The New 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 assessed a total of 8 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good. We found safety was a top priority, and staff took all concerns seriously. When things went wrong, staff acted to ensure people remained safe. Managers investigated all reported incidents to reduce the likelihood of them happening again. Staff supported people to live healthy lives and provided them with support and information on their care and treatment.

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.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. The surgery was an armed forces veteran friendly accredited GP practice, for meeting the standards required and supporting the health commitments of the armed forces covenant.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. 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 people support. Learning from incidents and complaints resulted in changes that improved care for others. The provider monitored and reviewed safety using information from a variety of sources and had clear policies and procedures to support staff to manage this information. There was a system for recording and acting on significant events and safety alerts. There was a culture of learning with staff encouraged to report concerns for the whole team to learn. Between January 2024 to September 2024 the practice recorded 84 events that had been investigated and learning shared as appropriate. The provider had a complaints policy in place and information was accessible to patients in various formats. The complaints we reviewed showed they were recorded and investigated appropriately. Patients received a final response which included details of the process if they wanted to escalate their complaint. Learning from complaints was identified and monitored to completion in a timely manner.

The limited feedback we received from patients prior to the inspection did not reflect any complaints about the systems except for access and appointments. The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse. The practice had a designated safeguarding lead. Staff knew how to identify and report concerns.

Staff had knowledge and understanding of local referral processes and arrangements. Reception staff had been trained to direct people to the most appropriate service. Staff understood their responsibilities to process routine referrals. Staff understood their responsibilities to manage urgent cancer referrals and follow these up to ensure patients had attended their appointments within the 2 week wait period.

We did not receive any concerns from commissioners or other system partners about safe systems, pathways and transitions.

Risk assessments were in place to determine the range of medicines held and a system was in place to monitor stock levels and expiry dates. The practice was equipped to respond to medical emergencies. There was medical oxygen and a defibrillator on site. We saw there were systems to ensure these were regularly checked and fit for use. All medicines and equipment we checked were in date and stored securely. Referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals. There was a process to check all patients with 2 week wait referrals had been referred appropriately and received their appointment with a specialist. There was a documented approach to the management of test results, and this was managed in a timely manner. Our searches showed no concerns for the management of test results.

People told us they felt supported by the practice. We did not receive any concerns regarding safeguarding at this practice.

Staff were aware of their responsibility to safeguard patients from harm and knew how to raise a safeguarding concern. All staff had completed training to a level appropriate to their role and were aware of who the safeguarding lead was.

We did not receive any concerns from commissioners or other system partners about safeguarding systems and processes.

The practice had effective systems and processes in place to ensure patients were protected from abuse and harm. There was a safeguarding policy that was accessible to staff and outlined who to contact if staff had concerns about a patient’s welfare. We looked at the training records of 5 staff members and found that all staff were up to date with safeguarding training appropriate to their role.

The evidence we reviewed did not show any concerns about people’s experience regarding involving people to manage risks at this practice.

Staff told us that people are informed about any risks and how to keep themselves safe through their treatment of conditions. Leaders told us of ways that they review consultations to ensure risks were managed whilst respecting patient choice.

At this assessment we found that the systems in place for the safe management of emergency medicines. Appropriate emergency equipment and emergency medicines were held, this included Adrenaline, held for the treatment of anaphylaxis (a severe, life-threatening allergic reaction). We saw that this was available in every clinical room.

Staff told us they felt safe to work at the practice, they told us facilities, equipment and technology were well-maintained so they could work safely and deliver a good quality of care to their patients.

We observed the practice including facilities and equipment to be well-maintained, accessible and suitable for the intended purpose.

We found risk assessments were completed, most remedial actions were completed, and the practice met the population needs. There were effective systems to ensure electrical equipment was regularly tested and medical equipment regularly calibrated. We saw evidence these had been completed annually. The practice completed regular risk assessments for fire, health and safety, legionella and Control of Substance Hazardous to Health (COSHH) and actions had been completed. The practice had maintenance records for checks of the fire alarm system, fire extinguishers and emergency lighting.

The limited feedback we received from patients prior to the inspection did not reflect any views on safe and effective staffing.

Staff received effective support, supervision and development to deliver safe care. They had regular appraisals and were able to discuss their development. We saw evidence of staff being upskilled to support their development and the practice. Staff told us staffing levels were adequate to cover absences and busy periods.

The provider had appropriate recruitment processes in place. We reviewed 2 personnel files during the site visit and found that recruitment checks such as disclosure and barring (DBS) checks and references had taken place. We reviewed the training records and found staff had received and were up to date with mandatory training and training required for their role.

The limited feedback we received from patients prior to the inspection did not reflect any views regarding infection prevention and control (IPC) at this practice.

The practice had clear roles and responsibilities, and staff were aware of these. The practice kept up to date with new risks to infection control which were shared with all staff.

On the day of inspection, we found the practice to be visibly clean and suitable personal protective equipment throughout the practice. We found posters to encourage staff around the practice including sharps injury, handwashing and clinical waste to support good practice.

The practice had effective processes to manage IPC which included a policy that was easily accessible to all staff. They had an IPC lead, and we saw evidence of regular IPC audits being completed which included any resulting actions. The practice had arrangements in place to manage healthcare waste and staff were aware of the action to take in event of sharps or contamination injury. The practice had undertaken environmental risk assessments and had carried out recommended actions.

As part of our assessment, our CQC GP specialist advisor undertook clinical record searches. These searches were visible to the practice. We found that improvements had been sustained in relation to the safe management and monitoring of high-risk medicines. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff received regular training on medicines management, and felt confident managing the storage, administration and recording of medicines. Staff managed medicines-related stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

Staff received regular training on medicines management, and felt confident managing the storage, administration and recording of medicines. Staff managed medicines-related stationery appropriately and securely.

Staff managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Staff showed how they disposed of expired or unwanted medicines that patients had returned. 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 people prescribed medicines with specific risks received recommended monitoring. There were suitable processes for staff to follow when dispensing medicines. There was an up to date cold-chain policy (the system of transporting and storing vaccines within the recommended temperature range). Vaccines were appropriately stored and monitored in line with UK Health Security Agency (UKHSA) guidance to ensure they remained safe and effective.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider were in line with the national averages.