Preston Hill 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

We found that the practice was providing safe services because the service had an embedded learning culture with which all staff were familiar. There were clear patient pathways in place and safeguarding processes which were prioritised and regularly reviewed. The service was provided in a clean and hygienic environment and was staffed appropriately. There were effective systems in place for medicines optimisation which included a program of audit. The practice actively involved people in managing risks.

This service scored 81 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Members of the patient participation group told us that the practice was responsive to the group’s ideas and they saw evidence of improvement over time.

Leaders actively identified and implemented learning and good practice from a wide range of sources, including the primary care network, professional bodies, validated guidelines, and published research. This was incorporated into regular in-house learning sessions. The clinical team also carried out some reviews, for example, new cancer diagnoses, together with network practices to identify learning. Staff and leaders understood their duty to raise concerns and report incidents and near misses. Feedback from staff and leaders demonstrated that the practice had a culture of learning and improvement.

The practice had policies and processes in place to learn from safety incidents; national patient safety alerts; updates to clinical guidelines; complaints; compliments and other forms of internal and external feedback. Learning incidents were reviewed at team meetings and the practice engaged with external partners and services to share learning where relevant. Staff were able to access evidence-based summaries from a range of reliable sources that the lead GP and clinicians had produced for easy reference.

People were able to describe examples of how the practice had followed up referrals when they had experienced delays and liaised with specialist services about individual cases. People were told when they needed to seek further help and what to do if their condition deteriorated.

Staff informed us that the practice prioritised care for their most clinically vulnerable patients. We found staff were knowledgeable in their role and were aware of support networks in the local area. The clinical team sought specialist expertise when indicated and persisted on behalf of people who did not have a clear initial diagnosis for their symptoms. Urgent referrals were tracked and followed-up as a priority.

We did not speak with representatives from partner agencies as part of the inspection. The provider was able to demonstrate many examples of multidisciplinary and partnership working.

There were appropriate referral pathways to make sure that people’s needs were addressed. The provider dealt with incoming test results, clinical correspondence and other open ‘tasks’ promptly.

People taking part in the assessment did not have any comments about safeguarding.

Staff were trained to appropriate levels for their role and leaders were able to demonstrate that safeguarding was being managed safely. The lead GP had completed the Royal College of General Practitioners (RCGP) child safeguarding toolkit and had run an inhouse teaching session on this for the practice team with key learning points. The lead GP was able to describe how they worked with local safeguarding partner agencies in line with the London-wide protocol to protect children and vulnerable adults at risk of abuse.

We did not speak with representatives from partner agencies as part of the inspection.

The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse. Clinical staff held detailed discussions about safeguarding during practice meetings. The provider maintained both a safeguarding register and a register of patients who did not meet safeguarding criteria but about whom the practice team had some concerns. Both lists were reviewed regularly by the clinicians with liaison with partner agencies where appropriate. We were given an example of a case where the GPs' early concerns contributed to subsequent protections put in place by the relevant agencies.

People were told when they needed to seek further help and what to do if their condition deteriorated.

Staff explained how people were informed about any risks and how to keep themselves safe through their treatment. The clinicians were able to provide examples of how they involved people to manage risk. For example, the lead GP proactively followed-up with patients at higher risk while they were waiting for specialist appointments.

The practice had clear written protocols for managing clinical risk, for example, when prescribing certain medicines with rare but potentially serious complications. The examples we reviewed emphasised the importance of effective patient counselling at the first consultation and the provision of ongoing information (for example prescription notes) between reviews.

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

We found no concerns regarding the care environment, equipment or facilities during our site visit. The equipment we inspected had been appropriately checked and serviced to ensure it was safe to use. The practice was equipped to deal with medical emergencies.

Risk assessments were completed to detect and control potential risks in the care environment and the practice had taken appropriate action to address identified risks. Risk assessments and procedures (for example the fire evacuation procedure) included consideration of more vulnerable people, such as those with a disability. There were systems in place to ensure that environmental risk assessments were reviewed periodically and equipment checks and monitoring were carried out in line with practice policy.

People we spoke with did not raise any concerns regarding staffing levels at the practice.

Staff told us they had adequate time to complete training and were supported by leaders to complete additional training to upskill. The provider could demonstrate good retention of staff and had recently taken on an additional GP with additional training and experience in paediatric care. We were consistently told by staff at all levels that there were enough clinicians and administrative staff to provide an accessible and safe service for people.

The provider had policies and processes in place to maintain a safe and effective workforce which included recruitment, supervision and training.

People providing feedback for this assessment did not raise any concerns about infection control or cleanliness at the practice. The practice carried out its own patient survey in 2023. This showed people's averaged rating of the cleanliness of the practice as 4.6 out of 5.

Staff were able to describe to us how they followed infection prevention and control policies and guidelines. Staff confirmed they received effective training and updates on infection prevention and control.

We observed the practice to be clean and well organised on the day of our visit, for example there were sufficient supplies of personal protective equipment; clearly displayed instructions on handwashing; and safe facilities for the disposal of sharps and to deal with specimens.

Infection prevention and control audits were carried out and the provider was acting on issues identified in the most recent internal audit in September 2023. A more recent external infection and prevention control audit (January 2024) had not identified any further issues. We noted gaps in the documented immunisation history for some staff. Following our inspection the provider informed us that the relevant staff had received blood tests to review immunity and the recruitment process had been amended to include this check.

There were no concerns raised about medicines or prescribing in the feedback from people who used the service. People we spoke with told us they were involved in the reviews of their medicines and were helped to understand how to manage their medicines safely. One person noted that being able to talk with a clinical pharmacist at the practice about their medicines was helpful.

The provider reviewed various aspects of prescribing. For example, the lead GP had instigated a regular review of psychotropic medicine prescribing for people with a learning disability with the aim of reducing any 'over-medication' in line with the NHS long-term commitment about this (also known as the STOMP initiative). Psychotropic medicines are a class of medicines which affect people’s behaviour, mood, thoughts or perception. The latest audit showed that all relevant patients had received a STOMP review in the previous 12 months.

During our site visit we saw medicines were managed and stored safely. Vaccines were appropriately stored, monitored and transported in line with guidance to ensure they remained safe and effective. Staff showed us how they monitored the stock levels and expiry dates for emergency medicines and how emergency oxygen was monitored to ensure this was stored safely and was fit for use. Staff managed medicines-related stationery appropriately and securely.

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.

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. There was a programme of regular clinical auditing of prescribing that focused on improving care and treatment. The lead GP also organised regular in-house training sessions which included prescribing guidelines where relevant.