Solent GP 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 assessed all quality statements under the Safe key question.

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 were able to share an example of a recent significant event, action taken and learning.

Staff were confident in responding to safeguarding concerns and had received the level of training relevant to their role. Recruitment checks were carried out in accordance with regulations. The service ensured workforce planning arrangements were in place to provide safe, high-quality care and staff had access to training and development opportunities to support them in their role.

Systems for the safe management of medicines, including emergency medicines and equipment and medicines optimisation were in place and regularly reviewed.

However, our clinical searches identified some omissions in the oversight of the monitoring of patients with long-term conditions and the actioning of national safety alerts. The practice took immediate action to mitigate any potential risks to these patients.

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.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Staff said they were encouraged to raise concerns when things went wrong. They told us significant events, complaints and examples of patient feedback were shared and discussed during regular all-staff meetings. Staff felt there was an open culture and understood their duty to raise concerns and report incidents, and were able to share examples. Furthermore, staff told us that they were able to suggest ideas for service improvement, and this was welcomed by leaders through staff forums; appraisals and annual feedback surveys.

There were policies and processes in place to record, investigate and take action from incidents and complaints. These were discussed in monthly meetings and minutes made available to staff who were unable to attend. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support in line with the duty of candour. Learning from incidents and complaints resulted in changes that improved care for others.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Leaders told us they worked with stakeholder organisations such as secondary healthcare providers to establish and maintain safe systems of care for patients. For example, the service reviewed referral pathway outcomes to ensure patients received co-ordinated and joined up care. They also told us continuity of care for patients was important and they achieved this through collaboration with others. For example, staff used a clinical decision support tool to log and monitor urgent referrals and this included input from external professionals involved in the patient's care. Staff we spoke with understood the referrals processes and how to manage correspondence.

We spoke with the local integrated care board ahead of this assessment. From the feedback we received from them there was no indication of concern in this area.

Policies and guidance were in place to support workflow and pathways for appointments, referrals, records and correspondence. The practice had a system in place for processing new patient information and summarising of notes. The practice had kept up to date with patient summarising to ensure accurate information was available for clinicians. There were processes to monitor and manage care when patients were moved between services such as after referral to secondary care, or admission to hospital. A review of the practice clinical system, which formed part of this assessment, indicated patient test results were being managed in a timely manner.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Leaders told us they used the clinical system to record and alert staff to safeguarding concerns. Staff told us they had received training in safeguarding and chaperoning and were able to explain their role in these processes, including how to recognise and escalate any concerns. At the time of the assessment, we found that all members of staff were up to date with training in these areas as well as in the Mental Capacity Act and the Deprivation of Liberty Safeguards, where required.

Leaders told us senior staff discussed safeguarding concerns at regular clinical governance meetings, this included information shared by Health Visitors in relation to children of concern. Staff told us they reported concerns with the local authority where required.

We spoke with the local integrated care board ahead of this assessment. From the feedback we received from them there was no indication of concern in this area.

There were designated safeguarding children and adult leads at the practice. There were monthly multi-disciplinary meetings where safeguarding issues were discussed and these were attended by GPs and a nurse. External stakeholders were invited to safeguarding meetings where relevant.

A mixture of clinical and non-clinical staff members had chaperone responsibilities as part of their role. Those staff members had completed Disclosure and Barring Service (DBS) records in place.

Policies for chaperoning and safeguarding were in place and accessible to staff.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Staff told us there were enough staff to manage workloads to prevent further backlogs of tasks and working excessive hours. Clinical staff were used to support the administrative filing of patient correspondence and summarising on occasions as leaders told us there were approximately 3,500 records awaiting to be processed. These had been reviewed to ensure patients had been alerted and contacted appropriately but the records required to be filed on the clinical records systems accordingly.

The practice had a dedicated workflow team comprised of administrative staff which supported correspondence and patient communications. Staff told us urgent tasks were raised to GPs based on information escalated by Out of Hours and 111 services, in particular, for patients who were required to be seen in-hours by the practice based on their symptoms and clinical presentation.

Leaders demonstrated the arrangements for reviewing abnormal results were prioritised to ensure patients were followed-up in a timely way. For example, we observed the practice’s pathology clinical system mailbox and identified abnormal results were assigned to the duty GP for review on the day and correspondence was picked up to prevent delays to care and treatment. Staff were able to describe their roles and responsibilities to manage risks associated with workflow and patient correspondence.

The practice had a team of 19 GPs. The practice had a team of three advanced care practitioners who provided urgent care and held clinics for long-term conditions.

Staff rotas were completed with oversight of cover where required, so that should a clinician be absent at short notice, their pre-booked appointments could be put into protected available same day slots with another clinician. There were effective staffing arrangements to ensure in the event of emergency, the risk of unsafe practice was mitigated to prevent lone working.

The practice had implemented a risk based patient coding system depending on people’s communication needs and co-morbidities. Higher risk patients had a named GP with dedicated clinics and reasonable adjustments for longer appointments. Audits had been carried out routinely to ensure patients were coded appropriately and kept up to date. This had a positive impact on providing safe and effective care and treatment based on the level of probability of mitigating incidents and vulnerability.

There were systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment. We identified processes to monitor delays in referrals and the practice carried out audits to ensure ‘two week wait’ (2WW) cancer referrals had been booked with secondary care providers as a safety netting mechanism. (2WW cancer referrals are urgent referrals used to investigate symptoms to detect cancer).

Staff told us they had undertaken required mandatory training in respect of health and safety, such as fire safety training, and they had no concerns related to health and safety in the practice. Staff confirmed fire alarm tests and emergency evacuation drills had been undertaken and this was supported by records we examined.

We saw across all 3 sites the premises were clean, modern and accessible. Equipment was stored safely. There was a lift available for staff and patients to access the first floor of the main site. There was appropriate signage in place, such as for fire doors and escape routes.

The provider had established processes to ensure that health and safety requirements were met. Equipment was tested and maintained regularly, and risk assessments had been carried out with identified actions and recommendations followed up and monitored. Portable appliance testing and equipment calibration had been completed and monitored on a routine basis. There were no issues identified as actions that required improvement. There was a fire evacuation plan and policy, and fire marshal training had been completed by a number of members of staff.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Staff told us they were able to raise concerns and there were opportunities to review their performance with leaders and mentors. We saw examples of audits of staff competency checks including non-medical prescribing data which was used to review performance at appraisals and clinical supervision meetings. Staff gave examples of external training courses that were offered by the practice as part of continuous professional development (CPD) to upskill staff to provide more effective care and treatment for patients.

Leaders demonstrated clinical supervision for staff which included weekly teaching sessions and recommendations led by GPs to ensure advanced clinical practitioners and nurses provided safe care and treatment.

There was a recruitment policy in place which had been reviewed in 2024. This included how the practice processed personal data in accordance with General Data Protection Regulations (GDPR).

Recruitment checks were carried out in accordance with Schedule 3 requirements of the Health & Social Care Act 2008, including for agency and locum staff. We carried out recruitment checks in relation to 4 members of staff which contained all of the required information as per practice policy, including Disclosure and Barring Service (DBS) checks. Staff vaccination was maintained in line with current UK Health and Security Agency (UKHSA) guidance as relevant to their role. The practice sought assurances to workplace occupational health staff information from the Trust’s central Human Resource (HR) team.

We identified that not all historic staff interview records were available during our inspection. However, leaders demonstrated that the practice recruitment systems had been improved at the start of 2024 to ensure that prospective staff applications would not be progressed until all Schedule 3 documentation had been uploaded to the system.

The practice had an induction programme for clinical and non-clinical staff which included information for training, appraisal and health and safety. The practice could demonstrate the prescribing competency of non-medical prescribers and there was a regular review of their prescribing practice supported by trust led prescribing medicine audits.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Feedback from staff informed us they had a good understanding of infection prevention and control (IPC). Staff knew who the IPC lead was and how to raise IPC concerns. Staff who handled clinical specimens told us that they had received guidance on how to do this safely.

On the day of the assessment, we found the premises and equipment across all 3 sites to be tidy and clean. Cleaning schedules and records were in place for various areas such as clinical rooms and refrigerators where vaccines and medicines were stored. Appropriate personal protective equipment was available to staff.

There was an infection prevention and control (IPC) lead for the practice who carried out weekly spot checks of cleanliness and reported any issues to staff and to the external cleaning company who were contracted to clean the practice. Staff received IPC training and this formed part of their mandatory training requirements. There was an IPC policy in place. Clinical waste was appropriately stored onsite and managed by an external company.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Leaders told us performance in relation to medicines outcomes were closely monitored through discussions in clinical meetings and through medicines audits. To ensure continued safe prescribing for patients who had not attended for required medicines monitoring, these patients received repeated contacts to encourage attendance and when necessary, prescribed lower amounts of medicines. Staff told us they received appropriate training and supervision in medicines management, including the management of vaccines.

As part of our assessment a CQC GP specialist advisor (SpA) undertook searches of patient records on the practice’s clinical system. Overall, the searches showed medicines had generally been effectively managed by the practice, which included ensuring ongoing monitoring requirements for those patients prescribed high-risk medicines were in line with national guidelines. Where areas for improvement were identified, clinical staff put immediate measures in place to action these with patients.

There were policies in place covering repeat prescribing, management of prescription forms, and vaccine management. Medicines within the practice were effectively ordered, stocked and monitored. There were Patient Group Directions (PGD) and Patient Specific Directions (PSD) in place which relevant staff worked to. There was a process in place to ensure prescription stationery was logged and stored securely. Refrigerators used to store vaccines and medicines were regularly cleaned, temperatures were monitored and logged, and products were appropriately stored within them.

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 as the practice performance was in line with or better than national averages for all indicators.

We saw examples of actions taken on recent alerts, for example, regarding sodium valproate within clinical audit activity. However, the provider was unable to demonstrate that all relevant safety alerts had been responded to. During our remote clinical searches, we identified patients who had been prescribed SGLT2 inhibitors used to treat diabetes were not always given Fournier gangrene and diabetic ketoacidosis advice as per national guidelines. The provider was able to provide assurances after the assessment that those patients had been contacted in line with the safety alert.

The practice pharmacy team held oversight for managing safety alerts where patient search report were run routinely. The practice held monthly pharmacy team meeting which discussed clinical performance, outstanding patient recalls and prescription queries.