Newington Road Surgery Limited Also known as Newington 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 8 quality statements from this key question. We found 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 provided people with support and information on their care and treatment. Improvements were made from our last inspection, for example systems had been embedded to manage emergency medicines and equipment in the practice. However, we identified some areas of improvement for example, legionella monitoring and medicines monitoring.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was information on the practice website and in the surgery advising patients how to make a complaint. People could also complete a form to offer suggestions on how the service could be improved. The practice gathered feedback from patients through the NHS Friends and Family test.

The practice management team encouraged staff to raise concerns when things went wrong. During staff meetings, the team discussed and learnt from both clinical and non-clinical issues. Staff felt there was an open culture, and that safety was a priority. Staff feedback was positive about significant events and felt they improved safety as well as encouraging a culture of learning and transparency. Staff and leaders demonstrated their understanding about how to raise significant events and the process for complaints. They were able to provide examples of recent incidents, as well as the learning that took place to improve care. Staff knew how to find the incident reporting policy and were able to direct patients to enable them to make a complaint.

The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

Most of the patient feedback CQC received reflected negatively on the care and treatment provided. Specific concerns included delays in processing prescriptions, challenges in obtaining a prescription after an urgent referral from the NHS111 service, and difficulties booking appointments. There was also feedback regarding the increased reliance on locum doctors, with reports of uncontrolled asthma and blood pressure management. Additionally, some patients highlighted issues with staff compassion and poor communication. One patient reported that their medication had been stopped multiple times without prior consultation. The recent GP patient survey results showed 85% of respondents were confident and had trust in the healthcare professional they spoke to, 82% said their needs were met and 56% of respondents said their overall experience of the GP practice was good.

The practice worked collaboratively with people to establish and maintain safe systems of care, ensuring safety is managed, monitored and assured. Staff demonstrated a clear understanding of the process for handling urgent referrals and were able to explain their responsibilities in following up to ensure that patients had received and attended their appointments. Staff explained that although workload was high, there were processes to identify any capacity issues, and they felt this was addressed. We were also informed about the recruitment of new staff to help manage demand, along with ongoing efforts to hire additional clinical staff.

Partners had no specific feedback on this area.

We saw systems were in place to ensure urgent referrals were completed within an appropriate time frame, and staff understood their responsibility to follow up on these referrals. We looked at the clinical system and saw correspondence, test results and referrals were managed promptly.

The provider had a designated safeguarding lead and deputy. All staff knew how to identify and report concerns. There were policies which were accessible to all staff. The policies outlined who to contact for further guidance if staff had concerns about a patient’s welfare. Safeguarding concerns were discussed in clinical meetings. Staff demonstrated they understood their responsibilities. The practice’s computer system alerted staff of children that were on the at-risk register. We looked at a sample of children that were subject to safeguarding at the time of our assessment. We found that an alert had been placed on family and other household members of these children.

We received feedback from partners including the commissioners of the service, NHS Kent and Medway integrated care board (ICB). The ICB worked closely with the practice to identify and build on existing strong safeguarding practices.

The provider conducted safety risk assessments. It had appropriate safety policies, which were regularly reviewed and communicated to staff. Staff received safety information from the service as part of their induction and refresher training. The service had systems to safeguard children and vulnerable adults from abuse. Staff received up-to-date safeguarding and safety training appropriate to their role. We saw the provider maintained a record of patients who were vulnerable or considered “at risk”. There were notices in the practice that advised patients chaperones were available if required. We looked at the personnel records of staff who acted as chaperones. We saw they were trained for the role and had received a Disclosure and Barring Service check (DBS). (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

Most of the patient feedback CQC received reflected negatively on the care and treatment provided. Specific concerns included delays in processing prescriptions, challenges in obtaining a prescription after an urgent referral from 111, and difficulties booking appointments. There was also feedback regarding the increased reliance on locum doctors, with reports of uncontrolled asthma and blood pressure management. Additionally, some patients highlighted issues with staff compassion and poor communication. One patient reported that their medication had been stopped multiple times without prior consultation. The recent GP patient survey results showed 85% of respondents were confident and had trust in the healthcare professional they spoke to, 82% said their needs were met, 84% said they were involved as much as they wanted to be in decisions about their care and treatment, 78% said the professional was good at listening to them and 77% said the healthcare professional was good at treating them with care and concern. 56% of respondents said their overall experience of the GP practice was good.

People were informed about any risks and how to keep themselves safe. Where risks had been identified and assessed, staff understood them. Risks were balanced and had a proportionate approach taken, to ensure they supported people and respected the choices they made about their care. When people communicated their needs, emotions or distress, staff could manage this in a positive way. Ensuring the person using the service had their rights and dignity protected and respected and in a way that maximised learning for the future about the causes of their distress. Staff informed us there were systems in place to schedule appointments for patients with long-term conditions as well as for immunisations and screening tests. They also said that if children or vulnerable individuals were not brought to their appointments or failed to attend, this would be flagged to practice management for follow up. Staff explained that although workload was high, there were processes to identify any capacity issues, and they felt this was addressed. We were also informed about the recruitment of new staff to help manage demand, along with ongoing efforts to hire additional clinical staff.

Records showed that fire drills and fire alarms were regularly tested. Records also showed that portable appliance testing, and calibration testing of equipment had been carried out within the last 12 months. Risk assessments about care were person-centred, proportionate, and regularly reviewed with the person, where possible.

Leaders we spoke with explained how they had oversight of tasks and processes to ensure they detected and controlled risks in the care environment. Designated staff members were responsible for completing tasks for example health and safety, fire risk assessments and infection and prevention control audits. Any specific learning from the audits were shared with staff via staff meetings and emails to facilitate improvements. Staff and leaders we spoke with told us the practice had a strong team ethic and worked well together. Staff said they felt able to raise concerns without fear of retribution.

The practice had an up-to-date staff immunisation policy and we saw evidence that staff had received vaccinations in line with this. All staff had completed annual fire safety training online and every 3 years they attended in-house fire safety training. We looked at the practice documentation relating to health and safety and saw a range of activities had been completed. Improvements had been made following our last inspection regarding the management of medicines and equipment. The practice was equipped to respond to medical emergencies (including suspected sepsis) and staff were suitably trained in emergency procedures. The practice maintained appropriate equipment and emergency medicines. There were systems in place to monitor stock levels and expiry dates. There was medical oxygen and a defibrillator on site and systems to ensure these were regularly checked and fit for use. All medicines and equipment we checked were in date and stored securely. We saw improvements had been made and processes embedded following our last inspection.

Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention. Fire drills and fire alarms were regularly tested. Portable appliance testing and calibration testing of equipment had been carried out. Risk assessments identified potential hazards to individuals and the provider had implemented improvements to address concerns. Training records of staff members designated as fire marshals were all up to date with fire marshal training.

Most of the patient feedback CQC received reflected negatively on the care and treatment provided. Specific concerns included delays in processing prescriptions, challenges in obtaining a prescription after an urgent referral from 111, and difficulties booking appointments. There was also feedback regarding the increased reliance on locum doctors, with reports of uncontrolled asthma and blood pressure management. Additionally, some patients highlighted issues with staff compassion and poor communication. One patient reported that their medication had been stopped multiple times without prior consultation. The GP patient survey showed that 91% of respondents knew what their next steps would be within 2 days of contacting the GP practice, 85% of respondents had confidence and trust in the healthcare professional they spoke to and 77% of respondents said the healthcare professional was good at treating the patient with care and concern.

Staff told us they received the support they needed to deliver safe care including appraisal and supervision. Staff also said they were given opportunities to complete extra training courses for their development. Some staff reported improvements over the past 12 months, stating the current staffing levels were sufficient. However, others expressed a need for more clinical and non-clinical staff. Despite acknowledging a high workload, staff explained that processes were in place to identify capacity issues, and they felt these were being addressed. Additionally, we were informed of recent recruitment efforts to manage demand, along with ongoing efforts to hire more clinical staff. We found regular consultation audits on staff were completed to maintain oversight of skills and developmental needs.

Improvements were made following our last inspection. We saw safe recruitment practices to make sure all staff, including agency staff or those not directly employed by the practice, were suitably experienced, competent and able to carry out their role. We found the practice’s policies were regularly reviewed to ensure there was no disadvantage based on any specific equality characteristic. Records showed staff were up to date with mandatory training relevant to their role.

We found no concerns relating to people’s experience of infection prevention and control.

There were clear roles and responsibilities around infection prevention and control. Any identified improvements were communicated to all staff. Additionally, staff played a role in identifying environmental risks, reporting these to the infection prevention and control (IPC) lead to enhance improvements and reduce the risk of infection control issues.

During our site visit we observed clinical rooms. We saw the practice had maintained appropriate standards of cleanliness and hygiene. The practice employed an internal cleaner and we saw that cleaning schedules and Control of Substances Hazardous to Health (COSHH) risk assessments were maintained and checked by the provider. We saw all sharps bins were correctly situated off the floor, labelled, dated and signed correctly. The arrangements for managing waste and clinical specimens kept people safe. There was an up to date cold-chain policy (the system of transporting and storing vaccines within the recommended temperature range). Vaccines were appropriately stored and monitored in line with UK Health Security Agency (UKHSA) guidance to ensure they remained safe and effective.

Staff received appropriate training in infection prevention and control (IPC). The practice had an IPC lead that was responsible for leading and maintaining an effective IPC programme. We saw regular audits were conducted to identify infection risks to the practice, its patients, visitors and staff. There was an action plan implemented to address issues identified. Records showed that legionella monitoring regularly took place to check the hot and cold outlets in the premises (legionella is a bacterium found in water supplies which could cause severe respiratory illness and thrives in warm water temperatures). We identified a discrepancy between the legionella policy and monitoring practices. The policy specified that hot water should reach a minimum of 55oC however the monitoring sheet indicated that the hot water should reach a minimum target of 50oC . Conflicting temperature standards between the policy (55oC) and the monitoring sheet (55oC) may lead to inconsistent monitoring practices. These inconsistencies risk errors in temperature logging and inaccurate assumptions about safe temperatures, potentially increasing the risk to safety. The health and safety risk assessment indicated that water samples should be tested annually by an external company, but the most recent test was from August 2022. The legionella risk assessment had a suggested review date of April 2023, however we did not see evidence of this.

Most of the patient feedback CQC received reflected negatively on the care and treatment provided. Specific concerns included delays in processing prescriptions, challenges in obtaining a prescription after an urgent referral from the NHS111 service, and difficulties booking appointments. There was also feedback regarding the increased reliance on locum doctors, with reports of uncontrolled asthma and blood pressure management. Additionally, some patients highlighted issues with staff compassion and poor communication. One patient reported that their medication had been stopped multiple times without prior consultation. The recent GP patient survey results showed 85% of respondents were confident and had trust in the healthcare professional they spoke to, 82% said their needs were met, 84% said they were involved as much as they wanted to be in decisions about their care and treatment, 78% said the professional was good at listening to them and 77% said the healthcare professional was good at treating them with care and concern. 56% of respondents said their overall experience of the GP practice was good.

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.

Staff managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Staff stored medical gases, such as oxygen, safely and had systems in place to ensure it was regularly checked and fit for use.

We completed searches on the practice’s clinical system to review if the practice was assessing and delivering care and treatment in line with evidence-based guidance. We reviewed a sample of patients prescribed a medicine used to treat autoimmune disease and inflammatory conditions; we saw prescribing and monitoring was in line with national guidance. We reviewed a sample of 5 patients prescribed a medicine used to treat heart failure; we saw all 5 patients were overdue monitoring tests and there was no evidence that the prescriber had verified that monitoring was up to date before issuing the next prescription. We reviewed a sample of 2 patients prescribed a medicine used to treat type 2 diabetes. National guidance stated this medicine is contraindicated when prescribed to patients whose kidneys are not functioning well (a blood test can be performed to measure and assess kidney function). Both patients had blood test results suggesting low kidney function but were still prescribed the medicine. The practice had a system for receiving, sharing and acting on safety alerts. Staff we spoke with understood how to process these alerts. We reviewed 1 safety alert and saw that it had not always been managed well. We reviewed a sample of patients over 65 years of age prescribed citalopram or escitalopram (medicine used to treat depression and anxiety disorders). This alert indicated that patients over 65 years of age should not be prescribed more than 20mg of citalopram or 10mg of escitalopram. The search identified 4 patients over 65 years of age prescribed either of these medicines. There was a potential risk for 3 of these patients, including a need to review the medication and discuss the risks with the patient. After the assessment, the provider contacted all the patients to arrange appointments or complete blood tests according to best practice guidance. We saw feedback was shared with staff and protocols were in put in place.

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 in line with local and national averages. Our review of patient records highlighted some areas for improvement in the monitoring of medicines.