and understand safeguarding concerns which was now available significantly quicker than previously, meaning the practice could begin engagement with families at an earlier date.

The service worked with patients to understand and manage risks by thinking holistically. They provided care to meet patients’ needs that was safe, supportive and enabled patients 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. All clinical requests for appointments were reviewed by a GP on the same day the request was made and triaged to ensure patients received timely, appropriate care.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There were 2 waiting areas in the practice. The largest waiting area was directly in front of reception and the second smaller area was down a corridor out of sight of reception staff. Leaders had completed a risk assessment to ensure patients who waited in the smaller waiting area were kept safe, despite being away from reception staff. For example, there were a number of red-flag (potentially serious) indicators which if identified in a patient, meant that patient would be asked to wait in the main waiting area. Practice staff completed regular walk arounds to check on patients in the smaller waiting area

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. There was a business continuity plan in place which was monitored and reviewed.

The service 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 patients’ 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 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 completed relevant training. Risk assessments and audits were completed, and actions taken to mitigate risks.

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

Staff involved patients in reviews of their medicines and helped them understand how to manage their medicines safely. Patients knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

Staff followed protocols to ensure they prescribed all medicines safely, and ensured patients received all recommended medicines reviews and monitoring. Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. 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. Staff followed established processes to ensure patients prescribed medicines with specific risks received recommended monitoring. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.