Archived: Glemsford Surgery

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• 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 Requires Improvement. At this assessment, the rating has changed to Good.

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, 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 they could raise concerns and felt staff treated them with compassion and understanding.

Leaders at the practice encouraged staff to raise concerns when things went wrong. We saw in the minutes of staff meetings, concerns were discussed, and learning and action points were agreed. We found actions identified had been completed or an appropriate time period for the actions to be completed was seen. Staff felt there was an open culture, and that safety was a 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 people support. Learning from incidents and complaints resulted in changes that improved care for others. For example, following complaints from people who could not use the online appointment system, a process was initiated for receptionists to create a sign in and book an appointment.

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

We received mainly positive feedback from people which related to the management of test results and referrals. Care home representatives confirmed people who had recently moved into a care home were both registered with the practice and received a health check by a clinician in a timely manner. They gave positive feedback in relation to timely, appropriate referrals being made, and being able to self-refer to some services.

There were systems in place to process information for people registering at the practice, which included for example homeless people and temporary residents.

The staff described a manageable backlog of new people’s notes which required summarising. All peoples records received by the practice that required summarising were reviewed immediately to prioritise their urgency.

Staff told us they had the information they needed to deliver safe care and treatment. Procedures were in place to manage the flow of work within the practice. This included for example, how results for a range of tests were reviewed and filed. People’s correspondence which was deemed urgent, for example scan results and ambulance reports were prioritised. Procedures were in place to ensure any required actions were reviewed and authorised by an appropriate clinician. Test results were managed where possible by the requesting clinician or the duty GP to ensure that when a clinical colleague took leave, their tasks were appropriately delegated and acted on. We saw tests results were cleared every day.

Staff who were involved in making referrals were clear about their role, and daily checks were in place to ensure people who had been referred for suspected cancer had attended their appointment, and follow up arrangements were in place. The practice had systems to ensure cervical cytology results were received. They also had systems to audit and follow up people who had an abnormal result with a recall system.

The practice worked with other providers to deliver shared care including when people moved between services.

We received positive feedback from partners about the systems used at the practice to ensure people received care and treatment from a range of services.

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 shared concerns quickly and appropriately. People who provided feedback for this assessment had no specific views or concerns in this area.

Staff told us they had received training in safeguarding children and adults, were confident to report any concerns and knew who the safeguarding leads in the practice were. Safeguarding policies were in place and known to staff.

The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. The practice held meetings where safeguarding was discussed. We reviewed the meeting minutes and saw people’s needs were discussed, and actions were agreed and followed up.

Arrangements were in place to follow up vulnerable people who had not attended for their appointment, which included for example, post-natal, and secondary care appointments for children and vulnerable adults.

We received positive feedback regarding the practice safeguarding arrangements and practice staff attendance at engagement and external meetings, which included safeguarding administrators.

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.

People who provided feedback for this assessment had no specific views or concerns in this area.Care home representatives told us practice clinicians involved people, their carer’s and family, appropriately to ensure care and treatment met individuals’ needs and preferences.

The practice had guidance for staff to identify, assess and manage people whose health was deteriorating, and for managing medical emergencies. Staff we spoke with told us they could recognise people whose health was deteriorating and knew the action to take. The practice had a duty GP every day who was available for immediate advice and support when necessary. The staff had received training, relevant to their role to support them manage deteriorating patients and medical emergencies. The practice had risk assessed which emergency medicines and equipment to have on site. There was a system in place to monitor stock levels, temperature control and expiry dates of emergency medicines. These were checked on a monthly basis and documented.

The practice detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People who provided feedback for this assessment told us they felt safe receiving their care and treatment, and had no concerns about the practice environment.

Arrangements were in place to keep the practice premises well maintained. There were a range of risk assessments to identify, manage and mitigate risks to people. Issues identified from risk assessments and safety checks were discussed at team meetings action had been taken. Ongoing checks relating to fire safety, electrical safety and equipment calibration had been completed. The practice had an up-to-date business continuity plan which identified a range of risks and how they would be managed. Risks identified had been addressed and a business continuity plan was in place which was monitored and reviewed.

During the site visit, we observed fire exits were clear and fire safety equipment was easily available and checked by an external company.

The practice used technology securely and effectively and conformed to relevant digital and information security standards with arrangements in place for the confidentiality of data management.

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.

Feedback from people was positive in relation to the knowledge, skills and competency of clinical staff. Representatives from care homes were also positive about the knowledge of clinical staff and the clinical care provided by the practice.

The practice had systems and processes for safe recruitment of staff. Staff personnel files were held centrally by the provider, West Suffolk NHS Foundation Trust. We were assured that appropriate recruitment checks had been carried out, which included Disclosure and Barring (DBS) checks. DBS checks were in place for all staff who required them for their role. We received assurance that professional registration of clinical staff was checked at recruitment and on an ongoing basis. All new staff received an induction programme that was tailored to their role.

New staff members told us they had received an effective induction and felt supported by management and colleagues in their new role. Staff told us they had received sufficient training, and we received evidence of competency checks and oversight of their work, and regular appraisals.

Some staff were multi-skilled and worked flexibly in response to peak times of demand from people using the practice, and to minimise the impact of unexpected staff absence. The majority of people we spoke with told us there were sufficient staff.

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.

Feedback we received from people was positive in respect of the cleanliness of the practice environment.

The practice had a Lead Nurse, and administrative support for infection, prevention and control (IPC), and had protected time to undertake the requirements of this role. The IPC lead carried out regular monitoring, audits, IPC staff training and attended regular update meetings. The IPC lead had support from a GP Partner for clinical support and advice.

During our on-site visit, we observed the practice to be clean and tidy. We saw documented checks of cleaning and arrangements to effectively communicate with cleaners to resolve any issues. There were records of equipment cleaning and appropriate arrangements to manage clinical waste in place.

Policies and guidance were available for staff and at the time of the site visit, all staff had completed training relevant to their role. Staff told us they had no IPC concerns and told us about the systems in place for safely dealing with clinical specimens and spilt bodily fluids

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.

As part of our assessment, we carried out remote searches of clinical records to check how the practice monitored people’s health in relation to medicines. We identified 31 people prescribed an immunosuppressant medication, of which 9 people were identified as not having some of the required monitoring. We reviewed a sample of 5 people’s records and found appropriate monitoring was in place for all 5. However, we found the day of the week people should take their medicine was not always recorded. During the onsite visit we received assurance that records were being updated with the day of the week people were taking this medicine, to support clinicians when they were prescribing.

A further search identified 15 people prescribed medicines to manage heart failure, of which 7 people had not received all the required monitoring. We reviewed a sample of 5 people’s records and found all 5 had not received their blood test monitoring within the expected time period. 1 patient had not had their results from the hospital laboratory system added to their records; 1 patient was identified as having difficulty with blood tests. At the site visit we found the other 5 people identified by our searches had been invited to have blood monitoring. We were told a regular repeat monitoring report had been set up to keep a check for the future.

A review of the remote long term condition management clinical searches showed 5 people did not have the expected monitoring recorded for their condition. At the site visit we found all monitoring had been updated and a repeat monitoring check was in place for the future.

We reviewed the quality of medicines reviews we found some people were overdue a medicines review. At the site visit those identified had been added to an action plan and the people had been booked for review. A repeat monitoring check was in place for the future.

We received positive feedback from people in relation to medicines management. During the site visit 2 of the people that we spoke with had been called into the practice to have their medicine reviewed. The care home representative told us the repeat ordering process worked well, people’s medicines were regularly reviewed, and staff answered and dealt with any queries effectively.

Patient Group Directions (PGDs) were in place to allow nurses to give vaccinations without a prescription and examples we reviewed had been appropriately authorised for use within the practice.

During our onsite visit we observed arrangements were in place to manage medicines safely. Medical gases were stored safely with appropriate signage in place. Vaccines were appropriately stored, monitored, and transported in accordance with national guidelines and medicines that required cold storage were being appropriately kept within temperature monitored fridges. Immediate arrangements were in place if temperatures went out of range. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and the temperature control of non-fridge items. Prescription stationery was stored securely, and the system to monitor prescription stationery was effective.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes. We reviewed a range of prescribing indicators, which included for example, antimicrobials, anti-psychotics, and antibiotics. The practice were within the expected range for prescribing these medicines. The practice prescribing data for hypnotics were more positive compared with local and national practices.

Staff told us they involved people in the reviews of their medicines and helped them understand how to manage their medicines safely.

Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. The practice had effective systems to manage and respond to safety alerts and medicine recalls. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was lower than local and national averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.