Graham Road 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 in the safe key question. Our rating for this key question is now good. The service regularly reviewed, analysed and learnt from events and incidents. 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 which required additional monitoring.

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.

We received no specific feedback in this area.

Staff understood how to raise concerns and report incidents both internally and externally. Staff told us learning from events and incidents was shared in daily huddle meetings and team meetings. Leaders were visible, approachable and promoted an open non-blame culture.

The practice had policies and procedures in place to support the learning culture. Significant events and complaints were discussed and analysed at regular meetings. The practice learned and made improvements when things went wrong. We saw evidence of this learning being shared with staff.

We received no specific feedback in this area.

Staff had systems for sharing information to enable them to deliver safe care and treatment. Staff knew the importance of continuity of care to ensure the right care at the right time.

Regular visits by named clinicians to care homes had recently started and were beginning to improve meeting patients’ health and care needs. However, partners told us important information was not always shared, and concerns they raised about patients were not always listened to.

There were appropriate referral pathways to make sure that patients’ needs were addressed. There was a system for processing information relating to new patients including the summarising of new patient notes. Referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals.

We received no specific feedback in this area.

Staff were trained to appropriate levels for their role and could identify vulnerable patients easily. They were aware of the systems and processes the practice had to keep people safe and safeguarded from abuse and felt confident in raising concerns. Staff knew who the safeguarding leads were.

Partners did not raise any concerns regarding safeguarding at the practice.

Safeguarding systems, processes and practices were developed, implemented and communicated to staff. The Out of Hours service was informed of relevant safeguarding information. There were regular discussions between the practice and other health and social care professionals such as health visitors, community midwives and social workers to support and protect adults and children at risk of significant harm.

We received no specific feedback in this area.

Patients’ needs were discussed during consultations. Staff informed people about risks and documented this on their patient record. Staff involved patients in their consultations to ensure they were informed of risks.

There were adequate systems to assess, monitor and manage risks to patient safety. Appropriately trained staff completed consultations and provided specific advice to people. Risks were recorded on patient records.

Staff were aware the building was not purpose-built to deliver GP services however, they worked with the adaptations to meet patients’ needs safely. Staff knew their responsibilities to ensure the environment was safe for their patients such as their role to ensure equipment was cleaned at appropriate intervals in line with guidance. Staff had completed appropriate training including fire safety and information governance.

The facilities and premises were limited due to the age of the building however, appropriate adaptations had been made for the services being delivered. Equipment was fit for purpose and was in good working order. Environmental risks had been assessed and where necessary, appropriate actions taken. There was clear signage around the building in the event of an emergency evacuation.

The practice made reasonable adjustments when patients found it hard to access services such as level access to the building. Health and safety risk assessments had been carried out and appropriate actions had been taken. We saw safe systems and processes were in place to support a safe environment.

We received no specific feedback in this area.

There was enough staff to provide appointments and prevent staff from working excessive hours. Some staff felt there should be more face-to-face appointments with GPs as some GPs employed only carried out remote consultations. Leaders were aware of safe staffing levels and responding appropriately to meet demand.

Systems demonstrated appointments were allocated to appropriate clinicians. Staff had completed mandatory training, and some had also completed specific training in their specialist area. Staff had protected time for learning and development and where needed, were supported to meet the requirements of professional revalidation. There was an ongoing recruitment advert to attract new staff to the practice.

We received no specific feedback in this area.

Staff were aware of their infection prevention and control (IPC) responsibilities and were able to name the IPC lead. Staff raised IPC concerns in team meetings. Staff knew how to manage clinical waste and specimens.

The arrangements for managing waste and clinical specimens kept people safe. The premises were visually clean and hygienic. Sharps bins were appropriately managed. PPE was available to staff.

Staff had completed appropriate training in line with their role and responsibilities. Policies and procedures were available to staff. An up-to-date infection prevention and control audit had been carried out and an action plan had been completed. There was a process to record, and risk assess staff vaccinations in line with national guidance.

We did not receive enough specific feedback in this area to rescore this evidence category.

Staff were aware of systems to identify patients who required monitoring based on the medicines they were prescribed. Staff carried out regular checks on emergency medicines and equipment. Non-medical prescribers (healthcare professionals who can prescribe medicines but are not GPs) were able to discuss their prescribing each day if needed with the duty GP.

Clinical records were kept accurate and up to date. Emergency medicines were stored securely and checked regularly. Vaccines were appropriately stored and monitored in line with national guidance to ensure they remained safe and effective. Blank prescriptions were kept securely, and their use monitored in line with national guidance. Appropriate authorisations for staff to administer medicines were in place including Patient Group Directions (a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition) or Patient Specific Directions (a written instruction from a doctor or other independent prescriber for a medicine to be supplied or administered to a named patient).

The practice had systems for the appropriate and safe use of medicines. Our remote clinical searches identified a process for monitoring patients’ health in relation to the use of medicines including medicines that require frequent monitoring (for example, warfarin, methotrexate and lithium). Our clinical searches identified 61 patients prescribed methotrexate (an immunosuppressant medicine for treating inflammatory conditions such as rheumatoid arthritis). We reviewed 5 of these patient records and found all 5 patients had received the required monitoring in the last 6 months in line with guidance. There was appropriate monitoring and clinical review prior to prescribing. The practice could demonstrate the prescribing competence of non-medical prescribers, and there was regular review of their prescribing practice supported by the clinical lead.

Prescribing data reviewed indicates the prescribing of some medicines was above the local and national expectations. For example, Pregabalin or Gabapentin (medicines prescribed for treatment of epilepsy, neuropathic pain or generalised anxiety disorder) were being prescribed at a higher rate than expected. The service was aware of this and carried out a regular audit for patients being prescribed these medicines to reduce their use. The audit reviewed if prescribing was appropriate, if it was safe and if a follow up had been arranged with the patient. Any issues with prescribing would be flagged with the lead clinician.