Northfield 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

At our previous inspection in May 23, the practice was rated inadequate at providing a safe service because they were unable to demonstrate that safe systems or practices were in place or working effectively in relation to medicines management, safeguarding, recruitment or the management of risks to patients or staff. At this assessment we have rated the practice as good for providing a safe service. We found safeguarding systems, processes and practices were implemented and that staff had received safeguarding training that was relevant to their role. We undertook clinical searches on the practices clinical system, this showed an improvement in medicines management. Recruitment checks were carried out in accordance with regulations. The practice had also improved their documentation of risk assessments and were able to provide up to date health and safety and infection, prevention and control risk assessments. Despite these improvements, some systems and processes were newly formed and would take time to fully embed and show sustained improvements.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients were given the opportunity to provide feedback and they knew how to make a complaint. The practice displayed feedback forms in the practice and information on how to make a complaint was available on site and on the practice website. However, some patients told us they experienced delays in getting a response after making a complaint.

Leaders told us they used incidents and complaints to improve systems and processes. The practice had recently recruited a patient experience manager who collected feedback from patients to improve services. Staff understood the need to raise concerns and report incidents and that these were discussed in team meetings. Staff and leaders were able to share examples of incidents and complaints which had been investigated and used to share learning. The majority of staff told us they felt they were able to raise concerns and report when things went wrong. The practice had QR codes on noticeboards that staff could use to raise comments or concerns anonymously.

The practice had a significant events policy, reporting forms were available to all staff members. There was also a matrix for reviewing significant events and complaints which could be used to look for themes and trends. Significant events and complaints were discussed at team meetings and learning shared with staff. The practice had a duty of candour policy and involved people when managing significant events. From the sample of complaint records we reviewed; we found the practice had responded to people’s complaints in a timely manner. The practice shared with us examples and minutes of external subject matter experts attending the practice to provide training, learning and development for staff. This included talks from Asthma UK, Chronic Kidney Disease (CKD) and dermatology specialists.

We did not receive any concerns from patients about delayed referrals or safe systems of care.

Staff who undertook referrals to secondary care understood systems and processes in place in order to minimise any potential delays. Staff had knowledge and understanding of local referral processes and arrangements. Staff were able to tell us the process for dealing with two week wait referrals and had systems in place to ensure timeframes were met. Staff shared examples of multidisciplinary team (MDT) meetings they attended and what was discussed at these. At our previous inspection, we identified that referrals were not always actioned in a timely manner and that there were limited MDT meetings. At this assessment we found that there was evidence of improvement.

We did not receive any concerns from commissioners or other system partners about delayed referrals or safe systems of care.

As part of our assessment we completed searches on the practice’s clinical system to look at how many results and documents were waiting to be processed. We identified that laboratory results were actioned in a timely manner however there was a delay in documents being processed. By the time we conducted a site visit we saw that all outstanding documents had been processed, the practice also provided their updated policy to deal with this.

Staff were able to tell us who the safeguarding lead was in the practice and how to raise concerns. They told us they received training in both safeguarding adults and children. Staff informed us they attended meetings where safeguarding was a standing agenda item. At our previous inspection we identified that gaps in safeguarding training for staff, at this assessment all except one member of staff had completed their safeguarding training.

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

The practice provided us with a recently updated safeguarding policy that was in place. This was accessible to all staff on practice computers. It included a flow chart to follow through when completing a safeguarding. The practice held multidisciplinary team (MDT) meetings at which safeguarding was a standing agenda. We saw examples of adults and children on the safeguarding register who had alerts on their records. At our previous inspection we identified that there was limited MDT working from the practice to discuss and share safeguarding information.

We received 1 give feedback on care submission which highlighted barriers for a person with specific needs being involved in their care. We addressed this with the practice as part of this inspection. Staff were given refresher training to ensure that the same issues did not happen again.

Staff told us that they had opportunities to attend multidisciplinary team (MDT) meetings with specialists where patients’ treatment could be discussed and used as an opportunity to involve people in their care. We saw examples of minuted MDT meetings involving the district nursing team where patients were discussed to help manage risks associated with them. At our previous inspection we identified that there was a lack of engagement in MDT meetings from the practice, at this assessment we found that this had improved.

At our previous inspection we identified that the practice had limited MDT meetings. They were unable to evidence that processes were in place for involving people to manage risks. At this assessment we saw evidence which showed that this had improved with more frequent MDT meetings taking place.

Leaders told us that since the previous inspection they had updated the health and safety risk assessments that were in place. Staff were able to inform us of what emergency medication was stocked, where it was located and processes for dealing with this. Leaders told us that they had used the last inspection as a learning event and as a result updated the policy for managing vaccine fridges and recording cold chain breaches.

We observed the environment and premises and found no concerns. We looked at treatment and consultation rooms, we also looked at the equipment within these. We observed vaccine fridges to be clean and frequently monitored. The practice had a comprehensive set of emergency medication which was accessible to all staff. Oxygen was stored and signposted appropriately. When reviewing the defibrillator we identified that the paediatric pads stored had expired, the practice addressed this immediately.

At our previous inspection the practice was unable to provide any evidence of health and safety risk assessments that were in place. As part of this assessment they provided evidence of updated risk assessments which included a fire risk assessment and monthly audits that had taken place. We saw evidence that regular checks were carried out when reviewing vaccine fridges and emergency medication. Following our site visit the practice updated their policy so that checks took place on defibrillator pads to ensure out of date equipment was replaced.

Some people had reported difficulties accessing services and thought there not enough staff.

Feedback from staff told us that they felt more staff were required, however the majority believed there was enough staff in place to do their jobs safely. Leaders told us that they completed audits on appointments to determine the level of clinical staff required for each week. If they identified areas that were short staffed, they could take actions to mitigate this. This included moving members of staff from one of the providers other sites to cover. Staff told us they had received relevant training for their role, and they had access to clinical supervision where appropriate. They told us they received regular appraisals and that their development and training was discussed in the appraisal. At our previous inspection we identified that staff files did not always contain information to demonstrate that appraisals had taken place, or that staff had received role specific training. Although this had improved from our previous inspection, the latest available data from the National GP Patient Survey and data which showed the practice was below national targets for childhood immunisations and cervical cancer screening which indicated that staffing could still be improved further.

At our previous inspection we identified that the practice had not always carried out the appropriate recruitment checks. At this assessment the provider had appropriate recruitment processes in place. We reviewed 3 personnel files during the site visit and found appropriate recruitment checks had been carried out, including disclosing and barring (DBS) checks. We reviewed the training records and found all staff had received and were up to date with mandatory training. Clinical staff had access to regular clinical supervision, this included the lead GP auditing the prescribing profile for clinical staff. The practice provided evidence to show that they had managed to reduce their prescribing cost. Give feedback on care submissions to CQC indicated there was a trend with patients not always able to access the practice, this showed there was not enough staff to meet the demands of patients. The latest available data from the National GP Patient Survey and data which showed the practice was below national targets for childhood immunisations and cervical cancer screening which indicated that staffing could still be improved further.

We did not receive any concerns from patients about infection, prevention and control.

All staff we spoke with were able to tell us who the lead for infection, prevention and control (IPC) was. Staff were able to tell us about the cleaning schedule at the practice. At our previous inspection, the practice was unable to demonstrate an effective and consistent system in place for IPC. They were unable to demonstrate that they had completed an IPC audit.

We observed the practice to be clean and tidy throughout. As part of our site visit, we reviewed a nurse room, treatment room, baby clinic room, consulting room and stock room. We discussed with the provider the use of fabric chairs in the treatment room as these chairs pose more of an IPC risk. The provider assured us that fabric chairs would only be used in consulting rooms where procedures did not take place. The provider had completed a risk assessment for this. All rooms were appropriate and clean.

At our previous inspection, the practice was unable to demonstrate an effective and consistent system in place for IPC. They were unable to demonstrate that they had completed an IPC audit. At this assessment they provided us with an annual IPC audit alongside monthly audits. An action plan was also produced following the audits, this included already identified risks such as the fabric chairs. The provider rented the building, the landlord commissioned an external company which was responsible for cleaning and dealing with clinical waste.

We received 1 negative give feedback on care submission which highlighted an issue for a patient being prescribed incorrect medication.

Staff and leaders told us they had systems and processes in place to support the safe prescribing of medicines. The practice employed 3 clinical pharmacists who supported the GPs in the practice. Prescribing and medicines management were discussed regularly at clinical meetings. Following our clinical searches the practice updated some of its policies, including medicines management in order to improve results for patients.

At our previous inspection clinical searches identified that there was not an effective system in place for monitoring patients prescribed direct oral anti-coagulants (DOACs). At this assessment we reviewed 5 patient records and 4 out of 5 had received a medicines review, 1 patient had been contacted numerous times but did not attend. However all 5 patients were due renal monitoring, this was fed back to the practice and a plan was in place to action this when we conducted our site visit. Our clinical searches showed good monitoring of patients on DMARD (a disease modifying anti-rheumatic drug) medicine. As part of our searches we looked at a medicines and healthcare products regulatory agency alert (MHRA) for women of childbearing age on teratogenic drugs. We identified that patients were sent a generic non-specific text to warn about the risks of this medication. We discussed this with the provider, they provided evidence to show this had been updated to provide patients with more information about the risks associated with this type of medicine, however, as this was implemented during the assessment we did not have assurance that this was fully embedded and would be sustained in order to be able to demonstrate a positive impact for patients. Searches also identified that patients on gabapentinoids were not receiving structured medicine reviews effectively. We looked at 5 patient records and 3 patients reviews had been carried out without the patient present. This was fed back to the practice at the assessment, they updated their medicines management policy to ensure patients on gabapentinoids received effective structured medicine reviews.

The practice had a policy in place for the management of medicines including repeat prescribing. The practice had systems in place to monitor the appropriateness of non-medical prescribers and clinical supervision was in place. The practice had up-to-date Patient Group Directions (PGDs) in place for nurses carrying out specific vaccinations and healthcare assistant staff had a good understanding of Patient Specific Directions (PSD’s). All staff administering vaccinations were up to date with refresher training. Our clinical searches identified that in some cases medicine reviews were taking place without the patient. This was fed back to the provider, shortly after the inspection they provided an updated medicines management policy which had clearer guidance for carrying out medicine reviews.

During our checks we found that all medicines were stored securely, and staff could quickly access these if required. The practice held appropriate emergency equipment and emergency medicine. Emergency equipment and medicines were checked on a regular basis. Vaccines were ordered and stored in accordance with national guidelines and the practice had systems in place to monitor the temperature of vaccine fridges.