Sheet 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

The service now had clear and effective processes to ensure the safe recruitment of staff. Systems and processes to ensure the premises were safe for use by people now existed and where risks with the premises were identified, the service now responded to manage and mitigate these. The service had reassessed its stock of emergency medicines and now stocked a medicine to treat croup. There was a clear system that ensured staff learned from any incidents that occurred within the service. Processes to safeguard vulnerable adults and children from the risk of abuse were clear and well understood by staff throughout the service. Non-clinical staff received clear guidance to support them to identify the most appropriate clinician to meet patients’ needs.

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.

The provider listened to people’s views and responded proactively to make improvements to the service. The safety of people using the service was a priority. Staff were confident in their understanding about how to report significant events and confirmed learning and changes were shared with them in a timely manner. Leaders actively promoted the importance of reporting incidents and an open culture of learning and candour with patients. The provider had clear and effective processes for staff to report incidents. When things went wrong, they were investigated and changes were made that ensured care and the quality of the service improved. The management team monitored incidents and completed trend analysis to ensure the effectiveness of changes that had been made.

People felt their care journeys were managed well by the practice including when they were referred or discharged from other services. When people needed to move between services, they felt their views were well listened to and they were given the information they needed to ensure it was managed safely, particularly while they waited for appointments in secondary care. We requested feedback from 3 stakeholders and received positive feedback that showed referrals and discharges were managed effectively by the practice. Staff involved with referrals were able to explain the processes which ensured continuity of care for patients. Leaders explained how the effectiveness of the processes were monitored to ensure people were kept safe, for example when urgent referrals were necessary to investigate suspected cancerous symptoms. The practice had clear processes to receive and action information received from other services. Our assessment found no backlogs of correspondence requiring action. A recent significant event related to a missed referral had led to an improvement in the practices’ processes which were quality assured via regular audits to avoid recurrence.

Patients raised no concerns surrounding safeguarding. Staff we spoke with had a good understanding of safeguarding and explained the specific concerns relevant to the practice’s population. They also explained how they would respond to a concern to safeguard patients from abuse or neglect. Leaders explained how the practice engaged and worked with partners to protect vulnerable people that used the service. A partner told us the safety and security of patients was a priority for the practice and had no concerns about the practice’s safeguarding processes. The provider had a clear safeguarding policy and mandatory training requirements were aligned with current intercollegiate guidance. We sampled the training records and found all reviewed were up to date with safeguarding training and had completed it to the level required by the practice. The practice had systems to identify vulnerable patients to all staff and processes to share this information with external partners.

People told us they felt well informed about the risks associated with their health and how to keep themselves safe, particularly while waiting for appointments both at the service or when being referred to other services. People told us their views had been listened to while they considered whether to start taking medication to treat their condition. Staff told us they could easily access a clinician for advice about serious symptoms or where a patient was at risk of deterioration. They also told us they had access to clear guidance to help them determine the most appropriate clinician when allocating appointments. Leaders explained the practice used a system to risk rate patients depending on the level of risks associated with their health. The assigned category was colour coded and numbered and the score determined the type of clinician most appropriate to provide their care and treatment. This system helped the practice create capacity and explain to patients why they were being triaged to different clinicians which focused on people seeing the right person, at the right time and, in the right place.

Staff explained the limitations of the premises and knew the associated risks and mitigation or control measures in place to manage them. For example, all staff we spoke with knew the lift should not be used if someone was alone in the building. Leaders explained the practice now had a programme of premises checks and risk assessments which were reviewed regularly to ensure the safety and suitability of the premises for patients. The practice now had an embedded system to identify risks associated with the premises and effective systems to monitor them and undertook routine premises management tasks. The practice now acted in response to issues identified by seeking advice and risk assessments from competent contractors. Issues were added to the risk register for routine review. Where practicable changes or improvements were made and where it was not, control measures to reduce the risk were put in place. Our observations found effective arrangements to maintain the safety and upkeep of the premises and equipment to ensure they were safe for use by people using the service. These included systems to monitor and manage the water, heating and electrical systems and fire safety processes were embedded and had operated consistently.

Patients raised no concerns about staffing and feedback received from them was positive. Staff and leaders explained how the practice ensured safe levels of staffing. Staff told us they felt well supported in their roles and that supervision of both clinical and non-clinical roles was effective. We also heard how staff felt the practice prioritised and supported personal development. Leaders explained how they now maintained oversight of staff training compliance to ensure staff were appropriately trained and qualified to carry out their roles. The practice now had safe and effective recruitment processes. We noted the provider was not formally recording the reason for gaps in staffs’ employment histories and raised this to be addressed. We found all staff groups were now up to date with appraisals and the practice could assure itself of training completed outside of the practice. There was a system to record the status of staffs’ immunisation history which followed current guidance.

Patients had no concerns in relation to infection control. Staff we spoke with had a clear understanding of the responsibilities in relation to managing the risk of infection within the premises. Staff knew who the infection prevention control (IPC) lead was and confirmed they were provided with training relevant to their own role. Leaders and staff were aware of the IPC risks associated with the premises, for example not all rooms had elbow operated taps, but these staff explained the reason the taps had not been changed and the risk was recorded in the risk register. Systems and processes existed to ensure premises and equipment remained clean and hygienic and audits were completed to ensure compliance. Our observations found the premises were clean and tidy and clinical waste was stored securely outside the premises.

People told us they felt appropriately involved in decisions about their medicines and reviews. This included when they wanted to consider whether to take medication and when they were at risk of deterioration without treatment. Staff were confident managing the storage, administration and recording of medicines. Leaders explained how medicines-related stationary was managed securely. 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 completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. We identified a small number of patients that were overdue monitoring or had potentially not been given information associated with their medicines, we found these issues related to clinical governance processes, not a lack of understanding by staff. The provider took immediate and proactive action to improve those processes which assured us they understood and followed current guidance. We saw evidence of audits to improve the quality of care and outcomes for patients. These audits included 2 cycles of audit to demonstrate improvement has been sustained and, where a member of staff had not been following guidance when prescribing, feedback had been provided and a further auditing was planned.