Field Street 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

There was a proactive culture when learning from events, we found staff were knowledgeable within their role and shared experiences to support development. There were processes in place to review and monitor safeguarded patients however these patients were not always linked to family members that may impact care received. The practice monitored medicines and treatments were safe and met people’s needs. However, at this inspection we identified some patients at risk. The practice took immediate action and reviewed these patients.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patient feedback regarding learning culture was limited. However, information we did receive was positive stating they felt listened to when raising concerns and changes were made when appropriate.

Staff were aware of their responsibilities and knew how to identify and report concerns and safety incidents. The practice demonstrated they managed significant events and complaints appropriately and staff were involved in identifying any learning.

Feedback and learning from significant events and complaints was shared with staff via their managers and at staff meetings. Information on how to make a complaint was displayed in the patient waiting area in various languages. Significant event reporting forms were available to all staff to access from the practice computer system.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The evidence we reviewed did not show any concerns about people’s experience regarding safeguarding at this practice.

Staff told us about how they would raise safeguarding concerns, we found they had a clear understanding of safeguarding with the appropriate training in place. Staff were aware of the safeguarding lead and evidenced literature around the practice to signpost them to support.

Partners told us about regular meetings that were held within the practice where safeguarding was discussed, whilst external colleagues such as school nurses and midwives were invited, they did not always attend. The practice could evidence contact with these colleagues when concerns were present.

During our assessment we found that the provider had systems and processes in place to ensure patients were safeguarded from harm. We gained remote access to patient records and found no risk associated with patients on the safeguarding register. However, at the time of reviewing we found family members were not linked if an immediate family member were on the register. The practice took immediate action and reviewed their safeguarding register to ensure these links were in place.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Feedback we received from Give Feedback of Care stated there were enough staff to meet the needs of the patient population, staff were knowledgeable, and patients felt involved in their treatment.

The leaders told us about the recruitment processes to ensure the right staff are employed in terms of skill mix to make sure people are receiving good quality care to meet their needs. We found evidence of this through staff files regarding their induction process and training completed. Leaders evidenced structured supervision which included random case analysis to ensure competencies of staff.

Throughout the inspection the practice evidenced a variety of polices to help them maintain a safe and effective workforce which included, recruitment, supervision, incident, performance management and training. However, the provider identified some shortcomings due to recent capacity in the leadership team, whilst all training and HR documents were accounted for these were presented in a mixture of ways both electronically and in paper form. The provider was in the process of streamlining this to ensure effective oversight.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The evidence we reviewed did not show any concerns about people’s experience regarding medicines optimisation at this practice.

Staff told us that they involved patients in decisions about their medicines during reviews and assessments. We found that staff had good knowledge of the patient population.

During our on-site assessment, we reviewed the medical fridges and emergency medicines and found robust systems in place to ensure in date and ready to use equipment and medicines. We found prescription storage and processes surrounding this were adequate.

The practice provided evidence of documented protocols for the management of medicines. There was a process for monitoring patients’ health in relation to the use of medicines including medicines that required monitoring (for example, warfarin, methotrexate and lithium) with appropriate monitoring and clinical review prior to prescribing. The remote review of patients who were prescribed medicines that required monitoring was generally well managed and showed patients received appropriate blood monitoring prior to medicines being prescribed. However, we found the provider did not always follow guidelines to stating the day of the week on the prescription in which the medicine prescribed should be taken. The practice took immediate action and reviewed the 3 patients identified. The practice had a system for recording and acting on safety alerts. However, we reviewed a safety alert which identified 4 patients at risk of harm due to medicines taken at childbearing age. The practice were responsive and discussed the findings with the pharmacy team to understand the process and how these patients were not identified through their searches.

The practice were undertaking audits to improve the quality of care given to patients, the practice shared various audits and how patients care had been affected. The practice understood the benefits of regular audits and aimed to continue these during the staff changes. However, we found through clinical searches that patients outcomes were not always safe as risk was not always identified.