Harris Memorial 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

The practice had a good learning culture and people could raise concerns. The practice regularly reviewed, analysed, and learnt from events and incidents. The practice had systems, services, 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. The facilities and equipment met the needs of people and were clean and well-maintained. There was enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. At our last assessment, we rated this key question as Inadequate. At this assessment, we rated the key question as Good.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Representatives from the Patient Participation Group (PPG) commented the practice took concerns seriously and proactively made improvements. Complaints were shared with the PPG who told us they felt the service was open, honest and transparent in the sharing of information. People felt supported to raise concerns and felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong, staff understood how to raise concerns and report incidents both internally and externally. Staff told us learning from events and incidents was shared in clinical meetings and in team meetings with the wider staff teams. Staff told us leaders were approachable and promoted an open, non-blame culture. Policies and procedures supported and promoted a learning culture. Significant events and complaints were discussed at meetings. There was a system to monitor incidents and complaints. This included undertaking an investigation into the cause and actions identified to address the concerns.

The practice worked with people and healthcare partners to establish and maintain safe systems of care. There was continuity of care, including when people moved between different services. Some partners said access had been challenging and the practice had not always been as responsive as they would like in meeting the needs of individuals. However, the practice had recently implemented a new system and process to improve this. Staff were knowledgeable about their responsibilities to ensure patient referrals to other services were actioned promptly and in line with policies and procedures. Staff we spoke with shared examples of how they worked with other healthcare services to ensure people’s needs were met. There were appropriate referral pathways to ensure peoples’ clinical needs were met. A system for processing information relating to new patients, including the summarisation of new patient records was followed. There was a backlog of 333 new patient records waiting to be summarised. The service was aware of this and had taken action to address the backlog. Referrals to specialist services were documented and contained the required information. There was a system to monitor referrals and follow up on any delays.

The practice worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The practice shared concerns quickly and appropriately with relevant partners. Staff were trained to appropriate levels for their role and were able to identify vulnerable people. They were aware of the systems and processes to keep people safe and safeguarded from abuse. Staff felt confident in raising concerns. Staff knew who the safeguarding lead was and how to access them. We saw the practice had implemented policies and procedures which demonstrated partnership working with other agencies and local safeguarding teams. Electronic systems alerted clinical staff to any potential safeguarding concerns when accessing patients records. There were regular meetings and discussions between the practice and other health care professionals, such as social workers, to support and protect vulnerable adults and children from risk of harm.

People’s needs were discussed during telephone and face to face consultations. Staff informed people about risks, for example in relation to medicines, and documented this on their patient record. This ensured they had an opportunity for their views to be listened to. Staff were confident in the systems and processes to enable them to respond to a deteriorating patient. There were adequate systems to assess, monitor and manage risks to patient safety. These had been shared with staff. Appropriately trained staff completed consultations and provided specific advice to people.

Staff were aware of their responsibilities to ensure the environment was safe for people, including their role in responding to an emergency. Staff had completed appropriate safety training. For example, health and safety, fire safety and information governance. The facilities and premises were appropriate for the services being delivered. Equipment was fit for purpose and in good working order. Environmental risks had been assessed and, where necessary, appropriate actions taken. Clear signage around the building supported people and staff in the event of an emergency evacuation. Fire evacuation grab packs were in specific areas of the building, containing the business continuity plan, fire evacuation procedure and a high visibility vest. The practice had made reasonable adjustments when people found it hard to access services. The practice was responsive to the needs of people in vulnerable circumstances. Health and safety risk assessments had been carried out and appropriate actions taken. We saw safe systems and processes were in place to support a safe environment.

The practice made sure there was enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked well together to provide safe care that met people’s individual needs. Staff told us there was enough staff to meet patient needs and prevent staff from working excessive hours. However, a small number of staff commented that the recent restructure in the service had placed increased pressure on clinicians. Leaders were aware of safe staffing levels and responded appropriately to meet demand. Staff were given protected time to complete mandatory training. The practice was able to demonstrate staff had the skills, knowledge and experience to carry out their roles. An induction programme was in place to support all newly appointed staff. Recruitment checks had been completed for all newly appointed staff prior to commencing in their roles. However, we found that some staff inductions had not been signed off by the person responsible for overseeing the induction. Some staff files did not contain references from previous employment. There was no evidence a risk assessment had been completed or evidence references had been requested. Following the on-site visit the practice provided assurances that references had been received for those files that did not contain this information and where this information could not be provided a risk assessment had been completed. There was a process to record staff immunisations status in line with national guidance. However, we found there were gaps in some files in the monitoring of staff immunisations. The practice provided assurances following the on-site visit that staff had been requested to provide the missing data and they had updated the recruitment process to include a request for staff vaccinations at the time of appointment. There was a system to ensure triaging was carried out by suitably qualified and trained staff and appointments allocated to appropriate clinicians.

Staff were aware of their infection prevention and control (IPC) responsibilities and who the IPC lead was should they need additional support. Staff raised IPC concerns in team meetings. Staff knew how to manage clinical waste and specimens. Cleaning schedules were in place and the premises were visually clean. However, we found there were gaps in the auditing and oversight of the areas being cleaned. High level cleaning in clinic rooms had not been consistently carried out. Sharps bins inside all clinical rooms were appropriately managed. Personal Protective Equipment (PPE) was available to staff. However, during the on-site visit, we found clinical waste bins were not stored securely. We requested the practice to provide further information on this, however, this was not provided. Staff had received training on infection prevention and control. Policies and procedures were available to staff. An up-to-date infection prevention and control audit had been carried out. However, the actions following the audit, identified areas that were still in progress, and these had not been reviewed since November 2024.

Prior to this assessment, some people reported difficulties with ordering repeat prescriptions and receiving the correct medicines. We found that concerns about medicine management were investigated and addressed appropriately. Staff identified people needing monitoring based on their medicines. Non-medical prescribers could consult with GPs daily (healthcare professionals who have undergone additional training and can prescribe medicines but are not GPs). Regular checks were conducted on emergency medicines and equipment, and medicines were stored securely at appropriate temperatures. However, the controlled drugs cupboard key was accessible to all staff. This was immediately addressed with a new system to improve security. There was no risk assessment for external cleaning staff accessing the dispensary with confidential patient medication history. We requested further information on this, but it was not provided. Prescription stationery was stored in an unlocked cupboard but was relocated to a secure location after our assessment. The service had effective systems for managing safety alerts and medicine recalls. Remote clinical searches identified shortfalls in patient monitoring for certain medicines. For example, 38 out of 218 people prescribed a direct oral anticoagulant (DOAC) had not received appropriate monitoring. Of 5 records reviewed, 3 patients were potentially overdue for monitoring. Additionally, 97 people were prescribed an SGLT-2 inhibitor (a medicine used to lower blood sugar) and 4 out of 5 records reviewed lacked information on associated risks of taking these medicines. The practice reviewed and strengthened their systems to ensure appropriate monitoring and review.