Mill View 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

This is the first inspection for this service since its new registration with CQC. This key question has been rated as Good. The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and any risks were mitigated. At the time of our assessment the provider had recruited further staff with the appropriate skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.

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.

Information reviewed demonstrated that people had opportunities to provide feedback and they knew how to make a complaint. For example, there had been one complaint raised by a patient since the provider registered and they felt supported to raise concerns and their concerns were taken seriously, listened to and acted upon to make improvements. Feedback and information were available in the practice and on their website.

Staff were encouraged to raise concerns when things went wrong. During the practice meetings the team discussed and learnt from significant events, complaints and patient feedback. Staff felt there was an open culture and understood their duty to raise concerns and report incidents, and most were able to share examples.

The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints and significant events and when things went wrong, the practice offered apologies to people, lessons were learnt from individual concerns and complaints and action was taken as a result to improve the quality of care.

We did not receive any feedback about people’s experiences in relation to safe and effective staffing. However, the results from the national patient survey demonstrated that 89% find the reception and administrative team at this GP practice helpful, 55% usually get to see or speak to their preferred healthcare professional when they would like to and 56% say they have had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses.

The provider made appropriate and timely referrals in line with protocols and up to date evidence-based guidance. This was supported by a system in place to ensure all patient information including documents, laboratory test results and referrals were reviewed and actioned in a timely manner. We found that test results were managed in a timely way and all workflow was followed up and actioned appropriately. Staff and leaders told us they had been in receipt of information governance training and safeguarding children and adults. They reported pop-up alerts and read codes were used as a safety net and referrals were discussed between the administration coder at the primary care network and the clinical team. Handover to the out of hours service were managed by the GPs.

The provider had processes in place that was monitored and managed to keep people safe. For example, the provider held weekly meetings with care homes to discuss information relating to patient care and treatment. Information was available to patients to support NHS England’s Accessible Information standards (AIS).

The practice maintained policies and procedures to enable safe systems, pathways and transitions for patients. Induction training included practice workflow. Electronic records were maintained with clinical oversight of urgent referrals to ensure that appropriate actions taken were timely. A protocol for the management of test results was in place to ensure these were reviewed and managed appropriately. Abnormal results were reviewed by a GP and patients recalled. GPs had access to patient safety alert information. Shared care and partnership agreements were in place with relevant parties.

We did not receive any feedback about people’s experiences in relation to safeguarding. However, results from the national patient survey demonstrated that 75% say the healthcare professional they saw or spoke to was good at treating them with care and concern during their last general practice appointment and 67% say the healthcare professional they saw or spoke to was good at considering their mental wellbeing during their last general practice appointment.

Staff told us they had access to their safeguarding policy, were trained to the appropriate level in accordance with their role and demonstrated a clear understanding of safeguarding. They knew who the designated clinical and administrative safeguarding leads were and of their deputising arrangements. Staff told us there were systems to identify vulnerable patients and they were in regular contact with the PCN safeguarding administrator who reconciled the safeguarding registers.

We spoke with the GP who was the safeguarding lead who told us they held monthly safeguarding meetings to review safeguarding registers. We saw evidence to assure us this was actioned appropriately.

Safeguarding systems, processes and practices were developed, implemented and communicated to staff. The practice worked with the administration Primary Care Network (PCN) staff member who reconciled registers with the local safeguarding team. The lead GP provided reports when requested for example, child protection conferences. Staff were in receipt of training at the level required for their roles. We fed back that meeting minutes did not flow in respect of actions taken and updates which the Lead GP actioned. We found the chaperone policy and the staff handbook noted a contradiction in the staff able to provide a chaperone service which was feedback to the Lead GP and this was actioned.

We saw evidence that a few patients had reported to the practice issues in relation to prescribing processes. The practice investigated these via their significant event process and action was taken immediately. Following a significant event analysis review the practice mitigating actions and systems were strengthened.

Reception and dispensing staff told us they were aware of actions to take if they encountered a deteriorating or acutely unwell patient. They had completed care navigation training awareness and been given Sepsis red flags guidance. This however was not in the reception area at the time of our discussions. Staff spoken to told us of how they would respond to potential medical emergencies such as chest pain and stroke symptoms. They told us they had no prompts or flowcharts to provide them with further guidance or support but noted they could easily contact the GPs.

The practice was equipped to respond to medical emergencies (including suspected sepsis) and staff were suitably trained in emergency procedures. After our assessment the practice took further action to strengthen processes. For example, face-to-face basic life support training and the provision of guidance/prompts for patients presenting with potential emergency symptoms.

Staff reported they were satisfied with the health and safety arrangements in the practice and had completed training such as fire safety, cardiopulmonary resuscitation (CPR) and basic life support. Staff were all aware of their overall responsibility for ensuring a safe environment at the practice and had completed health and safety awareness training. Arrangements were in place for the oversight of health and safety and fire safety, as well as liaising with the landlord on the building premises maintenance and contracts.

During our observations we identified gaps in the maintenance of a safe environment. For example, we saw two fire doors on the ground floor required attention as they did not fully close without use of the handle. On the day of the inspection this was rectified. There was no fire evacuation plan of the premises within the risk assessment or posted within reception areas for patients and staff. This was completed and forwarded post inspection with the exception of showing where the oxygen was held. We observed a few environmental areas that posed a potential risk to patients, staff and visitors. For example, the first-floor breast feeding/consulting room next to the stair well had not been risk assessed.

The provider was a tenant of the practice premises. Most but not all records were held of maintenance and completed health and safety risk assessments. Absent documentation was requested and the provider either asked for these from the landlord or actioned these requests promptly. For example, records held for fire drills undertaken contained no named staff and the practice put in place a new log book. A fire risk assessment had been completed but did not contain the building evacuation plan. The provider forwarded this post inspection, but it did not contain the oxygen cylinder placement information for the fire service. The first-floor stairwell had no risk assessment in place. There was no copy of the 5-year electrical safety certificate held. The provider ensured this was completed on 18 September 2024 following the inspection.

We did not receive any feedback about people’s experiences in relation to safe and effective staffing. However the results from the national patient survey demonstrated that 89% find the reception and administrative team at this GP practice helpful, 55% usually get to see or speak to their preferred healthcare professional when they would like to and 56% say they have had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses.

Staff and leaders told us workforce planning and safe recruitment had taken place. Reception and dispensary staff considered adequate numbers of staff with the right skillsets were employed once the new nurse and healthcare assistant (HCA) started, to meet patient’s needs. They confirmed they received a role specific induction and were provided with training and shadowing opportunities with experienced staff members. There was no nurse, HCA or staff with extended roles at the time of our inspection and assessment to speak with in respect of clinical supervision and competency reviews. However, this had been actioned and a new nurse and HCA was due to start employment in the upcoming weeks.

The practice had recently recruited two new staff yet to commence in post. We sampled staff files and found DBS checks were in place, but some had been completed by previous employers. Not all staff had received satisfactory information about any physical or mental health conditions which were relevant to their ability to carry on or manage their work. There were copies of immunisations that staff had received in their files, but these were not always in line with the Green Book. The practice was in the process of obtaining the required documentation for staff due to work at the practice shortly. Evidence during staff conversations suggested a staff induction was available. However, we did not see these inductions in staff files.

We did not receive any feedback about people’s experiences in relation to infection, prevention and control (IPC). However, you can find more details in the evidence category findings.

Staff told us they had access to an infection, prevention and control (IPC) policy, appropriate personal protective equipment and had received training. They were able to advise of the designated IPC practice lead and had no concerns in relation to the cleanliness of the practice. The practice manager was able to show a copy of the latest audit undertaken on 2 July 2024 where no remedial actions were identified.

The areas of the practice we reviewed were visibly clean on the day of our site visit. Staff had access to adequate supplies of personal protective equipment. However, the arrangements in place for maintaining cleaning standards and schedules were not always effective. For example, we saw undated disposable curtains, COSHH products in consulting rooms, mops not appropriately stored, cleaning schedules ticked but not signed and records that did not inform on when the carpets were last cleaned. The provider took action in response to some of the minor infection, prevention and control omissions we identified during our site visit.

There were systems in place to support staff with infection, prevention and control (IPC). The practice employed a cleaning contractor. Cleaning schedules were in place and ticked but not signed. The inspection team identified a number of areas for improvement, for example, the need to initial the cleaning schedules, mop heads storage, dating disposable curtains, records of dates of carpet cleaning, some cleaning products potentially hazardous to health were not locked away. We were assured the cleaning contractor would be made aware of the required changes. Staff immunisation history was not available in all staff files we sampled. Staff had completed infection prevention and control training and were aware of the systems and processes to follow to ensure clinical specimens were handled safely in their role.

We did not receive any feedback about people’s experiences in relation to medicines optimisation. However, results from the national patient survey demonstrated that 56% of patients told us they have had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses.

Staff received training and were competency assessed to manage medicines safely. Staff understood and followed appropriate policies and procedures so that there was a clear audit trail for the management of information about changes to a patient’s medicines. There was a designated person responsible for providing safe and effective leadership for the dispensary.

Medicines and medical gases were stored securely at appropriate temperatures. Medicines refrigerator temperature was monitored and recorded daily; this was within the required range. However, record keeping of controlled drugs was not always managed as per the provider’s policy and national guidance which the provider took action to review following our assessment.

There were systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received the recommended monitoring. However, our clinical search findings identified 3 patients who needed electronic alerts adding to their records in respect of the medicines that required monitoring. Two patients on a medicine combination which had a patient safety alert required a review. The provider following our feedback recalled patients and put mitigating actions in place. We sampled three medication reviews but could not assess the quality as they simply stated that a review had taken place. There was a process in place for staff to follow to enable safe acute and repeat prescribing of medicines. Emergency medicines, kept at the practice, were managed appropriately. There was medical oxygen and a defibrillator on site and systems to ensure these were regularly checked and fit for use. There were appropriate operating procedures to support staff to carry out this function safely in the dispensary. Records of controlled drugs (CDs) were not made in line with legislation and best practice. We also found NHS prescription stationery was not stored and recorded as per national guidance to have a robust audit trail. The provider took action to address this during our assessment.

The practice completed audits on medicines requiring regular monitoring. Patients requiring a monitoring recall or review were contacted by the reception/dispensing staff. There was a process for the safe handling of requests for repeat medicines and medicines reviews for patients on repeat medicines.