Church Hill 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 learn and reduce the likelihood of them happening again. Appropriate standards of cleanliness and hygiene were met. The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse. The practice had systems for the appropriate and safe use of medicines, including their effectiveness.

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 told us that if they felt the need to raise concerns, they had confidence that staff would treat them with compassion and understanding.

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. They gave examples of where learning from incidents had led to safety improvements and told us they were encouraged to participate in learning and to improve safety as much as possible.

The provider had processes for staff to report incidents, near misses, safety events and to support learning. There was a system to record and investigate complaints. Learning from incidents resulted in changes that improved patient safety.

People told us that their views were routinely listened to and taken into account (for example regarding referral and treatment options). They spoke positively about how the practice expedited and monitored referrals.

Staff across clinical and non-clinical teams were aware of the practice’s process for making referrals and we were told of a collaborative, joined-up approach towards referral tracking.

The district nursing team told us that the practice worked with partners to establish and maintain safe systems: highlighting that communications were good and that GPs were routinely available to discuss any patient concerns.

Systems were in place to ensure safety and continuity of care was a priority throughout people’s care journeys. The effectiveness of these systems was monitored and managed to keep people safe. For example, the practice routinely undertook workflow audits to ensure that incoming correspondence was appropriately acted upon in a timely manner.

Although people did not highlight any safeguarding concerns and had not accessed practice protocols in the past, they felt assured that if needed, the provider would take immediate action to keep people safe from abuse and neglect.

Staff confirmed the name of the practice’s safeguarding lead and there was a strong understanding of safeguarding at all levels and of how to take appropriate action. There were effective systems, processes and practices to make sure people were protected from abuse and neglect.

The district nursing team told us that there were effective systems, processes and practices in place to make sure people were protected from abuse and neglect; highlighting that joint safeguarding discussions were frequent and that GPs were routinely available to discuss any safeguarding concerns.

The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse. Staff had received training to the appropriate level and meeting minutes confirmed routine discussion of safeguarding matters with other health care professionals such as health visitors and district nurses.

People told us how clinicians routinely worked with them to manage risks (for example advising against continued prescribing of a particular medication due to increased clinical risk and in another case taking action to expedite a referral). People were informed about any risks and how to keep themselves safe.

Staff outlined protocols for dealing with various types of clinical risk. For example, patients whose condition deteriorated whilst at the practice, presented with immediate clinical risk or those who had missed an annual medications review or health checks.

We saw evidence of processes for managing risks (including those relating to safeguarding, missed medications reviews and health checks). Protocols were also in place to ensure that patients were to be able to access care or treatment by a GP or appropriate member of the practice team in line with their clinical needs. Risks associated with emergency situations were fully recognised, assessed and managed. The provider offered patients with impaired mobility, the use of a wheelchair on the premises.

Staff told us they were satisfied with the health and safety arrangements within the practice and we were told that the practice had provided additional technology where this was required to support the delivery of safe care.

People were cared for in a safe environment that was purpose built and designed to meet their needs. Facilities, equipment and technology were well-maintained and consistently supported staff to deliver safe and effective care.

The provider had systems in place to ensure that equipment, facilities and technology supported the delivery of safe care. For example, arrangements were in place to ensure that medical equipment was periodically calibrated. There were also effective arrangements in place to monitor the safety and upkeep of the premises (for example health and safety risk assessments; and routine servicing of firefighting equipment and fire alarm system). There were effective arrangements to monitor the safety and upkeep of the premises.

National GP Patient Surveys, Healthwatch Norfolk surveys and CQC patient interviews highlighted that overall, people were satisfied with staffing levels. People also told us that staff were qualified and had the skills needed to carry out their roles effectively.

Staff told us the practice ensured they continued to remain competent to undertake their roles. For example, through competency checks and by monitoring training needs. They felt supported and spoke positively about how training opportunities were available to further develop competency in their roles.

Records confirmed that staff had received up-to-date training in systems, processes and practices. Recruitment checks were carried out in accordance with regulations. Staff received the support they needed to deliver safe care (for example, through structured supervision and training).

People told us they did not have any concerns about the practice environment and that standards of cleanliness and hygiene were always met.

Staff had received infection prevention and control (IPC) training and were able to identify the practice’s IPC lead. Reception staff were able to explain the process for receiving and storing clinical specimens.

We observed that the practice environment was clean and that appropriate standards of cleanliness and hygiene were met.

There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance. There were clear roles and responsibilities around infection prevention and control. The practice’s Infection Prevention and Control (IPC) lead undertook regular IPC audits (covering for example the overall environment and consultation rooms). Systems were in place to monitor staff IPC training. We noted that the provider’s cleaning schedules lacked sufficient detail but shortly after our inspection, the provider submitted an amended and more detailed cleaning schedule template.

People told us that staff routinely involved them in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

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 managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Staff explained 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. We noted appropriate systems in place for managing most medicines processes. However, in two instances we found that appropriately signed documentation was not in place, authorising practice nurse administration of vaccinations. When this was highlighted, the provider took immediate action to authorise these vaccinations and going forward, to improve protocols.

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 was lower than local and national averages. Prescribing data reviewed as part of our assessment indicated that the number of prescribed psychotropic medications (used to treat conditions including dementia) were higher than local and national averages. The provider explained that this was due to the practice’s smaller patient list size having a larger proportion of older patients. There was a programme of clinical auditing of prescribing that focused on improving care and treatment.