The Oval Practice

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 reviewed 8 quality statements in the Safe key question – Learning culture, Safe systems, pathways and transitions, Safeguarding, Involving people to manage risks, Safe environments, Safe and effective staffing, Infection prevention and control and Medicines optimisation. There was a culture of safety and learning. Staff told us they were encouraged to raise concerns and felt supported in doing so. Incidents and complaints were appropriately investigated and reported. There was an effective system for reporting, recording, and learning from significant events and complaints. Risks were actively managed and viewed as an opportunity to learn and improve. Our review of the remote searches of patient records showed that patients were being effectively and safely managed. There was a process for the management of medicines, including high risk medicines, with appropriate monitoring and clinical review prior to prescribing. Patients were involved in regular reviews of their medicines. Medicine management was effective. Expiry dates of medicines were monitored, recorded and all in date. Fridge temperatures were recorded daily and no temperatures had gone out of range. Medicines were stored securely.

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 spoke with a member of the Patient Participation Group (PPG) and they raised no concerns about their experience of care at the practice. They feedback the practice had positive engagement with them and they felt listened to, for example they told us issues were raised in relation to the use and safety of the car park and the practice responded to this by having bollards installed. This made it safer for cars coming out of the practice and it also made it safer for people crossing the road. We reviewed the results of the national GP Patient Survey and found the percentage of respondents to the GP patient survey who stated that during their last GP appointment they had confidence and trust in the healthcare professional they saw or spoke to was 94% compared to a national average of 93%. In the last 12 months the practice had received 11 complaints, the practice showed us an action plan where they had reviewed these complaints for patterns, trends and themes, they implemented communication and customer service training for staff.

There was a system for recording and acting on significant events. Staff told us there was a no blame culture and staff felt able and were encouraged to raise concerns. We noted 3 incidents had been recorded in the last 12 months and the practice had used a learning response and review improvement tool to analyse and assess the events. We saw minutes from meetings where learning from significant events had been discussed. Staff were able to provide us with examples of incidents and learning that occurred as a result. We reviewed clinical meetings minutes and spoke with staff, we noted that the practice regularly discussed clinical issues and concerns and shared learning. Staff feedback they felt able to approach management and they were encouraged to provide feedback and raise concerns. Clinical staff we spoke with were able to describe how they kept up to date with evidence-based practice.

The practice had a significant event and incident policy which had been reviewed in July 2022. We saw evidence that incidents were discussed at practice meetings. The practice had a system to manage medicines safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) which included a policy, a log to record alerts. Alerts were disseminated to the required members of the team and where action was required, searches were conducted of clinical records to identify patients who may be affected. Alerts and any action taken was stored centrally so that all staff could access. From a sample of patients’ records we reviewed, we found action had been taken on alerts received, for example: Our remote GP Specialist Advisor (SpA) completed remote searches of the practice’s clinical system which included reviewing the management of an alert related to medicines which may cause birth defects if they are used during pregnancy. The search identified 24 patients of child-bearing age taking these medicines and we reviewed a sample of 5 patients’ records. We found all patients had been informed of the risk before our assessment. When things went wrong, staff apologised and gave patients honest information and suitable support. We noted an open culture in which all complaints were highly valued as being integral to learning and improvement. The practice had a complaints policy in place which clearly outlined the complaints process, we also saw a duty of candour policy. The practice kept a record of all complaints received and any action taken as a result of complaints. Staff were aware of how to support patients to make a complaint.

During this assessment we were only able to speak with one patient, the patient had no concerns with the care or treatment they had received.

Leaders informed us they regularly reviewed systems and process, they had undertaken risk assessments and followed up actions. Recruitment checks were carried out in accordance with regulations. The practice was equipped to respond to medical emergencies (including suspected sepsis) and staff were suitably trained in emergency procedures.

We had no feedback from any external partners.

We saw a number of systems including safeguarding systems, processes and practices that were developed, implemented and communicated to staff, staff were trained to appropriate levels for their role. We saw policies had been reviewed and updated. We saw clinical and practice meeting minutes.

All staff knew who the safeguarding lead was. Clinical staff regularly had discussions during clinical meetings, staff were aware of female genital mutilation (FMG) and trafficking, the practice often used searches to follow up patients who did not attend appointments.

We had no feedback from any external partners.

We saw safeguarding training records that showed staff were trained to appropriate levels for their role.

During this assessment we were only able to speak with one patient, they fed back that options were given for treatment and there was always two way communication.

Staff told us that patients were always given the opportunity to be involved in their care and treatment. Staff said for patients with long term conditions including housebound patients they were regularly given a list of patients to follow up to check on their well being and to arrange appointments if necessary.

We reviewed a range of consultation notes, medication reviews and saw appropriate care and treatment was given.

Leaders feedback they regularly undertook risk assessments to ensure patients and staff were in safe environments.

We observed the practice to be clean and tidy. The practice had no baby changing facility. We saw a system in place for monitoring, reviewing and storing emergency medicines and equipment, we also saw appropriate monitoring for the vaccine refrigerator. Guidance and information about reporting cold chain breach was available on the practice shared drive. Sharps bins were signed and dated, and there were appropriate waste disposal systems in place.

Fire risk assessments had been carried out and appropriate actions taken. Infection prevention and control audits were carried out. We saw certificates demonstrating that medical equipment was checked and working as intended.

We observed the practice to be clean and tidy.

Staff knew who lead staff members were for example the infection control lead, safeguarding lead. Leaders informed us they regularly reviewed policies and all staff were given access to them. Leaders feedback they had monthly meetings with staff and staff had annual appraisals.

We checked 5 staff files, there were no concerns staff had completed role specific training. All staff whose files we checked had Disclosure and Barring Service (DBS) checks done. We saw clinical and practice meeting minutes. We saw polices were reviewed and accessible to staff.

During this assessment we only received feedback from 1 patient, they had no concerns regarding the infection control of the practice, and feedback the practice was always very clean.

During the assessment we spoke with staff remotely and onsite. Staff and leaders told us they had systems and processes in place to monitor and manage infection control.

We observed the practice to be clean and tidy.

We saw an assessment policy detailing infection control and we saw cleaning schedules. All staff knew who the infection control lead was and all staff had completed infection control training.

We did not receive a lot of patient feedback, we asked the practice to share details of CQC Give Feedback on Care process on the practice website, however at the time of the inspection the practice did not have a website, they explained they shared the details via social media platforms. We received 2 negative comments from patients via Give Feedback on Care forms. The practice reviewed feedback from the national patient survey. We also reviewed data provided by the practice and from external sources which showed patients were able to access care, support, and treatment in a timely manner and in a way that met their needs or preferences. The practice also reviewed Friends and Family feedback, any complaints were used to improve practice and procedures. There was an active Patient Participation Group who told us the practice had listened to feedback. A patient fed back that the last GP they saw took time to explain things, which helped them understand the issue and treatment for it. The national GP patient survey showed that 87.7% respondents to the GP patient survey who stated that during their last GP appointment they were involved as much as they wanted to be in decisions about their care and treatment, the national average was 90.3%.

During the assessment we interviewed staff remotely clinical staff were able to tell us about how they monitored patients’ health in relation to the use of medicines including high risk medicines. Staff informed us of the process to ensure appropriate clinical oversight of test results. Staff we spoke with were knowledgeable about systems and processes within the practice that enabled positive patient care. We saw the practice had undertaken a range of audits to develop and improve the quality and care given to patients.

While on site we reviewed emergency medicines and equipment held by the practice and found these were stored securely. We found equipment and medicines were monitored appropriately. We reviewed the cold chain processes and found the recording of temperatures were well documented they were being monitored and recorded daily . We also found the vaccine fridge was clean and not overstocked. We sampled a number of medicines in the vaccine fridge, and all were in date and we observed that the fridge was locked when not in use, with the key stored securely. Guidance and information about reporting cold chain breach was available on the practice shared drive. We reviewed Patient Group Directions (PGDs). PGDs provide a legal framework that allows some registered health professionals to supply and/or administer specified medicines to a pre-defined group of patients, without them having to see a prescriber such as a doctor or nurse prescriber. The PGDs we reviewed were signed and dated and authorised by appropriate staff members. We reviewed 3 DNACPR (Do not attempt cardiopulmonary resuscitation) patient records 2 were fine, 1 was not clear from the notes if a discussion was recorded, although it appeared it had been coded. We also noted there was no RESPECT form attached to patients notes but text was entered into patients consultation notes, when we raised this the Lead GP said he would look into this. After the inspection the practice informed us the correct form was saved under documents rather than in the consultation, the practice had a staff meeting and all staff were made aware that documents must be filled under a consultation.

The approach to medicines reflected current and relevant best practice and professional guidance. Medicines were appropriately prescribed in line with the relevant legislation, current national guidance or best available evidence. Patient records were well written and held up-to-date information about people’s care in line with current national guidance. The results of our remote clinical searches assured us the practice had effective processes to manage safety alerts from the Medicines Healthcare products and Regulatory Agency (MHRA). There were clear processes to monitor the expiration dates for emergency medicines and equipment and we found these operating as the practice intended, with no items out of date. The management of the cold chain included clear processes which involved twice daily checks and recording.

Remote clinical searches completed by our GP Specialist Advisor found the practice had completed 996 medicines reviews in the last 3 months, we identified that medication reviews were mainly coded with no patient contact. Patients who were prescribed medicines were being monitored and reviewed in the required timescales. Searches showed that patients were being effectively and safely managed. Overall our review of searches indicated patients care and treatment was managed in line with current guidance and that information, including, examination, management plans, safety netting and follow ups were adequately documented. However, one concern from the searches was that one staff member had given a patient incorrect advice, and their documentation was not always robust. When this was raised with the practice, they addressed these concerns immediately, they spoke with the staff member, submitted an action plan and confirmed that they would provide additional supervision for this staff member and confirmed the concerns would be discussed in the next clinical meeting.