Healey 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 22 quality statements from this key question. We found safety was a priority, and managers took 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. There were gaps, however, in processes in place to assure the provider that all people with ongoing conditions were always correctly monitored.

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.

Feedback from CQC Give Feedback on Care (GFoC) returns indicated that, in the main, people felt the practice provided safe care and treatment because referrals were timely and appropriate. People commented that the practice was clean and clinical staff were knowledgeable. The results in the NHS 2024 GP patient survey indicated patient satisfaction relating to care and treatment was in keeping with local and national averages in that over 90% of patients felt the clinicians listened to them, over 90% of patients trusted the opinion of clinical staff, over 90% of patients were involved in the decisions about their care and over 90% felt their needs were met during the last appointment.

Leaders described changes made as a result of safety concerns raised during the CQC inspection clinical searches and supported this with written evidence. Leaders described the checks and balances in place to promote safety which included daily supervision for, and feedback from, the doctors training as GP’s. Leaders described clinical and medicines audits needed to meet the requirements of their NHS contract was used as means of measuring safe practice. Staff confirmed training in health and safety topics such as managing specimens and said there was sufficient safety equipment. Administration staff described processes for maintaining safety such as those for dealing with test results.

Processes and systems did not fully support a learning culture. Full staff meetings to discuss significant events did not take place. The incident reporting policy was not specific to the practice, included detailed information which had not been revised to ensure the information was fully accessible and relevant to Healey Surgery staff. The policy included sections on all aspects of investigating incidents, complaints and concerns. The incident reports and records completed by the practice did not reflect the guidance in their policy. The policy also included specific templates for recording and assessing incidents and concerns, however these were not used, and the policy had not been updated to describe the alternatives that were used. Records indicated that clinical staff meetings included discussions and sharing information for lessons learnt and any clinical issues raised. Records also confirmed significant events and reflections on patient outcomes were discussed between partners and experienced doctors individually at each clinical session. It was clear that learning took place for individual doctors, however, it was not always possible to identify how this learning influenced the future safety of the practice.

People told us they were signposted and referred to other agencies so that their overall needs could be met.

Managers and staff could explain how people moved between services. Leaders confirmed they were beginning to audit referrals and had begun by recording baseline information about cancer diagnosis made as a result of referrals by the practice. Staff understood their responsibilities for monitoring the progress of referrals. They described the direct actions they took to progress referrals and encourage people to attend monitoring appointments. They described contacting people about attending the practice to discuss test results. We saw during observation that staff were rushed and there were not enough administration staff to complete all the tasks required.

Partners reported that systems for health referrals and referrals for social support was embedded. Feedback from Healthwatch indicated one patient felt their referral was not dealt with in a timely manner. At the time of inspection information indicated the referral system was being reviewed by the practice.

We saw evidence of discussions with administration staff about safe working practices such as managing tasks, discharges, repeat prescriptions and partnership working, Observations indicated the process worked from day to day. Clear written protocols, however, were not always evident about time-frames by when tasks should be completed. We saw that appropriate systems were in place to manage prescribing for patients and medicines optimisation. Reports confirmed that the staff and leaders ensured patients benefited from a well-resourced social prescribing service. Leaders and staff also promoted well-being by appropriate referral to well-trained and supervised healthcare professionals. CQC Clinical searches revealed referrals to specialist services were appropriate. There was a documented approach to the management of test results. We did not find evidence of undue delay; however the practice had started to monitor the timeliness of referrals. The results and learning was not available at the time of the inspection. The CQC clinical searches, however, also revealed some gaps in the recording and coding in the clinical system which meant it was unclear, at times, whether appropriate advice was given to patients on how to manage their conditions. A small number of the clinical records reviewed during the clinical searches also identified improvements could be made in the detail of records made. The practice was responsive and made changes in light of feedback given during the CQC assessment. The provider took immediate and appropriate remedial action which included confirmation of duty of candour and additional processes including adding flags to records and allocating specific tasks for administration staff to complete.

People who gave feedback did not highlight any concerns about safeguarding.

We found a clear understanding amongst leaders and staff about ensuring adult safeguarding and child protection. There were safeguarding registers which were updated, and the safeguarding lead contributed to safeguarding meetings as required. The practice had means of identifying vulnerable patients and vulnerable patients who missed appointments were followed up. When interviewed staff knew how to raise and follow-up safeguarding concerns.

We did not receive feedback from partners about safeguarding and child protection.

Registers and clinical meetings kept the practice up to date about patients who required additional safeguarding monitoring. Staff safeguarding training was up to date and they had completed the correct level of training depending on their roles. All staff were aware of the safeguarding lead and managers described attending safeguarding meetings and we saw protocols for responding to children who missed appointments and vulnerable adults who missed appointments. Information about external contacts in relation to safeguarding was readily available. The practice adhered to the local ICB safeguarding policies and procedures. There was a safeguarding register updated when new information was received, and the safeguarding lead contributed to safeguarding meetings as required.

We found patients did not understand the reasons and safety netting in place when they were signposted to alternative allied health care professionals or alternative services instead of seeing a doctor. We found that many patients were especially negative about the experience of being signposted, even if they had a positive outcome from the health professional who provided their care.

Managers described the ways in which people were supported to manage risk and this information was reflected in the information provided by patients.

We saw a care navigation system was in place. Administration staff had completed care navigation training which included using specific triage questions to help identify the very sick patient and to navigate patients to the right person, at the right place, at the right time. There was a process to manage urgent referrals. The telephone holding message was standardised and provided a clear description of symptoms that required emergency intervention. The new telephone system has the capacity to record calls so that quality monitoring checks can take place to ensure consistency. We saw people were supported to make their own decisions about following specific health advice, however, the processes for monitoring those patients should be strengthened. Reflective practice records made by doctors indicated that patients were given plenty information about the choices available and potential impact of the choices they made.

Leaders and staff were proud that building was purpose built and fully accessible.

We saw that the premises was secure, clean and well-maintained. Equipment used to deliver care and treatment was also well maintained, servicing and calibration was up to date. Rooms were kept locked as required. There premises was spacious with plenty of rooms that could be used flexibly as required.

The provider had appropriate health and safety protocols in place, fire safety risk assessments and safety checks had been completed. Actions plans which included competing maintenance checks were in place.

Most people who responded to the 2024 NHS GP patient survey found that reception staff were unhelpful and the experience of dealing with the practice difficult. Most of the negative comments made in the feedback given through the CQC Give Feedback on Care service concerned a poor attitude from administration staff. However, all comments about doctors and professional staff were positive.

Leaders told us all staff received the support they needed to deliver safe care. This included supervision, appraisal and support to develop and improve their practice and where needed, ensure successful professional revalidation. We found this was true for clinical staff and allied health care professionals. We noted, however, that the practice had been without a practice manager for nine months at the time of the inspection. Feedback from leaders did not, initially, indicate that they understood the impact this was having on the performance and running of the administrative side of the practice, especially in relation to patient experience. Leaders confirmed they had advertised to fill the post, but suitable candidates had not come forwards. This meant the practice manager tasks had been shared between the partners and remaining senior administrator staff. The leaders stated that the impact of not having a practice manager was negated because they had an open door policy and staff could some and talk to them about issues at any time. Administration staff feedback indicated that the GP partners were approachable, sympathetic, and hardworking. During the inspection, following CQC feedback, the partners took additional steps to increase administration support and secure an interim practice manager.

Staff received training appropriate and relevant to their role. Recruitment checks were conducted in accordance with regulations (including for agency staff and locums). Healey Surgery is a teaching practice and significant portion of consultations were carried out by ST 3 doctors in the final phase of their GP training under supervision of the partners. ST3 GP registrars are in their final year of GP training, most will have their own surgeries, but will be supervised by their GP trainer until the final exam and sign-off. We saw that a new appointment system had been installed in 2024 with the capability of monitoring appointments and tasks. This process provided evidence that the partners used feedback to identify how appointments and tasks could be better managed to allow an increase in the availability of face-to-face appointments, either at the practice or using an extended care service. The supervision process for administration staff was unclear. It was reported that supervision had been completed but records did not fully confirm what was discussed. We were informed that because the staff group was small information was easily shared and staff could approach the partners individually with requests for training or advancement. Processes were not used to ensure equity of access to training, and opportunities for advancement. Meeting notes confirmed staff who came forward were supported, but how this supported the an overall improvement plan was not evident and how opportunities were shared was not clear.

People gave feedback confirming that the facilities were clean.

Staff knew who the infection prevention and control lead for the practice was. They felt supported in understanding infection prevention and told us they received appropriate training, such as hand washing, recognising sepsis and handling specimens.

The premises were clean, and equipment, fixtures and fittings met best practice standards. Equipment was also correctly cleaned and serviced. This helped to protect patients and visitors from the spread of infection. Clinical staff were observed as bare below the elbow as per guidelines. Staff who handled clinical specimens did so safely. Sufficient PPE and hand washing facilities were available in clinical areas.

The responsibility for infection prevention and control was clear. There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance. The provider completed regular infection control audits, the results of these were actioned to maintain and improve cleanliness. Staff had completed training about various aspects of infection control.

Patients who provided feedback confirmed they were advised about how to request repeat prescriptions, however a small number of people indicated that changes in medication prescriptions or medicine collection did not always run smoothly.

Leaders commented they worked with the wider GP community to ensure effective medicines optimisation for patients. Leaders and staff confirmed new processes had been introduced to improve the efficiency and safety of managing repeat prescriptions. Staff confirmed that support was available to patients if they needed help with the new processes.

We saw that staff managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. We noted that the practice did not stock all of the medicines recommended in best practice guidance so the provider should consider documenting the risk assessment and rationale for not including these medicine.

We completed a clinical search as part of the assessment process. We found that staff followed established processes to ensure people prescribed medicines with specific risks received recommended advice, however, information recorded by doctors about medicine reviews were not always in enough detail, and, it was not always clear that people taking high-risk medicines had been checked and monitored often enough and in line with recommendations. This was discussed with the partners who took immediate action to review all patients on medicines that should be regularly monitored. Immediate action included changing processes so that patients start being invited for monitoring with more time before the checks were officially due. Other processes reviewed included how patient records could be updated more quickly when reviews had been carried out by secondary care for example a hospital consultant. We found most people identified as without a review by the clinical search had in fact been reviewed, by a different service or had not attended a review when invited. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff managed medicines-related stationery appropriately and securely.

Staff took steps to ensure they prescribed medicines appropriately to optimise health outcomes, including antibiotics. Prescribing data reviewed confirmed this, for example, data indicated that the practice correctly prescribed less antibiotics than other practices in the local area and nationally. In addition, prescribing, of all other medicines measured, was in line with local and national averages.